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NfcALTH SCIENCES LIBRARY
UNIVERSITY OF MARYLAND
BALT1M
CIRCULATES AFTER
STATE MEDICAL
journal
Pnhlichfifi Rv Thft Ah in Shift
Published By The Ohio State
Medical Association
GENETICS IN MEDICINE . . .
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4-5
.
II *1 11 11 H
4 * A 1
6-12, Including 2 X
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13-15
16-18
« # S 1
* * * * «
19-20
41 21-22
Its practical
application to everyday
practice . .
. . Pages 33 - 50.
(Table of Contents Page 3)
Also Featured in This Issue: Ohio’s Part in the AMA
Clinical Convention .... Page 58
1966 OSMA Annual Meeting
Cleveland May 24-28
OHIO STATE MEDICAL
journal
VOL. 62 JANUARY, 1966 NO. 1 (g
OSMA OFFICERS
President g
Henry A. Crawford, M. D. g
1058 Hanna Bldg., Cleveland 44115 g
President-Elect ^
Lawrence C. Meredith, M. D. g
205 Elyria Block, Elyria 44035 g
Past-President §1
Robert E. Tschantz, M. D. g
515 Third St., N. W., Canton 44703 g
T reasurer =f
Philip B. Hardymon, M. D. g
350 E. Broad St., Columbus 43215 |I
EDITORIAL STAFF jj
Editor PB
Perry R. Ayres, M. D. g
Managing Editor and g
Business Manager g
Hart F. Page g
Executive Editor and H
Executive Business Manager g
R. Gordon Moore g
OSMA EXECUTIVE STAFF Jj
Executive Secretary K
Hart F. Page g
Director of Public Relations and g
Assistant Executive Secretary g
Charles W. Edgar m
Administrative Assistants g
W. Michael Traphagan g
Herbert E. Gillen g
Address All Correspondence: g
The Ohio State Medical Journal g
79 E. State Street g
Columbus, Ohio 43215 fH
Published monthly under the direction of The
Council for and by members of The Ohio State
Medical Association, 79 E. State Street, Columbus,
Ohio 43215, a scientific society, nonprofit organi-
zation, with a definite membership for scientific
and educational purposes.
Subscription, $6.00 per year to non-members;
single copy, 50 cents (outside Continental U.S.,
$7.50 and 75 cents).
Entered as second class matter July 5, 1905, at
the Postoffice at Columbus, Ohio, under the Act
of Congress of March 3, 1879; Acceptance for
mailing at special rate of postage provided for in
Section 1103, Act of Oct. 3, 1917. Authority
July 10, 1918.
The Journal does not assume responsibility for
opinions expressed by the essayists. Advertisers
must conform to policies and regulations estab-
lished by The Council of the Ohio State Medical
Association.
Table of Contents
Pase Scientific Section
33 The Application of Genetics in Medicine Today. Richard
,-c M. Goodman, M. D., Columbus.
40 The Importance of Chromosome Analysis in Down’s
Syndrome. A Case Report of a 21/21 Transloca-
tion. Leslie M. Eber, M. D., and Richard M. Good-
man, M. D., Columbus.
44 Gonadal Dysgenesis. Report of a Case of Male Geno-
type with Female Phenotype — "Pure Testicular
Dysgenesis.” M. Balucani, M. D., Pescara, Italy,
(formerly Toledo, Ohio), and Donald E. Schnell,
M. D., Toledo.
48 Chromatin Sexing in Carcinoma of the Breast. R. E.
Cohn, M. D., Pittsburgh, Pennsylvania, T. W. Wykoff,
Capt. M. C., Maxwell AFB, Alabama, and E. E. Ecker,
Ph. D., Cleveland.
51 A Clinicopathological Conference from The Ohio State
University Hospital, Columbus, Ohio.
8 The Historian’s Notebook: Yellow Fever in Ohio
(Part II). N. Paul Hudson, Ph. D., M. D., Columbus.
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
News and Organization Section
18 Mortus a Morbilli
30 Two Ohio Physicians Join Project Viet-Nam
58 AM A Philadelphia Meeting
Ohio Delegates Play Leading Roles
61 American College of Surgeons Sectional Meeting in
Cleveland
62 Proceedings of The Council — Meeting of November 21
63 New' Provisions in OSMA Bylaws Pertaining to
Nomination of President-Elect
64 Deadline for Submission of Resolutions to Be
Considered by the OSMA House of Delegates,
1966 OSMA Annual Meeting
65 Application for Space in OSMA Annual Meeting
Scientific and Health Education Exhibit
67 Hotel Reservation Form for 1966 OSMA
Annual Meeting
( Continued on Page 86 )
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The Historian’s Notebook
Yellow Fever in Ohio
N. PAUL HUDSON, Ph. D., M. D.*
PART II
( Continued from December Issue )
T
^HE appearance of yellow fever in Gallipolis
was dramatically associated with the famous
steamboat, John A. Porter, and its several barges.
As the flotilla pushed its way upstream, it gained its
reputation for evil which reached its lethal crisis at
Gallipolis. In spite of quarantine, fumigation, burn-
ing of tar, segregation, medical assistance and flight,
the towboat itself and then the town and community
were visited by an epidemic of terrifying proportions
(Frazier5 and Sibley6). Figures in the literature on
the number of cases and deaths vary greatly, depend-
ing apparently on whether the account was limited
in time or was inclusive in respect to the boats, vil-
lage and county; from 17 to 51 cases and 2 to 51
deaths are recorded by various writers. The popula-
tion of Gallipolis at that time numbered 3700.
Table 1. Yellow Fever in Ohio
Year Place Source of Infection Reported No. of
Cases Deaths
1871 Cincinnati Natchez 1 1
1873 Cincinnati Memphis 1 1
"outside” 2 2
1878 Cincinnati Ohio River docks 2 2
Memphis 13 7
New Orleans 3 2
South of Ohio River 3 1
Gallipolis 1 1
steamboats 13 4
Gallipolis towboat and barges 17-51* 2-51*
Pomeroy ” ” ” 7 2
Aberdeen ” ” ” 8 5
Brown County Memphis 1 1
"some
Dayton "all refugees from the South” few 1
cases”
*Various figures recorded, depending apparently on whether
cases and deaths in Gallia County and on boats were included.
The other cases in Ohio in that fateful year were
in Pomeroy (7) and Aberdeen (8) apparently from
exposure to towboats and barges tied up at the shore,
and in Brown County (1) and Dayton "some few
cases’’ — the patients being refugees from Memphis
and the South. Among these patients there were
nine deaths reported.
Table 1 gives a summary of the reported number
*Dr. Hudson, Columbus, is Professor Emeritus of Microbiology,
The Ohio State University College of Medicine; 1963-1964 Presi-
dent of Ohio Academy of Medical History; former service (1927-
1930) with Rockefeller Foundation, yellow fever research, West
Africa and Rockefeller Institute.
Read at the annual meeting of the Ohio Academy of Medical
History, held in Columbus, Ohio, on May 9, 1965.
of cases and deaths and the presumed sources of
infection.
Discussion
The incidence of yellow fever in Ohio in the
1870’s can only be estimated. Data on the number
of deaths may be fairly reliable, except possibly for
some duplication among various recorders. The re-
ported number of fatal cases totaled 81, perhaps 75
actually. If we assume a case-fatality rate of 40
per cent, we could estimate that there were about
190 cases in all. A maximum of something over
100 cases was recorded, and, although the discrepancy
in numbers is marked, we are inclined to accept the
larger figure as reflecting the case-fatality rate of
that epidemic, with the recognition that we are deal-
ing here with relatively small numbers, possible errors
in diagnosis, and perhaps incomplete reporting.
Before the scientific era of experimentation in
yellow fever was introduced by the U. S. Army Com-
mission (Walter Reed, et al.) in 1900, there was
much confusion regarding the conditions associated
with the transmission of the disease. If an attendant
or visitor of a yellow fever patient contracted the
illness, contagion was considered to be the controlling
factor. If, on the other hand, a nurse or a member
of the patient’s family remained healthy, contagion
was not thought to be involved and common factors
such as filth, bad air or vegetable decomposition
were operating. The introduction of the disease to
a community from a steamboat in spite of rigid per-
sonal quarantine argued against contagion, and cargo
from the suspected vessel, especially if despicable
such as rags or rotting freight, was incriminated.
Confusion in medical judgment and in control for pub-
lic protection naturally resulted from ignorance of the
essential factors. If those responsible could only have
put the mosquito into the equation, conflicts could
have been reconciled and effective measures of con-
trol applied. But such was not to be the case until
Reed and his associates confirmed the theory of
mosquito transmission proposed earlier by Finlay, the
Cuban doctor.
Whether yellow fever could be "engendered” and
sustained in Ohio were considered important ques-
tions in the last century. We can now say that its
occurrence depended on introduction and its persist-
8
The Ohio State Medical Journal
ence on the presence of the Aedes mosquito. South-
ern Ohio is not now within the zone of Aedes aegypti
prevalence, but the assumption is reasonable that
plenty of opportunity for its importation to the region
was provided by fresh water containers and by bilge
water in vessels plying the rivers from the South.
On the other hand, we find no firm evidence that
secondary tertiary cases, dependent on mosquitoes,
occurred in Ohio. Even in the Gallipolis community
the 35 or 40 ill could have been bitten by mosquitoes
from the John A. Porter and its barges; nevertheless,
the interval between the arrival of the towboat and
heaven-sent frost (August 17 to October 17) could
have allowed at least a few- secondary cases from
those first infected. Certainly, the history of 31
yellow fever cases among the crew on the infamous
towboat and its barges from Louisiana on July 19 to
Gallipolis on September 3 speaks for the perpetua-
tion of a small but classical man - mosquito - man
epidemic on board.
Why this disease should occur only in the three
years mentioned is a puzzling question, when steam-
boat commerce began long before the 1870’s and
increased greatly during the subsequent 25 years
before measures for control were known and the
malady disappeared from the southern states and along
the Mississippi River. One can only assume that
yellow fever was subject to factors less conspicuous
than the mosquito, or that only rarely did a virus
strain appear capable of breaking through natural
barriers and instituting disease.
Summary
Yellow fever occurred between 1871 and 1878 in
six communities in Ohio, mostly along the Ohio
River, with the largest numbers of cases in Cincin-
nati and Gallipolis. Records of incidence are in-
complete and inconsistent, and only an estimation
can be made that there were probably as many as
190 cases and 75 deaths. These figures include vic-
tims among the crews of towboats and their barges
in Ohio waters.
It is doubtful that the disease was ever estab-
lished in Ohio with secondary and tertian’ cases after
introduction, because of limited time between its ap-
pearance in the Summer and inactivation of the mos-
quito by frost, although a few secondary cases could
have developed in Gallipolis in 1878.
Persons who became ill of yellow fever were
refugees from epidemics in the South who were in-
fected before their departure, passengers and mem-
bers of crews of steamboats infected on board, persons
ashore exposed to incriminated towboats and barges,
and laborers on Ohio River docks. Thus conditions
of transportation and commerce made possible the
existence of this malady in a northern state.
With the role of the mosquito in transmission then
unknown, many measures intended to control the
disease proved ineffective and much medical and pub-
lic confusion prevailed.
In spite of the fact that knowledge essential to
prevent the spread of yellow fever was not available
until the turn of the century, no further visitation of
Ohio has taken place since frost in October 1878.
References
5. Frazier, J.: Yellow Fever and the John A. Porter. Ohio's
Health. 10:1-6 (June - July) 1958; Yellow Fever at Gallipolis:
1878. ibid., 11:20-24 (March-May) 1959.
6. Sibley, W. G.: The French Five Hundred and Other Papers.
Gallipolis: Tribune Press, 1901.
WILLIAM OSLER MEDAL STUDENT ESSAY CONTEST. — The
William Osier Medal of the American Association for the History of
Medicine is awarded for the best unpublished essay on a medico-historical subject
written by a student in one of the medical schools in the United States or Canada.
All students who are candidates for the degree of Doctor of Medicine, or who
graduated in 1965, are eligible. This medal, first awarded in 1942, commemorates
the great physician. Sir William Osier, who stimulated an interest in the humanities
among students and physicians alike.
Essays should demonstrate either original research or an unusual appreciation
and understanding of a medico-historical problem. Maximum length is 10.000
words. The prize-winning essay will be submitted to the Editorial Committee of
the Association, which may recommend it for publication in the Bulletin of the
History of Medicine.
Essays must be submitted by March 23, 1966, to the Chairman of the Osier
Medal Committee, Wiliam K. Beatty, Librarian and Professor of Medical
Bibliography, Northwestern University Medical School, 303 East Chicago Avenue,
Chicago, Illinois 60611.
for January, 1966
9
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Room 201, 1818 West Lane Ave., P. O. Box 5684, Columbus 43221 Tel. 614-486-3939
SOUTHERN OHIO OFFICE: D. M. Routt, III, Representative
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10
The Ohio State Medical Journal
>ut if you prescribe
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et any one of these
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In quality control tests... many generic penta-
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Nearly one hundred separate tests — including
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individual tablet analysis, and others — assure
the therapeutic consistency of Peritrate
(pentaerythritol tetranitrate) today,
tomorrow, next year.2
That the therapeutic effect you desire from a
drug can be compromised by disparities among
such parameters as solubility, purity, potency
and particle size is underscored in a recent
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name and “generic equivalent” drugs.
All available evidence indicates Peritrate
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in pentaerythritol tetranitrate therapy...
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References: 1. Johnson, P. C., and Sevelius, G.: J.A.M.A.
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• • •
OSMA Campaign Directed to the Public Will Stress
The Importance of Immunization Against Measles
THE Ohio State Medical Association is about to
conduct an Educational Campaign, directed to
the general public, to make parents aware of
the fact that measles is a preventable disease and
that they should contact their physicians for the im-
munization. This campaign, starting in mid-Janu-
ary, will consist of about six weekly news releases
to be prepared by the OSMA staff for local news-
papers, spot announcements for radio and television
stations, and posters to be displayed in physicians’
offices and appropriate public places.
In view of the role Ohio physicians will play in
this campaign, the Subcommittee on Measles Im-
munizations, OSMA School Committee, prepared as
guidelines the following information and recom-
mendations, which were approved by The Council.
Members of the Subcommittee are Charles H. Mc-
Mullen, M. D., Chairman; Thomas E. Shaffer, M. D.,
and Carl L. Petersilege, M. D.
To have an effective tool and not use it is an error
of omission as serious as a wrong diagnosis. "The
development period of measles vaccine is now over
and measles vaccine should be administered routinely
to all children without a history of clinical measles
or measles vaccination.” This statement is quoted
from the April, 1965 report of the Committee on
Control of Infectious Disease, American Academy of
Pediatrics.
Experience in Michigan
A similar measles education campaign was con-
ducted in Michigan last year. It was accompanied
by a five-fold increase in measles immunization rate
during the campaign. OSMA officials feel it is a
public service obligation of the Association, and its
component county societies, to promote this new pre-
ventive tool rather than leave the job to a lay or
political organization.
Dosage schedules for measles vaccine, as recom-
mended by the Public Health Service Advisory Com-
mittee on Immunization Practice (Morbidity and
Mortality Weekly Reports 14:64 February 20, 1965),
are summarized in the table accompanying this article.
It is to be noted that three types of vaccines are
available:
Three Types of Vaccines
(1) Inactivated vaccine, (2) live attenuated vac-
cine (Edmonston strain), and (3) live "further at-
tenuated vaccine.” The live vaccines produce im-
munity for longer periods of time than do the inacti-
vated vaccine, and do it with but one dose. The live
vaccines have the disadvantages, however, that they
produce a febrile reaction in 10 to 30 per cent of
the inoculated children, from the sixth to the tenth
day. The "further attenuated vaccine” (Schwartz
strain) produces reactions less frequently than the
Edmonston strain. Reactions can be reduced by
simultaneous administration of Measles Immune Glo-
bulin or prior inoculations with inactivated vaccine.
Live virus vaccine should not be administered to
infants less than twelve months of age because they
may retain maternal antibody which may interfere
with antibody response. Schedule 5, as shown in
the table, should be a good program for routine
immunization of infants under one year of age.
Schedules 2 and 3 are the most generally employed
for children over twelve months because they pro-
vide the most prolonged protection for the least num-
ber of injections. Children in the preschool age are
particularly prone to develop complications of me-
asles, so immunizations as soon after nine months of
age as possible is to be urged.
(See table on facing page.)
Immunization is particularly recommended for
children in high risk groups such as those with heart
disease, cystic fibrosis, tuberculosis, asthma and other
chronic pulmonary disease. Attention is directed to
the fact that inactivated vaccine should be used for
children with altered immune response such as that
resulting from lukemia, steroid therapy, irradiation,
alkylating agents, and antimetabolities.
A child afflicted with measles encephalitis may be
as crippled as one afflicted with paralytic poliomyelitis.
In 1961, nearly five times more children were killed
by measles than by poliomyelitis. The Ohio State
Medical Association urges all physicians to take what-
ever steps are necessary to see that all susceptible chil-
dren receive measles vaccine.
"Mortus a Morbilli.”
18
The Ohio State Medical Journal
Dosage Schedules for Measles Vaccines
Schedule Type of Vaccine
Age Doses* and Administration
Comment
1 Live, Attenuated 12 months Although the live, attenuated vaccine may
Vaccine and older 1 be administered safely with or without the
simultaneous administration of Measles Im-
mune Globulin, most physicians will wish
(Edmonston Strain) to use the two combined because of the
lessened frequency of clinical reactions.
2 Live, Attenuated 12 months
Vaccine plus Measles and older
Immune Globulin
1 plus Measles Immune
Globulin (.01 cc per
pound at different site
with different syringe)
The live attenuated vaccines should be ad-
ministered only to those 12 months of age
or older since residual maternal antibody
may interfere with a satisfactory response
among younger children.
3 Live, "Further 12 months Clinical reactions following the "Further
Attenuated Vaccine’’ and older 1 Attenuated Vaccine’’ are relatively infre-
( Schwartz strain) quent: Measles Immune Globulin is not
necessary with this Vaccine.
4 Inactivated Vaccine Any Age 3** (monthly intervals) In view of the rapid fall-off in antibody and
plus a booster dose after evidence of decreasing immunity following
one year a primary immunization series, use of this
vaccine is not preferred except for special
groups in which live attenuated vaccine is
contraindicated. The degree and duration of
protection which might be afforded to those
given a booster has not yet been determined.
5 Inactivated Vaccine
followed by Live,
Attenuated Vaccine
12 months
and older
1 dose inactivated vac-
cine followed in 1 to 3
months by 1 dose live
attenuated vaccine
The preceding administration of inactivated
vaccine serves to reduce the frequency and
severity of clinical reactions following live
attenuated vaccine administration.
Under 12
months
3 doses inactivated vac-
cine at monthly intervals
followed by 1 dose live
attenuated vaccine at 12
months of age or older
The live attenuated vaccine should be ad-
ministered only to those 12 months of age
or older since residual maternal antibody
may interfere with a satisfactory response
among younger children.
* Manufacturers’ directions regarding volume of dose should be followed.
**In view of rapidly declining antibody levels and protection, at least one booster dose about a year later is necessary.
Data are not yet available to indicate when or with what frequency additional booster doses might be required.
Spring Pediatrics Course
Offered by Ohio State
The faculty of the Department of Pediatrics, Col-
lege of Medicine, Ohio State University and the staff
of The Columbus Children’s Hospital will sponsor a
postgraduate course for pediatricians on March 30,
31 and April 1, 1966. The program will include
formal presentations, small discussion groups and
demonstration of cases illustrating recent advances in
pediatrics.
Attendance of the course is limited to 75. The
registration fee is $60.00. For program details write:
Center for Continuing Medical Education, Ohio State
University, 1645 Neil Avenue, Columbus, Ohio 43210.
Professional Placement Service
For Nurses Is Maintained
Physicians are reminded that the Ohio State Nurses
Association maintains the Professional Counseling
and Placement Service as a function of the organiza-
tion. The sendee compiles records of nurses, refers
positions to them and sends professional biographies
to prospective employers.
Additional information may be obtained from Mrs.
Madlyn Lee Schmidt, R. N., Assistant Executive Di-
rector, The Ohio State Nurses Association, 4000 E.
Main Street, Columbus, Ohio 43213.
Dr. Jane P. McCollough, Cleveland, was elected
president of the Ohio Thoracic Society at a recent
meeting in Granville.
for January, 1966
19
Harding Hospital
(Formerly Harding Sanitarium)
WORTHINGTON, OHIO
For the Diagnosis and Treatment of Psychiatric Disorders
and with
Limited Facilities for the Aging
GEORGE T. HARDING, M. D.
Medical Director
CHARLES W. HARDING, M. D.
Clinical Director
DONALD H. BURK, M. D.
GEORGE T. HARDING, Jr., M. D.
HERNDON P. HARDING, M. D.
RICHARD G. GRIFFIN, M. D.
JAMES L. HAGLE, M. B. A.
Administrator
GRACE M. COLLET, Ph. D.
Clinical Psychologist
MARY JANE McCONAUGHEY, M. S. W.
JUDITH L. VERES, M. S. W.
Psychiatric Social Workers
PAULINE L. TOOILL, R. R. L.
Medical Record Librarian
ESTHER L. SIMPSON, R. N.
Director of Nurses
ANN HARPER, B. S., O. T. R.
Occupational Therapist
JAMES MYERS, B. S., M. Ed.
Recreational Therapist
Phone: Columbus 885-5381
(Area Code: 614)
ANNUAL CLINICAL CONFERENCE
CHICAGO MEDICAL SOCIETY
FEBRUARY 27, 28 - MARCH 1, 2, 1966
Palmer House, Chicago
THIS CONFERENCE WILL BE OF INTEREST TO ALL PHYSICIANS. It
will be presented in a manner designed to interest the generalist and special-
ist alike. The program is presented by types of disease entities , not sectional-
ized by medical specialties. All physicians, regardless of their field of interest,
will find this program to be informative and useful.
For program or registration information address:
Clinical Conference Committee
Chicago Medical Society
310 So. Michigan Ave.
Chicago, Illinois 60604
20
The Ohio State Medical Journal
introduce your patient to
NEW FROM TUTAG for fast, emphatic diuretic action with
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DIURETIC ACTION: Clinically, the oral administration of
AQUATAG (benzthiazide) results in diuretic activity within two
hours with maximal natriuretic, chloruretic, and diuretic effects
occurring during the fourth, fifth and sixth hours. Maintenance
of response continues for approximately 12 to 18 hours. Acidosis
is an unlikely complication since therapeutic doses of AQUATAG
(benzthiazide) do not appreciably increase bicarbonate excretion.
Edematous patients receiving 50 mg. of AQUATAG (benzthiazide)
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In congestive heart-failure patients, AQUATAG (benzthiazide)
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DOSAGE: Diuresis, initially 50 to 200 mg.; maintenance 25 to
150 mg., daily. Hypertension 50 to 100 mg. initially, adjusted
to 50 mg. t.i.d. or downward to minimal effective dosage level.
PRECAUTIONS AND SIDE EFFECTS: Electrolyte imbalance
with hypokalemia, hypochloremic alkalosis and hyponatremia
may occur. Other reactions may include blood dyscrasias,
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diarrhea, dizziness, paresthesia, photosensitivity and headache.
Insulin requirements may be altered in diabetes.
WARNINGS: Dosage of coadministered antihypertensive agents
should be reduced by at least 50%. Use with caution in edema
due to renal disease; advanced hepatic disease or suspected
presence of electrolyte imbalance. Stenosis or ulcer of small
intestine have been reported with coated potassium formulas
and should be administered only when indicated. Until further
clinical experience is obtained, the use of the drug in pregnant
patients should be carefully weighed against possible hazards
to the fetus.
CONTRAINDICATIONS: AQUATAG (benzthiazide) is contra-
indicated in progressive renal disease or disfunction including
increasing oliguria and azotemia. Continued administration of
this drug is contraindicated in patients who show no response to
its diuretic or antihypertensive properties.
Before prescribing or administering, read the package insert or
file card available on request.
Available as 25 or 50 mg. scored tablets.
Request clinical samples and literature on your letterhead.
S.J.TUTAG
& COMPANY
Detroit, Michigan 48234
for January, 1966
23
Regular Medical Expense Insurance
On Increase, Institute Reports
Over 108 million Americans have regular medi-
cal expense insurance which helps pay nonsurgical
doctor bills, the Health Insurance Institute reported.
The coverage is provided in many basic hospital,
major medical and other health insurance policies.
This type of protection has grown from 47,248,000
persons insured at the end of 1954 to 108,717,000
persons insured at the end of 1964, according to the
Institute.
The growth of this coverage is one measure of
how the American people have materially broadened
their health insurance protection over the past ten
years, the Institute said.
At the end of 1954, more than 101 million Ameri-
cans had hospital expense coverage, indicating that
nearly five out of every ten persons with hospital in-
surance also had regular medical.
Ten years later, more than 151 million persons had
hospital insurance, so that seven out of every ten
persons with hospital insurance now have regular
medical protection, said the Institute.
Regular medical expense protection can be ex-
pected to continue to grow, the Institute said. It
estimated that as of June 1, 1965 some 111 million
persons had this coverage.
Benefits paid by insurance companies to persons
covered by this insurance have increased three times
as fast over the last 5 years as the climb in the num-
ber of persons protected, the Institute said.
From the end of 1959 to the end of 1964 the net
insurance company average of persons with regular
medical expense insurance climbed from 38.2 to 55.2
million, a 43.3 per cent increase.
At the same time, the total amount of benefits paid
by insurance companies for these physician expenses,
including benefits for such expenses received under
major medical expense policies, increased 132 per
cent, from $23 6 million to $548 million.
Ohio Among Top States in Number
Of Health Insurance Groups
After Texas, other states leading in the number of
licensed health insuring organizations include Illinois
with 46l, California and New York 4l6 each, Florida
414, Pennsylvania 413, Ohio 382, Indiana 377,
Georgia 360, and Washington 351.
Ohio has 343 insurance companies, 10 Blue Cross,
Blue Shield and medical society plans, and 29 in-
dependent plans, according to the Health Insurance
Institute.
The Third Annual Midwest Conference on Anes-
thesiology will be held at the Continental Plaza Hotel,
Chicago, April 28-30, 1966. Details may be obtain-
ed by writing T. L. Ashcraft, M. D., general chairman,
33 East Cedar Street, Chicago, Illinois 60611.
24
DEPROE
meprobamate 400 mg. +
benactyzine hydrochloride 1 mg.
Indications: ‘Deprol’ is useful in the manage-
ment of depression, both acute (reactive) and
chronic. It is particularly useful in the less
severe depressions and where the depression is
accompanied by anxiety, insomnia, agitation,
or rumination. It is also useful for management
of depression and associated anxiety accom-
panying or related to organic illnesses.
Contraindications: Benactyzine hydrochloride
is contraindicated in glaucoma. Previous aller-
gic or idiosyncratic reactions to meprobamate
contraindicate subsequent use.
Precautions: Meprobamate— Careful super-
vision of dose and amounts prescribed is
advised. Consider possibility of dependence,
particularly in patients with history of drug or
alcohol addiction; withdraw gradually after use
for weeks or months at excessive dosage. Abrupt
withdrawal may precipitate recurrence of pre-
existing symptoms, or withdrawal reactions in-
cluding, rarely, epileptiform seizures. Should
meprobamate cause drowsiness or visual dis-
turbances, the dose should be reduced and
operation of motor vehicles or machinery or
other activity requiring alertness should be
avoided if these symptoms are present. Effects
of excessive alcohol may possibly be increased
by meprobamate. Grand mal seizures may be
precipitated in persons suffering from both
grand and petit mal. Prescribe cautiously and
in small quantities to patients with suicidal
tendencies.
Side effects: Side effects associated with recom-
mended doses of ‘Deprol’ have been infrequent
and usually easily controlled. These have in-
cluded drowsiness and occasional dizziness,
headache, infrequent skin rash, dryness of
mouth, gastrointestinal symptoms, paresthesias,
rare instances of syncope, and one case each of
severe nervousness, loss of power of concen-
tration, and withdrawal reaction (status epilep-
ticus) after sudden discontinuation of excessive
dosage.
Benactyzine hydrochloride— Benactyzine
hydrochloride, particularly in high dosage, may
produce dizziness, thought-blocking, a sense of
depersonalization, aggravation of anxiety or
disturbance of sleep patterns, and a subjective
feeling of muscle relaxation, as well as anti-
cholinergic effects such as blurred vision, dry-
ness of mouth, or failure of visual accommoda-
tion. Other reported side effects have included
gastric distress, allergic response, ataxia, and
euphoria.
Meprobamate— Drowsiness may occur and,
rarely, ataxia, usually controlled by decreasing
the dose. Allergic or idiosyncratic reactions are
rare, generally developing after one to four
doses. Mild reactions are characterized by an
urticarial or erythematous, maculopapular rash.
Acute nonthrombocytopenic purpura with pe-
ripheral edema and fever, transient leukopenia,
and a single case of fatal bullous dermatitis
after administration of meprobamate and pred-
nisolone have been reported. More severe and
very rare cases of hypersensitivity may produce
fever, chills, fainting spells, angioneurotic
edema, bronchial spasms, hypotensive crises (1
fatal case), anuria, anaphylaxis, stomatitis and
proctitis. Treatment should be symptomatic in
such cases, and the drug should not be reinsti-
tuted. Isolated cases of agranulocytosis, throm-
bocytopenic purpura, and a single fatal instance
of aplastic anemia have been reported, but only
when other drugs known to elicit these con-
ditions were given concomitantly. Fast EEG
activity has been reported, usually after exces-
sive meprobamate dosage. Suicidal attempts
may produce lethargy, stupor, ataxia, coma,
shock, vasomotor and respiratory collapse.
Dosage: Usual starting dose, one tablet three or
four times daily. May be increased gradually
to six tablets daily and gradually reduced to
maintenance levels upon establishment of relief.
Doses above six tablets daily are not recom-
mended even though higher doses have been
used by some clinicians to control depression
and in chronic psychotic patients.
Supplied: Light-pink, scored tablets, each con-
taining meprobamate 400 mg. and benactyzine
hydrochloride 1 mg.
Before prescribing, consult package circular.
#. Wallace Laboratories / Cranbury, N. J.
DUST AS NO "VACUUM CLEANER" CAN!
Revolutionary... and in a class by itself!
FIIUEIR QUEEIN
has the scientific cleaning features that
hospitals need most
All “vacuum" cleaners were much the same until the
FILTER QUEEN SANITATION SYSTEM was designed.
FILTER QUEEN'S patented Sanitary Filter Cone eliminates
the need for messy bags, traps practically all airborne con-
taminants passing into the machine(Harvard Medical School
Report in Journal of the American Medical Association,
November 25, 1958) *
Experienced hospital housekeepers know this well. That
is why FILTER QUEENS have replaced every type of
vacuum cleaner in hundreds of hospitals throughout the
world.
FILTER QUEEN has no porous bag that permits dust and
dirt to reenter the room. FILTER QUEEN operates on an
entirely different principle, “Cyclonic Cleaning Action.”
Here's how it works: Inrushing air, laden with dirt and
dust, is deflected by a patented inlet guide as it enters the
container; then is whirled by centrifugal force away from
the cone. Dust and dirt are dropped to the bottom of the
container. (See illustration.) Air, being lighter, is funnelled
to the center of the “cyclone,” filters through the Sanitary
Filter Cone and returns to the room dust-free.
Why not ask your local FILTER QUEEN Distributor to
make the dramatic handkerchief test (pictured at left) in
your hospital? There is no better way to prove the improve-
ment in cleaning ability between a FILTER QUEEN SAN-
ITATION SYSTEM and any type of vacuum cleaner. (You’ll
find your distributor listed in the Yellow Pages; or write
Health-Mor, Inc. direct).
*We will be glad to send you a reprint of this report on request.
FI O’ER
What hospital
administrators say
about FILTER QUEEN
“I heartily recommend to any hospital administrator who is
presently unhappy with the type of cleaning machine in use,
that he try FILTER QUEEN for only two days and the machine
will sell itself. "
“The FILTER QUEEN is great— a very important factor in
patient areas, and is constructed so as to prevent air turbu-
lence of dust at floor level. Filtering of the air, while in general
operation, is also a very important and desirable factor."
“One of the most pleasing features of the machine is its
quietness. We can even dean in the rooms while occupied by
the patients, and many have commented on how pleasant it is
not to be disturbed by noisy, old-fashioned vacuum cleaners
anymore."
“The air exhaust at the top of the unit is a wonderful fea-
ture, and the Sanitary Filter Cone is certainly our answer for
working in closely confined patient areas.”
“We thought we had a clean hospital and a fairly good method
of achieving acceptable sanitation, but this little machine
made us revise our thinking and our methods.”
“A quiet motor which possesses excellent cleaning power
and the convenience of having to clean out the cleaning com-
partment only once a month, has proved very advantageous.
One of the most important points ... is that there is no bag
to empty. "
QUEEN
In Canada: Filter Queen Corp., Ltd., 252 Victoria Street, Toronto, Ont. • In Mexico: Industrias Filter Queen, S.A., Av. Jardin #330, Col. del Gas, Mexico 15, D.F.
A Product of HEALTH-MOR, INCORPORATED, 203 North Wabash Avenue, Chicago, Illinois 60601
Two Ohio Physicians Join Project Viet-Nam
Two Ohio physicians are in this group of volunteers for Project Viet-Nam, poised in Los Angeles on December 2
before their flight to Saigon. Standing, extreme left, is Dr. Aaron I. Grollman, Cincinnati, and seated second from
right is Dr. John E. Stephens, Columbus.
10 Doctors Leave for Viet-Nam
To Serve Two-Months Tours
Dr. Edwin W. Brown, Jr. (seated far left in the
picture), associate medical director of Project HOPE
and project director of Project Viet-Nam, points
out locations of assignments on a map to the latest
group of American doctors to volunteer two-months’
service in South Viet-Nam.
The doctors (left to right, seated) Dr. Brown;
Dr. Isaiah Reed Salladay of Pierre, S. D.; Dr. S.
William Kalb, Newalk, N. J.; Dr. Wayne G. Parker,
Oberlin, Kans.; Dr. John E. Stephens, Columbus,
Ohio; Dr. Julius D. Krombach, Henderson, N. Y.;
(Standing) Dr. Aaron I. Grollman, Cincinnati,
Ohio; Dr. Warren B. Ross, Nampa, Idaho; Dr. James
S. Vanderhoof, Ross, Calif.; Dr. J. Ralph Dunn, Tar-
boro, N. C.; and Dr. Charles A. Rodman, Minot, N. D.
The 10 doctors were briefed by Dr. Brown in Los
Angeles on December 2 and flew to Saigon the next
day.
Additional information may be obtained by writing
Project Viet-Nam, 2233 Wisconsin Avenue, N. W.,
Washington, D. C., 20007.
Two Ohioans Scheduled to Participate
In Washington Diabetes Program
Two Ohio physicians are on the program for the
1 3th postgraduate course offered by the American
Diabetes Association at the Mayflower Hotel in
Washington, D. C., on January 19-21.
Dr. George J. Hamwi, professor of medicine and
director of the Division of Endocrinology and Me-
tabolism, Ohio State University College of Medicine,
will discuss the current status of oral agents, and
participate in other phases of the program.
Dr. Max Miller, associate professor of medicine
and director of the Clinical Research Center at West-
ern Reserve University School of Medicine, will speak
on the topic of pregnancy and diabetes and will take
part in a panel discussion.
Additional information about the program may be
obtained from the association at 18 East 48th Street,
New York, N. Y. 10017.
Dr. Bertha A. Bouroncle, associate professor of
medicine in the Ohio State University College of
Medicine, has been awarded a $31,766 grant from
the U.S. Public Health Service to support her in-
vestigation of tissue culture of human bone marrow.
30
The Ohio State Medical Journal
Vol. 62
January, 1966
No. 1
The Application of Genetics
In Medicine Today
RICHARD M. GOODMAN, M.D.
The Author
• Dr. Goodman, Columbus, a member of the
Attending Staff, Ohio State University Hospitals,
is Assistant Professor of Medicine, Department of
Medicine, The Ohio State University.
DURING the past decade, the contributions of
basic genetics to medicine has done more to
reshape the future of medicine than any
other scientific discipline. This new found special-
ization of medical genetics has grown with unbeliev-
able rapidity. Though much of the work in medical
genetics, along with its advances, are centered in an
academic environment, the physician of today must
be aware of the practical applications that have
evolved.
The purpose of this paper is to relate some of the
advances in medical genetics that pertain to the daily
practice of medicine. Before discussing the various
aspects of application, it is imperative that one be
acquainted with a few general genetic terms and
concepts.
The field of medical genetics can be divided into
four subdivisions: (1) clinical genetics which mainly
is concerned with family studies, (2) biochemical
genetics, (3) cytogenetics which deals primarily with
the study of chromosomes and other genetic markers
in cells and (4) population genetics. This paper will
touch upon all of these areas with the exception of
population genetics.
Terms and Concepts
In 1956, the observation was made that the nu-
cleus of human somatic cells contains 23 pairs of
chromosomes (a total of 46) instead of the previously
accepted number of 48 chromosomes. Of the 23
Supported by National Institutes of Health General Research
Grant. Rotary Number 42071, Project 262.
Submitted May 20, 1965.
pairs of chromosomes, 22 are referred to as auto somes
and the remaining pair is called the sex chromosomes,
XX in the female and XY in the male.
Chromosomes are rod-like structures within the
nucleus of a cell, containing hundreds of genes ar-
ranged in a linear order. These genes, as the chromo-
somes themselves, are made up of a chemical sub-
stance called desoxyribonucleic acid, DNA, and are
the functional units of the chromosomes. Genes
function as blueprints for the manufacture of proteins.
The factories which produce the various protein mole-
cules are located outside the cell nucleus in cytoplasmic
structures called ribosomes. The main component of
the ribosome is a form of ribonucleic acid (RNA).
The blueprints for the manufacture of the numerous
proteins in the body are transported from the genes
in the nucleus to the ribosomes in the cytoplasm via
a special form of RNA referred to as "messenger”
RNA. The building blocks, or the various amino
acids that go to make up the protein molecules, are
contained in the cytoplasm. Each amino acid is acti-
vated by a specific enzyme and then carried to the
ribosome for synthesis of a given protein. The
transport of the amino acids to the ribosome is per-
Fig. 1. A brief schematic diagram showing the proposed
mechanism of protein synthesis.
formed by another form of RNA referred to as
"transfer” RNA (Fig. 1).
In most instances, an individual receives a haploid
number (half the basic chromosome complement or
one of each pair) of chromosomes from each parent,
thus resulting in a full diploid complement of chro-
mosomes. The reductional division of germinal cells
producing a haploid number of chromosomes is re-
ferred to as meiosis; while the somatic division of
cells is called mitosis. The cell resulting from the
fertilization of an egg by a sperm restoring the
diploid number of chromosomes is called a zygote.
In various abnormal chromosomal states, an ir-
regular number of chromosomes (aneuploidy) is
found, that is 45, 47, 48 and so on. This occurs as
a result of loss or addition of one or more chro-
mosomes, be they autosomes or sex chromosomes.
Mutant genes (altered genes) are carried on either
the autosomes or the sex chromosomes. In general,
the Y sex chromosome of man probably carries little
genetic material other than that which determines
maleness; while the X chromosome of a female is
known to carry many genes other than those deter-
mining sex. The term X-linked therefore refers to
those genes carried only on the X chromosome. For
the sake of simplicity and understanding, genetic traits
or diseases are generally said to be inherited as either
dominant or recessive — that is, autosomal or X-
linked dominant or recessive.
A dominant trait may be inherited in either the
homozygous (DD) or heterozygous (Dd) state,
though most are thought to be of the latter form.
Other features of the inheritance of a dominant trait
are that one of the parents, one half of the sibs and
one half of the offspring would be expected to show
the condition in any given pedigree. Generally, there
is vertical transmission from generation to generation.
The chance of recurrence is 50 per cent in subsequent
members of a sibship.
A recessive trait in an individual is generally in-
herited in the homozygous state (dd). Each parent
contributes an identical mutant gene to the affected
child who carries a double dose of the gene. Both
parents are clinically normal but are genetic carriers.
The chance of recurrence in another child (or in a
sib) is one in four. Consanguineous marriages (be-
tween relatives) are important to note in connection
with recessive conditions. Closely related individuals
have a greater chance of carrying the same genes, thus
children from such matings are more frequently
homozygous for various genes than are children
from non-related marriages.
In understanding X-linked inheritance (sex linked
in the old terminology), it is important to recall that
the mother receives an X chromosome from each
of her parents and gives either one or the other to
her sons and daughters. A daughter receives one X
from the mother and in addition a second X chro-
mosome from the father. Thus, in an X-linked
recessive disease such as classical hemophilia the
mother, although clinically normal, is a carrier. She
gives the disease to one half of her sons while one
half of her daughters are carriers. The daughters
in turn will give the disease to one half of their
sons.
Genetic Diseases
With these brief concepts in mind, let us begin
to look at some of the various genetic disorders.
Genetic diseases can be divided into three categories:
( 1 ) those associated with a known chromosomal
abnormality, either of the autosomes or sex chro-
mosomes, (2) those which are due to a mutant gene
producing a known alteration in a protein or enzyme
— diseases in the latter group are referred to as be-
longing to the inborn errors of metabolism, and (3)
those that make up the largest group in which the
basic abnormality has not been defined.
Chromosomal Abnormalities
The Autosomal Trisomy Syndromes
Physicians practicing obstetrics and pediatrics should
be aware of this important group of disease states.
Infants in this group usually have gross clinical find-
ings due to an extra autosome which can be demon-
strated readily by chromosomal analysis. In 1959, it
was shown that individuals with mongoloid idiocy
(now referred to as Down’s syndrome by many) had
an extra autosome associated with chromosome num-
ber 21. More recently, chromosomal defects other
than 21 trisomy have been noted in patients with
Down’s syndrome. The following paper by Dr. Eber
will discuss the various chromosomal changes that
have been observed in this genetic disease. Mongol-
ism is a common condition since it occurs in approxi-
mately 1 in 600 births of the general population.
The 15-15 syndrome or D trisomy syndrome is
34
The Ohio State Medical Journal
Fig. 2. A fetnale infant with the 13-15 trisomy. At the time of birth, the mother was 39 and the father was 40 years
old. The following anomalies can be noted, (A and B) microcephaly, low set and malformed ears, single external
nasal orifice, anopthalmia (C) polydactyly and clenched fingers. In addition, the patient had many internal congenital
defects.
characterized by an extra chromosome in the 13-15
group. These infants frequently have many or all of
the following defects: deafness, seizures, retroflexi-
bility of the thumbs, polydactyly, cleft palate, harelip,
hemangioma, and eye defects, notably anophthalmia
or micropthalmia (Fig. 2).
Infants with the 18 or E trisomy syndrome (Fig. 3)
frequently show spasticity, clenched fingers, overlap-
ping index fingers, micrognathia, malformed ears,
umbilical or inguinal hernias, ventricular septal defect,
patent ductus, Meckel’s diverticulum, and ectopic
pancreatic tissue.
Common to both the 13-15 and 18 trisomy syn-
dromes are mental retardation, low-set ears, rocker
bottom feet, anomalies of the heart, increased age of
the mother at time of conception, and failure of the
infant to thrive. The incidence of these syndromes
is not known though they are thought to occur much
less frequently than Down’s syndrome.
Other Autosomal Abnormalities
Within the past year, Dr. Lejeune of the University
of Paris (the man who first observed the chro-
mosomal defect in Down’s syndrome) has described
a new syndrome called the Cat Cry or cri du chat syn-
drome. Infants with this disorder have a cry that
sounds like a cat in pain and their chromosomal
defect is a loss of a chromosomal fragment from the
short arm of chromosome number 5. These infants
for January, 1966
35
have many of the abnormalities noted in the previous
trisomy syndromes such as mental retardation, low-
set ears, small mandible, and congenital defects of
the heart. In addition, they may have the simian
crease noted in patients with Down’s syndrome and
downward slanting eyes set far apart.
In the previous syndromes which have been dis-
cussed, the gross abnormalities that accompany them
are thought to be the result of the genetic alteration
in the amount of chromosomal material present. In
other words, a causal relationship seems apparent.
When one discusses the chromosomal changes that
have been observed in various neoplastic and other
diseases, such a causal relationship remains less ap-
parent. Nevertheless, there are two diseases in which
chromosomal changes seem to be consistent. The
first and most important is that of chronic myelocytic
leukemia (CML). In I960, two research workers
in Philadelphia demonstrated that patients with CML
have a small number 21 chromosome, while the other
21 chromosome is normal in size. This small chro-
mosome has come to be called the Ph1 or Philadelphia
chromosome and is observed characteristically only in
patients with CML. More recently, in patients with
Waldenstrom’s macroglobulinaemia, a very large
chromosome has been noted in addition to the normal-
appearing 46 chromosomes. This is mentioned only
to point out that in a variety of neoplastic, viral and
diseases of unknown etiology, such as Waldenstrom’s
macroglobulinaemia, various chromosomal abnormal-
ities have been demonstrated. Yet, to date, only the
Ph1 chromosome has proven to be consistent and thus
diagnostic for a given neoplastic disease. Further
chromosomal research work will undoubtedly prove
useful in characterizing other previously mentioned
diseases.
Sex Chromosome Abnormalities
One cannot discuss this group of disorders without
the knowledge of what promoted its investigation. In
1949, it was recognized that the cell nuclei from
normal female tissue contained a small body called
sex chromatin (or Barr body). This Barr body was
observed to be adjacent to the nuclear membrane and
stained specifically for DNA. Cells which contain
such a structure are termed chromatin-positive. Nor-
mal male cell nuclei do not contain a sex chromatin
body and are termed chromatin-negative. It is thought
that the sex chromatin represents part or all of one X
chromosome which may be genetically inactive. The
method (buccal smear) for analyzing cells for the
presence of a sex chromatin body is relatively simple
and can be considered an office procedure.
Using the buccal smear test as a screening technique,
a considerable number of abnormalities have been
recognized in which there is an altered number of sex
chromosomes. The patient is sterile in nearly all of
these cases. It therefore behooves the physician seeing
patients for a sterility problem to be aware of these
syndromes. The Klinefelter syndrome (XXY) and
the Turner syndrome (XO) are the most common sex
chromosome abnormalities.
In the Klinefelter syndrome, chromatin-positive
males are characterized by primary hypogonadism in-
variably associated with small testes and variable
clinical features including eunuchoidism and gyne-
comastia (Fig. 4). They frequently seek medical
Fig. 4. An 18 year old patient with the Klinefelter syndrome. Note the gynecomastia, sparse body hair and body size.
He never shaved and also demonstrated small testes. His chromosome pattern shows the (XXY) abnormality.
(From McKusick, V. A.: Medical Genetics 1958-1960, St. Louis: C. V. Mosby, 1961, p. 172.
36
The Ohio State Medical Journal
Fig. 5. A 37 year old patient with the Turner syndrome. Note the short stature, web neck, shield-like chest and wide
set nipples. She has been operated on for coarctation of the aorta. Her chromosome pattern (XO) shows the absence
of a (X) sex chromosome.
(From McKusick, V. A.: Medical Genetics 1958-1960, St. Louis: C. V. Mosby, 1961, p. 174.
attention because of problems of infertility, eunuch-
oidism, or gynecomastia. Others may have no com-
plaints, and the only incidental finding is small testes.
The Klinefelter syndrome has been estimated to occur
about once in every 400 male births.
The Turner syndrome (or gonadal aplasia) refers
to chromatin-negative females who fail to mature at
puberty and maintain infantile internal and external
genitalia throughout adult life. Pubic and axillary
hair develops but the breasts remain prepubertal.
Amenorrhea is often the presenting complaint. Clini-
cally, these patients are of short stature and frequently
have webbing of the neck, a shieldlike chest, coarcta-
tion of the aorta, hypoplasia of the nails, short fingers,
abnormal facies with micrognathia, and pigmented
moles (Fig. 5). Histologically, there is absence of
a true gonad and, in place of the ovary, there is a
streak of white tissue composed of ovarian stroma
lacking germinal follicles. The frequency of this
syndrome in the general population is not known.
One authority suggests a minimum frequency of one
in 5,000 female births but others are of the opinion
that it is probably higher.
These chromosomal aberrations are produced by ab-
normal chromosome divisions in the germinal cells
before or shortly after fertilization, resulting in an
altered number of sex chromosomes.
Biochemical Abnormalities
Thoughts of diseases producing metabolic blocks
due to mutant genes were initiated and set forth by
Sir Archibald Garrod in his famous lectures entitled,
"Inborn Errors of Metabolism.’’ Advances made in this
area of study have been not only phenomenal in num-
ber but in many instances, of utmost importance to pa-
tients affected with a given disorder. In several of
the "inborn errors,’’ early recognition is essential for
the patient’s future well-being. The following dis-
orders or traits are partially understood and can be
treated either supportively or totally.
Sickle Cell Disease
Of all the diseases known to man, few have been
studied as intensely and with such reward as sickle cell
disease. The electrophoretic identification of the
abnormal hemoglobin marked the early probing of the
basic structure of the hemoglobin molecule. Further
studies have beautifully delineated the basic defect
as due to the substitution of a valine residue for a
single glutamic acid residue in the beta chain of
hemoglobin. Other hemoglobinopathies have been
shown subsequently to be due to an abnormal amino
acid substitution.
G6PD Deficiency
The development of hemolytic anemia in the
Negro, in people of Mediterranean extraction, and
in the Sephardic Jew is often on the basis of a
metabolic defect in the erythrocyte — a deficiency of
the enzyme, glucose 6 - phosphate dehydrogenase
(G6PD). The expression of this abnormality is
triggered by the ingestion of various drugs and foods,
such as primaquine, nitrofurantoin, fava beans, and
other agents. The diagnosis of G6PD deficiency,
which is an X-linked disease, can easily be con-
firmed by various laboratory techniques. Patients with
this disorder do well if the initiating agent is discon-
for fanuary, 1966
37
tinued and if subsequently it and all other products
capable of producing the disease are avoided.
Pseudo cholinesterase Deficiency
When anesthesia is contemplated, it is well to know
that some patients lack the enzyme pseudocholin-
esterase in their blood and thus are slow to destroy the
muscle relaxing drug, succinylcholine. This condition
is called hereditary pseudocholinesterase deficiency.
The enzyme deficiency alone is harmless, as is the
conventional dose of the drug, but, when succinyl-
choline is given to a genetically susceptible individual,
prolonged apnea occurs.
INH biactivation
In the treatment of tuberculosis with isonicotinic
acid hy dr azide (INH), it has been shown that the
rate of inactivation of the drug is genetically con-
trolled. Some individuals are rapid activators, while
others inactivate the drug slowly. Therapeutically,
the rapid inactivator receives less benefit from the
same dose of drug as compared to the slow inactivator.
. Phenylketonuria
Mental retardation resulting from phenylketonuria
(missing enzyme-phenylalanine hydroxylase) if
recognized early enough can, in many instances, be
prevented by eliminating the amino acid, phenylala-
nine, from the infant’s diet. Figure 6 illustrates the
site of the metabolic block in phenylketonuria and
also two other genetically determined diseases (al-
binism and alkaptonuria) of altered aromatic amino
acid metabolism. These are only a few of the bio-
chemical defects in which recognition is advantageous
to the affected individual. Certainly, there are many
more conditions to be uncovered.
In referring to the subject of biochemical genetics,
one should be aware that besides diseases in which
a missing enyzme has been identified (for example,
G6PD deficiency, pseudocholinesterase deficiency, and
phenylketonuria), there are other disorders in which
the primary defect is not enzymatic but is due to an
alteration or lack of a known protein. The hemoglo-
binopathies and the hereditary clotting disorders are
cardinal examples of this latter group.
There is also a larger group in which the general
metabolic area involved is suspected but, as yet, the
precise defect has not been pinpointed. Some com-
mon diseases in this group include cystic fibrosis of
the pancreas, the porphyrias, gout, osteogenesis im-
perfecta, and Marfan’s syndrome.
Other Genetic Disorders
In many conditions, the role of genetic factors is
probably significant but remains to be defined pre-
cisely. Atherosclerosis, hypertension, allergies, rheu-
matic diseases, and various neoplastic diseases are a
few of the disorders with hazy genetic implications.
Approach to a Possible Genetic Problem
The recognition of a genetic disease may often be
difficult, especially if the clinical and laboratory find-
ings are not suggestive of a known disorder. A
thorough family history is always important. Inquiry
as to parental consanguinity is helpful in the evalua-
tion of possible recessive inheritance. So often this
point is omitted in case reports of a genetically deter-
mined disease. There is no substitution for keen
observation both in the physical examination and his-
tory. Unquestionably, new genetic disorders await
recognition by the astute observer.
Once a disorder is suspected, other family members
must be evaluated as to their genetic make-up —
that is, whether they are affected, normal, or carriers
who appear normal. Ultimately, the physician must
turn to the laboratory in trying to delineate the basic
defect. Many elaborate techniques are now avail-
able to help make this delineation.
Once a physician recognizes a genetic disorder, he
will face a multitude of questions, some of which
cannot be answered at this stage of knowledge. What
is the cause of the disease ? What can be done ? Will
the children be affected? What are the chances of
PHENYLALANINE
PHENYLKETONURIA
PHENYLALANINE
HYDROXYLASE
►TYROSINE
A
ALBINISM
TYROSINASE
3,4-DIHYDROXYPHENYLALANINE
(DOPA)
•DOPA QUINONE
• HOMOGENTISIC
ACID
►(INTERMEDIATES)
1
MELANIN
ALCAPTONURIA
HOMOGENT/S/CASE
MALEYACETOACETIC
ACID
FUMARYLACETOACETIC
ACID
ACETOACETIC
ACID
Fig. 6. Sites of metabolic block in the degradation of phenylalanine producing the disorders of phenylketonuria, albinism and
alkaptonuria. The slanted words in the blocks indicate the missing enzyme.
38
The Ohio State Medical Journal
having a normal child? To answer many of these
questions, the physician will need to educate himself.
Summary
The application of genetics in medicine today can
be thought of in the following terms:
I. Diagnosis: Chromosomal studies are now avail-
able in many hospitals and such studies can be of
diagnostic value for the physician seeing an infant with
multiple congenital anomalies. Chromosomal analysis
should also be employed after a buccal smear test,
when the results of the latter do not coincide with the
appearing sex of the patient in question.
There are numerous biochemical determinations
now available to aid in the diagnosis of many genetic
disorders of altered protein synthesis.
II. Counseling: In many genetic disorders, it is
possible to state the genetic risk in rather precise
terms. For example, any child of a parent affected
with an autosomal dominant disorder has a one in
two chance of having the same condition as the af-
fected parent. In an autosomal recessive disorder,
once an affected child is born to unaffected parents,
the risk to any child subsequently born is one in
four. Genetic counseling is now possible for many
known conditions and should play a vital role in the
overall care of a patient.
III. Treatment: Treatment of genetic disorders
should not be looked upon as a hopeless situation.
True, one cannot cure a patient with genetic disease,
but tremendous progress has been made during the
past few years with regard to certain conditions.
Phenylketonuria and galactosemia are two severely
mentally retarding disorders, which can be treated if
diagnosed early enough. Proper treatment can pre-
vent the irreversible changes that produce mental
retardation.
Other genetic disorders can be aided greatly if
one is aware of the condition.
In conclusion, medical genetics can play a prac-
tical role in medicine today. This role will continue
to increase as our knowledge advances and thus we
must equip ourselves not only for the future, but for
the present.
Acknowledgment: The author is indebted to Dr. M. A.
Ferguson-Smith, of the University of Glasgow, (formerly at
Johns Hopkins Hospital) in whose laboratory the chromo-
some studies were performed and to Mrs. Patricia Roberts
for typing the manuscript.
References
(A list of texts pertaining to the subject of medical
genetics is available upon request.)
SPECIALTY BOARDS. — Members of specialty boards are conscientious,
honest, dedicated persons who contribute freely of their time and effort, often
at great sacrifice, to advance the standards of their specialty, without thought of
personal aggrandizement or recompense for their sendees. Like members of the
faculty of a great university sitting at a defence of a doctoral dissertation, they
are imbued with a sense of their responsibility to determine the competence of
candidates who appear voluntarily before them for certification as diplomates.
Aside from setting up minimal standards which must be met before candidates
can appear for examination before a board, such a board performs no function
in the educational programme available for training future diplomates. It is the
function of a specialty examining board to determine competence only and to
certify those who possess it to a sufficient degree to warrant approbation. Some-
what like the dissociation between the judicial and the legislative branches of a
modern democracy, a specialty examining board scrupulously avoids participation
in that phase of the educational programme which aims at development of com-
petency. Similarly, like a judicial body in and of itself, a specialty board has
neither the will nor the authority to prevent the practice of any specialty by a
licensed physician, regardless of his ability or lack of it. The chief objective
of all specialty examining boards is to elevate and to maintain the standards of
specialty practice, and the finite manifestation of their efforts toward this objective
is the certificate of competence which they issue to all physicians who can meet
minimal requirements of licensure and graduate medical education. — Louis A.
Buie, Sr., M. D., Rochester, Minnesota: British Medical Journal, 1:543-547,
February 27, 1965.
for January, 1966
39
The Importance of Chromosome Analysis
In Down’s Syndrome
A Case Report of a 21/21 Translocation
LESLIE M. EBER, M. D., and RICHARD M. GOODMAN, M. D.
IANGDON-DOWN (1866) generally is credited
with the first description of the relatively com-
^ mon syndrome called mongolism or Down’s
syndrome.1 The establishment of 46 chromosomes as
the normal number in man2 led to the discovery of a
chromosomal alteration in the cells of patients with
mongolism.3 Although this syndrome has long been
recognized as a clinical entity, recent cytogenetic
techniques now permit a more definitive diagnosis.
Several authors have commented upon the difficulty
of making the diagnosis of Down’s syndrome on clini-
cal grounds alone.4’5 Our case illustrates this point
and augments the relatively few reported cases of
mongolism associated with a translocation type of
chromosomal defect. This report reviews chiefly the
various chromosomal abnormalities associated with
Down’s syndrome and stresses the need for studying
chromosomes with regard to genetic counseling.
Case Report
This 31 year old white single woman entered the Ohio
State University Hospital on August 10, 1964 for evaluation
of glycosuria discovered by a diabetic grandmother. The
patient had no other diabetic symptoms. She was the first
born of 11 children, when her mother was 19 and her
father, 24 years old. The patient’s mother stated that there
was no prenatal exposure to X-irradiation and that the
delivery was full term and normal.
Her early development was noted to be very slow and,
because of her retardation, she never attended school. The
past history was interesting in that she had only the usual
childhood diseases, without frequent respiratory infections.
Menarche was at age 15, and her periods have remained
scanty and irregular. Although the patient had been seen
by physicians in the past, the parents were unaware of the
cause of her retardation. There was no known history of
consanguinity or mental retardation in other family members.
Physical examination showed a short, slightly obese,
obviously retarded woman (Fig.l). Vital signs were within
normal limits. Her height was 57 inches, weight 129
pounds, arm span 5D/2 inches, pubis to heel 27 inches and
crown to pubis 30 inches. The head was brachycephalic
with a normal female hair line. Epicanthal folds were ob-
served about the eyes. Slit lamp examination of the eyes
was normal. The palate was high arched, and the tongue
horizontally fissured (Fig. 2). There was poor dental de-
velopment with severe periodontitis. The neck was supple
with no thyromegaly. Breast development was normal. The
From the Deparpnent of Medicine, College of Medicine, The
Ohio State University Health Center, Columbus, Ohio. Supported
by National Institutes of Health General Research Grant, Rotary
Number 42071, Project 262.
Submitted May 28, 1965.
The Authors
• Dr. Eber, Columbus, is an Assistant Resident in
Medicine, The Ohio State University Hospitals.
• Dr. Goodman, Columbus, is Assistant Professor
of Medicine, The Ohio State University College
of Medicine.
heart and lungs were unremarkable. The abdomen was
slightly pendulous, with no palpable organs or masses.
Pelvic examination showed normal external genitalia. The
joints were not hyperextensible. Incurving of the little
finger (clinodactyly) was noted only on the left hand.
There was a wide gap between the great and second toes
bilaterally (Fig. 3). Neurological examination was within
normal limits except for the mental retardation. She was
pleasant and amiable but able to answer simple questions
only with short phrases.
The following laboratory determinations were within nor-
mal limits: hemogram, urinalysis, blood urea nitrogen,
creatinine, fasting and two hour post standard glucose meal
blood sugars, cholesterol, serology, protein-bound iodine,
achilles tendon test, twenty-four hour I131 uptake, serum
calcium, phosphorous, and alkaline phosphatase. A buccal
smear was positive. The chest x-ray and an intravenous
pyelogram were normal. The radiologist commented upon
the small size of the skull for a 31 year old woman and the
non-fusion of the lambdoidal suture. Electrocardiogram
was normal.
Chromosome analysis was performed on peripheral blood.
A total of 36 cells were counted, 32 of which showed a
21/21 translocation with a modal number of 46 (Fig. 4).
Chromosomal studies performed on the patient’s mother,
father, and four youngest siblings were normal. Leukocyte
alkaline phosphatase determinations showed only the pa-
tient’s to be abnormally elevated, 219 units6 (normal 100-
180). Fingerprint patterns of the hands showed a triradius
near the center bilaterally and a small digital loop in the
hallucal area of both feet. Though the commonly observed
simian crease of the hand was absent, these other derma-
toglyphic findings are seen frequently in Down’s syndrome.
Discussion
The reported frequency of Down’s snydrome in
the general population varies from author to author,
probably due to the large number of patients who die
during the first year of life and also to diagnostic
errors. It is thought to occur in about 1 in 600
live births and to account for 40 to 50 per cent of
the mentally retarded among the newborn and ap-
proximately 10 per cent of all the mentally deficient.7
Mongolism should be considered a syndrome in
40
The Ohio State Medical Journal
which no single clinical finding is pathognomonic.
Clinical diagnosis is made by a careful search for a
cluster of features associated with this condition.
Some of the more common of these are: mental re-
tardation, brachycephaly (shortening of the occipito-
frontal diameter), and epicanthal folds. The syn-
drome derives its name from the superficial resem-
Fig. 1. Shows the patient to be of short stature and slightl)
obese. Her facies is suggestive of Down’s syndrome.
blance of the eyes to those of the Mongolian people.
Closer examination has shown that Mongolians do
not actually manifest epicanthal folds. Part of the
diagnostic difficulty in the mentally retarded adult
with Down’s syndrome stems from the fact that often
this fold disappears with advancing age.
As in many forms of mental retardation, convergent
strabismus and nystagmus are found frequently. Cat-
aracts appear after age 8 and may be found in about
50 per cent of mongols after age 25. The tongue
after the second year may appear "scrotal” with
horizontal fissures. The palate frequently may be
high with a tendency to clefting and dentition is often
poor.
Numerous abnormalities of the extremities have
Fig. 2. Illustrates the patient’s fissured tongue and epican-
thal folds about the eyes.
been described such as malformation of the acetabu-
lum, dwarfism, laxity of the joints, and flabbiness
of the muscles. The hand may show the characteristic
"simian” line (a transverse fold across the whole
palm) and clinodactyly. Finger and toe print an-
alysis often show abnormal patterns.8 The foot is
broader and shorter than normal with the anterior
margin forming a horizontal line instead of an arch.
About 60 per cent of cases have a large cleft between
the big and second toes.
Congenital heart disease is present in up to 60
per cent of cases. A recent series9 found 40 per
cent with congenital heart disease. The leading de-
fects were atrioventricularis communis and ventricu-
lar septal defects. Patent ductus arteriosus, atrial
septal defects, and isolated aberrant subclavian artery
were less common.
Patients afflicted with this syndrome have a marked
Fig. 3. Shows the space between the first and second toes
which is a frequent finding in Down’s syndrome.
for Jam/ary, 1%6'
41
propensity to infections usually of the respiratory tract.
In addition, acute lymphatic leukemia is more common
in this disorder than in the general population.
Chromosomal aberrations are not unique to this
syndrome. They have been observed for many years
in rapidly regenerating tissue, cancer cells, and X-ir-
radiated cells of fruit flies. The association of Down’s
syndrome with chromosomal abnormalities was rec-
ognized in 1959- 3 Since then various characteristic
karyotypes have emerged.
(A) Trisomy 21. This is by far the most com-
mon type and the one associated with increasing
maternal age. These individuals have cells which
contain 47 chromosomes, three of which are number
21 instead of the normal two. This is thought to
arise during the meiotic division of gametogenesis
by a process referred to as nondisjunction, a failure of
the two chromosomes 21 to separate. Thus, the
single egg formed can possess either 24 chromosomes
(two 21 chromosomes) or 22 (no 21 chromosomes).
When the former is fertilized by a normal sperm
containing 23 chromosomes, the offspring is a mongol
with three chromosomes 21 and a modal number of
47. Such nondisjunction may also occur in the male
parent’s gametes. In this type of monogolism, family
karyotyping has failed to uncover any consistent
abnormalities. The probability of a second trisomy
21 child being born to a family in which there is
already one trisomy mongol is greater than that which
would be expected in a family with one normal child.
Furthermore, there is evidence to suggest that the
presence of one nondisjunction mongol in a family
makes it more likely for the appearance of other
types of chromosomal abnormalities to occur and vice
versa.10 It is also conceivable that there is a genetic
predisposition to nondisjunction.11
(B) Translocation 15/21. As in trisomy 21, this
chromosomal abnormality has the extra 21 chromo-
somal material, but the karyotype shows the normal
number of chromosomes, 46. Chromosomes are
known to break and recombine with the same or dif-
ferent chromosomes during meiosis. When part of
one chromosome combines with another, translocation
is said to have taken place. If this were to occur in
a grandparent’s germ cells, it could be transmitted to
a parent who phenotypically is normal, but who has
only 45 chromosomes. Theoretically, one fourth of
the next generation will be nonviable due to a paucity
of chromosomal material, one fourth will have Down’s
syndrome, one fourth will be translocation "carriers”
like the parent, and one fourth will be genotypically
and phenotypically normal. The above is probably
only an approximation, as there are multiple, un-
predictable factors involved. Male "carriers” usually
produce either mongols or normals and are thought
rarely to give rise to other "carriers.”12 Thus, the
"carrier” parent can be detected by cytogenetic studies
and should be sought for in all cases of translocation
monogolism, for there is high risk of producing an-
other mongol or perpetuation of the carrier state.
If no "carrier” is identified in the parents, theoreti-
cally the risk of having another affected child is less.
Family studies of 15/21 translocation mongolism
have shown that either the father or the mother may
be the "carrier,” that large families derived from a
"carrier” will contain several mongols, and that here
the incidence of Down’s syndrome does not parallel
parental age.
(C) Translocation 21/21. This type of mon-
golism is illustrated by our case whose karyotype is
shown in Figure 4. One chromosome in the 21-22
group is absent, and a new one is present (arrow).
Fig. 4. Shows the karyotype of the patient. Note there are
46 chromosomes and only one 21 chromosome. The arrow
points to the translocated chromosome which is made up of
two 21 chromosomes (21 1 21) attached to each other.
This represents a translocation between 21/21 or
22/21. This translocation may occur during meiosis
in a normal individual and may give rise to a phe-
notypically normal "carrier” with 45 chromosomes,
who in the next generation, may produce a mongol.
If one of the parents were a "carrier,” there would
be a high probability that the next child would also
have Down’s syndrome. Occasionally, as in our
case, no translocation carrier is identified in the par-
ents, making it likely that the translocation occurred
probably in one of the parent’s germ cells and could
not be detected in their somatic cells.
It should be noted that it is most difficult to
distinguish between chromosomes 21 and 22 micro-
scopically. Theoretically, a "carrier” of a true 21/21
translocation would produce only offspring with
Down’s syndrome. The fact that some "carriers”
have produced normal children further lends credence
to the difficulty in precisely identifying chromosomes
21 and 22. It is conceivable that these "carrier”
individuals are really 22/21 translocations thus ac-
counting for the increased probability of having nor-
mal offspring as in 15/21 translocations discussed
above.
(D) Mosaicism. The cells of this individual
show a mixture of trisomy 21 and normal cells.13
The hypothesis here is that the abnormality arose
42
The Ohio State Medical Journal
after fertilization during one of the early mitotic di-
visions giving rise to two populations of cells.
(E) At least one clinical case of Down’s syn-
drome has been reported in which no abnormal
karyotype was demonstrated.14 This is such a remote
finding that it does not preclude cytogenetic studies
on all cases of mongolism.
There is no way to distinguish between the various
types of mongolism clinically. A careful family his-
tory may alert the physician to the possibility of
translocation Down's syndrome; however, all cases
should be karyotyped. If a translocation is discovered,
the parent’s cells should also be examined with regard
to the carrier state. In this way the physician can
advise the family of the possibility of having future
children with mongolism. The cytogenetic approach
to Down’s syndrome also establishes the diagnosis in
questionable cases.
The chromosomal anomalies described above are
thought of by many as the basic abnormality in
Down’s syndrome. It is assumed that the extra chro-
mosomal 21 material in some way gives rise to the
various characteristics observed in the disorder. It
should be pointed out, however, that to date no
single mediator between the abnormal chromosome
and the patient has been discovered. No consistent
enzymatic or hormonal defect has been demonstrated
in this disease.
Summary
A case of Down’s syndrome in an adult woman
with a chromosomal 21/21 translocation has been
described. No translocation "carrier” was identified
in the family. The various types of chromosomal
abnormalities found in mongolism have been discussed
with emphasis on the necessity of performing cyto-
genetic studies for the purpose of genetic counseling.
Acknowledgment: The authors would like to express
their thanks to Dr. George Hamwi for his permission to
publish this case, to Mrs. Glenna Currier for chromosome
and finger print studies, and to Mrs. Pat Roberts for prep-
aration of the manuscript.
References
1. Down, J. L, H.: Observation on Ethnic Classification of
Idiots. Clin. Lect. and Rep. (London Hosp.), 3:259-262, 1866.
2. Tjio, J. H., and Levan, A.: The Chromosome Number of
Man. Heretitas. 42:1, 1956.
3. Lejeune, J., Gauthier, M.. and Turpin. R.: Etude des
Chromosomes Somatiques de Neuf Enfants Mongoliens. C R Acad.
Sci. (Paris), 248:1721-1722, March 16, 1959.
4. Lee, C. H., Schmid, W., and Smith, P. M.: Definitive Diag-
nosis of Mongolism in Newborn Infants by Chromosome Studies.
/. A. M. A., 178:1030-1032, Dec. 9, 1961.
5. Opie, L. H., Spaulding, W. B., and Cohen, P. E.: Masked
Mongolism — - Group 21 Trisomy in a Fifty-Three Year Old Woman.
Amer. J. Med., 35:135-142 (July) 1963.
6. Ackerman, G. A.: Substituted Naphthol as Phosphate Deriv-
atives for the Localization of Leukocyte Alkaline Phosphatase Ac-
tivity. Lab. Invest., 11:563-567 (July) 1962.
7. Engler, M.: Mongolism (Peristatic Amentia ), Baltimore: Wil-
liams and Wilkins, 1949.
8. Walker, N. F.: Inkless Methods of Finger, Palm, and Sole
Printing. J. Pediat., 50:27-29 (Jan.) 1957.
9. Rowe, R. D.. and Uchida, I. M. : Cardiac Malformation in
Mongolism. Amer. J. Med., 31:726-35 (Nov.) 1961.
10. Hecht, F., Bryant, J. S., Gruber, D., and Townes, P. L. :
The Nonrandomness of Chromosomal Abnormalities. New Eng. J.
Med., 271:1081-1086, Nov. 19, 1964.
11. Lubs, H. A., Jr.: Causes of Familial Mongolism. (Letter to
the Editor), Lancet, 2:881, Oct. 14, 1961.
12. Hamerton, J. L., and Steinberg, A. G.: Progeny of D/G
Translocation Heterozygotes in Familial Down’s Syndrome. (Letter to
the Editor), Lancet, 1:1408, June 30, 1962.
13. Clarke, C. M., Edwards, J. H., and Smallpiece, V.: 21 Tri-
somy/Normal Mosaicism in an Intelligent Child with Some Mongo-
loid Characters. Lancet, 1:1028-1030, May 13, 1961.
14. Hall, B.: Down’s Syndrome (Mongolism) with Normal
Chromosomes. Lancet, 2:1026-1027, Nov. 17, 1962.
ME'
iDICAL RESEARCH, like women’s clothing, is subject to fashion. Molec-
ular biology at present is in style; a generation ago most investigators
were microbe hunters. What comes next?
This, I think, can be predicted with fair certainty: molecular biologists will
proceed from the study of processes to that of whole organisms and of societies
of organisms. The myriad of biochemical events revealed by analysis of living
systems must be reassembled, at least conceptually, to bring life back to biology.
Functional unity and the purposeful responses of organisms somehow derive from
an ensemble of biochemical processes, but how this comes about is quite unknown.
We do not even have the beginnings of a theory that can be taken into the bio-
chemical laboratory for experimental test. Yet the question is there, and it is too
challenging to be ignored. Many of the best minds of this generation and the
next will be occupied with the relation between the biological whole and its
biochemical parts. — Vincent P. Dole, M. D., New York, N. Y.: Bulletin of the
New York Academy of Medicine, 41:211-213, February 1965.
I or January, 1966
43
Gonadal Dysgenesis
Report of a Case of Male Genotype with Female
Phenotype — “Pure Testicular Dysgenesis”
M. BALUCANI, M. D., and D. SCHNELL, M. D.
THERE are many varieties of sexual infantilism.
The classic "Turner Syndrome," with webbing
of the neck, cubitus valgus and short stature has
been discovered to have a 45/XO chromosome pat-
tern.1'3 Recently several cases have been reported in
association with XO/XX2'6 and XO/XXX7’8 pattern
and also anomalies of chromosomes such as Xx (dele-
tion of long arm of one of the X chromosomes),7
Xa (deletion of short arm of one of the X chro-
mosomes),8 XX (enlarged X chromosome, isochromo-
some)2'8 and the mosaic XO/XX2’9 have been found
in this syndrome. Occasional cases of sexual infantil-
ism without the other anomalies described by Turner
have also been found to have a 45/XO pattern.8
Therefore it has been found best to classify these
diseases by the genetic constitution and to call them
both "ovarian dysgenesis.” Recently, a few cases of
sexual infantilism without the classic deformities of
the Turner variety have been found to possess a
46/XY chromosomal pattern.2’10'14 This has been
called "pure testicular dysgenesis.”14 These cases are
apparently physically indistinguishable from the cases
with an XO pattern lacking Turner anomalies and
therefore present diagnostic difficulties. We are
presenting an additional case of a "pure testicular
dysgenesis.”
Case History
This is a 17 year old Negro girl with the chief complaints
of amenorrhea and failure of full external characteristic
sexual development. She was born by a healthy mother who
has normal menses and who delivered three other children,
all males. Her height was 64 inches, her weight 136 lbs.
There was sparce pubic and axillary hair and only slight
breast development. The abdomen was in direct continuity
with the chest (Fig. 1). The external genitalia were of the
infantile type but with an apparent clitoris and a rudi-
mentary vaginal introitus able to take a small size Sims
speculum. The vaginal vault was red and several folds
were present. A small nubbin of white tissue was seen in
the middle of the vault. A finger examination confirmed the
presence of a very small cervix. No pelvic organs or masses
were felt vaginally or rectally.
Positive findings in the x-ray study were: (1) the elbows
showed all epiphysis to be opened with approximate bone
age of 13-14 years, (2) a spina bifida of L-5 and S-l was
found, and ( 3 ) the hysterosalpingogram showed a very
small uterus with patent tubes Fig. 2. Positive findings
From the Department of Obstetrics and Gynecology, and the De-
partment of Pathology, Maumee Valley Hospital, Toledo, Ohio.
Submitted April 12, 1965.
The Authors
• Dr. Balucani, formerly Chief Resident, Ob-
stetrics and Gynecology, Maumee Valley Hospital,
Toledo, has completed his residency and now
returned to his home in Pescara, Italy.
• Dr. Schnell, Toledo, is Resident in Pathology,
Maumee Valley Hospital.
in the Laboratory studies were: Urine Gonadotropins,
were 72 units of U.R.W. X24 hours, a trace of estrone
was present in the urine, and it was impossible to detect
estradiol or estriol. The maturation index was negative for
estrogen effect. Buccal smear was chromatin negative. A re-
peat chromosome examination from leukocytic culture showed
46 chromosomes with a constant XY pattern (Fig. 3).
At laparotomy primitive gonadal streaks were found.
Biopsies were made of the edges and microscopic examina-
tion revealed a primitive fetal type of mesenchyme with
surface cells of cuboidal appearance. Within the mesen-
chyme were widely scattered small abortive testicular cords
and occasional islands of plump, rounded cells having the
appearance of Leydig cells (Figs. 4-5-6).
Discussion
As more cases are reported in the world literature,
the etiopathogenesis of "gonadal” dysgenesis becomes
less and less clear. The gonadal streaks that Turner
called "agenetic ovaries” have been found in the pa-
tients with tall and short stature, with or without
mental deficiency, with or without pubic hair, with
or without webbed neck or skeletal deformities. The
true clinical entity of gonadal dysgenesis is very dif-
ficult to understand because of such variety of clinical
findings. These patients usually have an elevated
urinary follicle -stimulating hormone (FSH) and
amenorrhea but cases with occasional menses and
histologic findings of ova and follicles have been
reported.13’ 16 The sex chromatin pattern is in the
majority of the cases a 45 XO chromosome, however
several patterns of chromosomes are possible. Bahner
et al.17 reported a case of a short patient with 45/XO
chromosome who had normal secondary sex char-
acteristics, had a normal menses and had delivered
a child. It would be of interest to know the chromatin
pattern of this child and to follow his progress.
In the literature, cases of normal appearing fe-
44
The Ohio State Medical Journal
Fig. 1. The patient. Note small breast development. Closer
inspection reveals that patietit has a more eunuchoid appear-
ance with broad shoulders and narrow hips rather than true
feminine.
males with abnormal chromosomal patterns have been
reported. Graham14 noted that there is no correlation
between the chromosomal pattern and the somatic
manifestation, except that 45 chromosomes are more
often found in the short patient. Jones et al.18 noted
that congenital anomalies are more prone in the pa-
tient with XO chromosomes. Why our patient had
a spina bifida with an XY pattern is very difficult to
correlate.
Of the few cases of gonadal dysgenesis with XY
chromosome pattern, three had operative and histologic
confirmation of the presence of primitive testicular gen-
FlG. 2. Hysterosalpingogram showing shallow, narrow vag-
ina. primitive uterus and thready tubal structures. The
pattern is infantile.
ital ridge, Leydig’s cells, wolffian or mullerian duct
remnants.14 Graham14 feels that "pure ovarian dys-
genesis” (XO chromosome pattern) can be differen-
tiated from pure testicular dysgenesis (XY chromatin
pattern) only on the basis of chromosomal constitution,
since physical and laboratory findings are similar.
However, it appears that differentiation can also be
made histologically (although with difficulty) on the
basis of finding primitive testicular tissue such as in
the case of Graham,1 4Dominguez and Greenblatt,19
deGrouchy et al.10 and in the present case. Occasion-
ally, primitive ovarian tissue can be found in the typi-
cal case of gonadal dysgenesis with an XO chromo-
some pattern.
It has been generally accepted that the chromatin
pattern present in the patient with ovarian dysgenesis
is a result of nondisj unction of sex chromosomes.
The presence of a Y chromosome usually gives rise
to a male phenotype, regardless of the number of X
chromosomes present.20 However, the presence of
a female phenotype in patients with gonadal dys-
genesis having a male pattern (XY) can probably
be best explained on the basis of Jost’s classic ex-
periments.21 He showed that in the mammals
i i Am
E
* Jfc
Fig. 3. Chromosomal Ideogram showing essentially normal
pattern with XY sex chromosomes.
for January, 1966
45
Fig. 4. Low power view of microscopic section of ridge
biopsy showing general structure of primitive, well vascu-
larized mesenchyme. (x50)
Fig. 5. Higher power view of ridge biopsy showing detail
of mesenchymal structure with surface cells assuming colum-
nar or cuboidal shape. (x430)
Fig. 6. Area of microscopic section of genital ridge biopsy
showing primitive testicular cord formation. (x430)
there is a definite tendency for feminization in the
absence of gonadal development or gonadal abla-
tion in chromosomal males. His conclusion was that
this probably is closely allied to the endocrine influ-
ence of the maternal organism. Thus in the absence
of a normally maturing and functionary testis, a male
phenotype cannot develop and the maternal endocrine
influences are not overcome by the offspring.
It is, then, clear that the inherent problem is why
the testis fails to develop in cases of gonadal dys-
genesis with an XY pattern. To date no satisfactory
explanation has been offered.22
Jones et al.18 tried to explain it on the basis of lack
of migration of the germinal cells to the medullary
ridge. This is suggested by the experiments of Don-
tchakoff23 who demonstrated the phenomenon in
rabbits. However the question of why migration is
arrested has not been answered. Jones et al.18 sug-
gested that absence of a Y chromosome or of an
X chromosome inhibits migration of the primitive
germ cells. Their reasoning is tenuous and does not
seem applicable to cases of gonadal dysgenesis with
an XY pattern since a Y chromosome is present.
Miller et al.22 have suggested the defect may be due
to the absence of some male-determining factor in
the Y chromosome, providing an XO/XY mosaic
pattern is not present.
In cases of gonoadal dysgenesis, either XO or XY
or other patterns, histologic definition of the gonadal
streak into primitive ovary or testes may be dif-
ficult to ascertain. This is due to the similar appear-
ance of Leydig (interestitial) cells and hilar cells,
the former obviously indicating testes and the latter
ovary. Histologic definition therefore appears to
rest on the negative finding of lack of primitive fol-
licles or the positive finding of primitive testicular
tubules. We are fortunate in seeing primitive cords
in addition to the nests of large cells of Leydig or
hilar type thus indicating a primardial testis rather
than ovary. The findings correlate well with the
chromosomal pattern.
As far as management of the patient with any
chromosomal sexual anomaly is concerned, it has been
generally agreed that the patient should be oriented
socially according to somatic appearance and devel-
opment. In this case, the patient was allowed to
continue life as a female and was told only that
she would be sterile.
Summary
1. It is impossible to clinically distinguish most
cases of sexual infantilism without the aid of chromo-
some studies and perhaps laparotomy with biopsy.
Many cases with a 45/XO chromosome pattern will
not have the classical Turner’s syndrome anomalies
and will be indistinguishable from XY chromosome
patterns with female somatotype.
2. The term "pure testicular dysgenesis” should
be accepted as a clinical classification in patients
with XY chromosome and female phenotype and
with histologic findings of a primitive testes.
3. It is not known why gonadal development
should fail to take place in cases of gonadal dys-
genesis with an XY chromosome pattern. It has
been suggested, (a) that germ cells fail to migrate
46
The Ohio State Medical Journal
to the ridge, and (b) that there is absence of a male
determining factor in the Y chromosome.
4. Management should generally follow along
the line of the patient’s somatic and psychologic
development.
References
1. Aubert, L.: Syndrome de Turner avec test de Barr positif et
sexe genitique feminen normal. Ann. Endocr., 23:225-231 (Mar.-
Apr. ) 1962.
2. Court-Brown, W. M. ; Jacobs, P. A., and Doll, R. : Inter-
pretation of Chromosome Counts on Bone Marrow Cells. Lancet,
1:160-163 (Jan. 16) I960.
3. de la Chapelle, A.: Cytogenetical and Clinical Observations
in Female Gonadal Dysgenesis. Acta Endocr., 40: (suppl 65): 1-
122, 1962.
4. Ferrier, P.; Shepard, T.; Gartler, S., and Burt, B.: Chro-
matin Positive Gonadal Dysgenesis and Mosaicism. Lancet, 1:1170,
(May 27) 1961.
5. Ford. C. E.: Human Cytogenetics: Its Present Place and
Future Possibilities. Amer. J. Hum. Genet., 12:104 (Mar. 17) I960.
6. de Grouchy, J.; Lamy, M.; Frezal, J., and Ribier, J.:
XX/XO Mosaics in Turner’s Syndrome: Two Further Cases.
Lancet, 1:1369-1371 (June 24) 1961.
7. Jacobs, P. A.; Harnden, D. G.; Court-Brown, W. M.; Gold-
stein, J.; Close, H. G.; MacGregor, T. N.; MacLean, N., and Strong,
I. A.: Abnormalities Involving the X Chromosome in Women.
Lancet, 1:1213-121 6 (June 4) I960.
8. Jacobs, P. A.; Harnden, D. G.; Buckton, K. E.; Court-Brown.
W. M.; King, N. J.; McBride, J. A.; MacGregor, T. N., and
MacLean, N.: Cytogenetic Studies in Primary Amenorrhea. Lancet,
1:1183-1189 (June 3) 1961.
9. de la Chapelle, A.: Chromosomal Mosaicism, X Chromosome
Anomally and Sex Chromatin Discrepancy in a Case of Gonadal
Dysgenesis. Acta Endocr., 39:175-182 (Feb.) 1962.
10. de Grouchy, J.; Cottin, S.; Lamy M.; Netter, A.; Netter-
Lambert, A.; Trevoux, R., and Delzant, G.: Un case de dysgenesie
gonadique a formule chromosomique male (xy) normale. Rev.
Franc, et Clin. Biol., 5:377-381 (Apr.) I960.
11. Harnden, D. G., and Stewart, J. S.: The Chromosomes in
a Case of Pure Gonadal Dysgenesis. Brit. AI. ]., 2:1285-1287 (Dec.
12), 1959.
12. Netter, A.; Lambert, A.; Lumbroso, P.; Trevoux, R.;
Delzant, G.; de Grouchy, J., and Lamy M.: Dysgenesie Gonadique
Avec Chromosome XY. Bull. Mim. Soc. Med. Hop. Paris, 76:275-
277 (19-26 Feb.) I960.
13- Stewart, J. S.: Gonadal Dysgenesis. The Genetic Significance
of Unusual Variants. Acta. Endocr. (Kobenhavn ) , 33:89-102 (Jan.)
I960.
14. Graham, T. C.; Greenblatt, R. B., and Byrd, J. R.: Gonadal
Dysgenesis with an XY Chromosomal Constitution. Obstet. Gynec.,
24:701-706 (Nov.) 1964.
15. Ashley, D. J. B.: "Turner’s Syndrome,’’ in Human lntersex,
Baltimore, Md.: Williams & Wilkins, 1962, Chap. 15.
16. Greenblatt, R. B.: Clinical Aspects of Abnormalities in Man.
Recent Prog. Hormone Res., 14:335-404, 1958.
17. Bahner, F.; Schwarz, G.; Harnden, D. G.; Jacobs, P. A.;
Hienz, H. A., and Walter, K.: A Fertile Female with XO Sex
Chromosome Constitution. Lancet, 2:100-101 (July) I960.
18. Jones, H. W., Jr.; Ferguson-Smith, M. A., and Heller, R. H.:
The Pathology and Cytogenetics of Gonadal Agenesis. Amer. J.
Obstet. Gynec., 87:578-600 (Nov.) 1963.
19. Dominguez, C. J., and Greenblatt, R. B.: Dysgerminoma of
the Ovary in a Patient with Turner’s Syndrome. Amer. J. Obst.
Gynec., 83:674-677, 1962.
20. Kupperman, H. S.: Human Endocrinology, Philadelphia:
F. A. Davis Co., 1963, vol. 3, p. 994.
21. Jost, A., quoted in Kupperman, H. S.: Ibid, p. 994, refs. 21, 22.
22. Miller, O. J.: The Sex Chromosome Anomalies. Amer. J.
Obstet. Gynec., 90:1078-1139 (Dec.) 1964.
23. Dontchakoff: Quoted by Jones, H. W., Jr.; Ferguson-Smith,
M. A., and Heller, R. H.: The Pathology and Cytogenetics of Gon-
adal Agenesis. Amer. J. Obstet Gynec.. 87:578-600 (Nov.) 1963.
AGE AND STILLBIRTHS. — The older the father and mother, the greater
L possibility that babies will be stillborn. The author analyzed records of 742
stillbirths that occurred during 1958-1961 with particular reference to parental
age; an equal number of live births, occurring in I960, were used as controls
for comparison. The largest number of stillbirths (311) fell into the category
of "cause of death unspecified.” The mean ages of the fathers and mothers of
these stillbirths were greater than those of the corresponding fathers and mothers
of the liveborn. Fathers in the first group were over age 31, mothers just under
age 29; among the controls, fathers were under 30 years and mothers under 27
years. In each case the difference is highly significant. In the second largest cate-
gory of 262 stillbirths listed as "cause of death ill-defined,” the mean age of fathers
was higher than the mean age of fathers of the controls — over age 30 versus
under age 30. Mothers were actually younger than those in the control group,
giving support to the hypothesis that advancing paternal age is significant.
While several explanations can be given for the relationship between still-
birth rate and maternal age, paternal age effects are more enigmatic. Differential
transmission of abnormal chromosomes with advancing age and the accumulation
of mutations in older males may be a partial explanation. A disproportionate
number of studies have been concerned with maternal age as compared with
paternal age. This is partly due to lack of available data on the age of the father,
but also results from a general apathy in the past toward the concept that paternal
age could be of any etiologic importance for congenital malformation or stillbirth.
Thus, a Los Angeles study of fetal deaths could not be compared with the Arizona
findings because the age of the father was not given.
Since certain congenital malformations and stillbirth rates increase with the
father’s age, it is unfortunate that the father’s age is not included in, or compiled
from, many vital statistics and obstetrics records in the United States at the
present time. Because of this unfortunate oversight, information that could be
of importance for etiologic studies is not available. — Abstract: Charles M.
Woolf, Ph. D., Arizona State Univ. : Obstetrics & Gynecology, July 1965, pp. 1-7.
for January, 1966
47
Chromatin Sexing in Carcinoma
Of the Breast
R. E. COHN, M.D., T. W. WYKOFF, Capt. M. C., and E. E. ECKER, Ph. D.
CARCINOMA of the breast is treated by radical
mastectomy in the majority of cases. Most
surgeons follow the rules set forth by Haagen-
sen in determining operability. The therapeutic
course thereafter may include irradiation, oophorec-
tomy, androgens, estrogens, adrenalectomy, or hypo-
physectomy, depending upon the individual surgeon’s
readings, philosophies, and experience, and upon the
type of tumor and the patient’s particular course.
In the European literature1-10 we now gain some
new insight into what might represent additional con-
crete factors in our thinking. These investigators
have shown that a direct correlation exists between
the chromatin sex of breast carcinoma cells in women
and prognosis with hormone therapy. They demon-
strated that patients with Barr positive tumor cells
improved with androgen therapy, whereas those with
Barr negative tumor cells rapidly deteriorated.
It was our purpose to test this hypothesis on a
randomly selected group of patients. Our findings
are presented.
Methods
Tissues from 29 patients operated upon for breast
cancer in 1957 were selected at random and sectioned
at 4-5 micron thickness. No attempt was made to dif-
ferentiate the tumors by the usual histologic classifica-
tions. Various staining techniques were screened in
our laboratories.11-16 Bouin fixed tissues were used
in our study, therefore the stains employed by the
European workers proved to be unsatisfactory.3- 7 The
Guard stain finally was selected.12 Using this method,
the slide is stained with Biebrich scarlet, which colors
all nuclear chromatin material. The preparation is
then overstained with Fast Green which displaces all
the scarlet color except that in the chromatin body and
the nucleolus. Two hundred and fifty neoplastic
cells from each cancer were examined for the presence
or absence of nuclear chromatin. Classification of
tumor cell type was accomplished as noted in Table 1.
If 20 per cent or more of cells contained Barr bodies,
they were classified as Barr Positive. A designation
of Barr Negative was given for a 6 per cent or less
From the Departments of Medical and Surgical Research, St. Luke's
Hospital of the Methodist Church, Cleveland. Ohio. Submitted
May 3, 1965.
The Authors
• Dr. Cohn, Pittsburgh, Pennsylvania, formerly
on staff at St. Luke’s Hospital, Cleveland, at pres-
ent is a Fellow in Endocrinology and Metabolism,
University of Pittsburgh School of Medicine.
• Dr. Wykoff, Maxwell Air Force Base, Alabama,
formerly on staff at St. Luke’s Hospital, Cleveland,
at present is Otolaryngologist at the USAF Hosp-
tal, Maxwell.
• Dr. Ecker, Cleveland, Professor Emeritus of
Immunology, Western Reserve University School
of Medicine, formerly was Bacteriologist and Im-
munologist, University Hospitals (Western Reserve
University), and Consulting Bacteriologist and
Immunologist, St. Luke’s Hospital.
Table 1. Criteria for Chromatin Sexing
% of Cells Sex of
with Barr Bodies Tumor
Barr Positive greater than 19.9 Female
6.1-19.9 Undetermined
Barr Negative less than 6.1 Male
count. The intermediate zone was simply called un-
determined. Barr positive and Barr negative cells
are loosely referred to as female and male, respectively.
The findings were then correlated with the status
of each patient up to seven years post-mastectomy (as
data were available) and with the treatment program
employed.
Results
Thirty-three per cent of the tumors studied con-
tained Barr negative cells, 50 per cent of the tumors
contained Barr positive cells; in the remainder the
cell type could not be determined (Table 2). These
Table 2. Breast Carcinoma
Cohn-Wykoff
Cases %
Mitterauer
Cases %
Ehlers
Cases %
Barr Negative
tumors
10
33
45
31
25 33
Barr Positive
tumors
15
50
59
41
Undetermined
5
17
39
28
48
The Ohio State Medical Journal
percentages correlate well with the results of the
European studies. Note that Ehlers gives only a single
figure for the combined Barr positive and undeter-
mined sex. These may all be subsequently classified
as Barr positive.
Considering only the Barr negative (or male type)
carcinomas in our series, two of the three treated with
androgen or oophorectomy were dead within five
years while only one of seven treated with no hormone
therapy was dead (Table 3). Although these num-
bers are small, the results are compatible with the
European conclusion that androgen therapy (or ooph-
orectomy) stimulates breast carcinomas with Barr
negative cells.
Regele, Domanig, and Lorbek5 found that when
patients with Barr negative and Barr positive cells
Table 4. Clinical History in 29 Patients and the Frequency of Nuclear Chromatin in Tumor Cells
Case
Number
Mastectomy
X-Ray Rx.
Hormones
Oophorectomy
Survival
Frequency of Chromatic
Sex Nuclear Chromatin
1
Radical
No
No
No
7 yrs.
Living
24.8%
F
2
Radical
No
No
No
7 yrs.
Living
20%
F
3
Radical
No
No
Yes
4 yrs.
Living
23.3%
F
4
Radical
No
No
No
6 yrs.
Living
12.8%
U
5
Radical
No
No
No
3 yrs.
Dead
22.4%
F
6
Radical
No
No
No
7 yrs.
Living
6%
M
7
Radical
Yes
No
No
5 yrs.
Living
6%
M
8
Radical
No
No
Yes
5 yrs.
Living
4.8%
M
9
Radical
No
No
No
6 yrs.
Living
28.4%
F
10
Radical
No
No
No
5 yrs.
Living
26.8%
F
11
Radical
6 yrs.
Living
13.2%
U
12
Radical
No
No
No
6 yrs.
Living
3.2%
M
13
Radical
No
No
No
5 yrs.
Living
30.0%
F
14
Radical
No
No
No
5 yrs.
Living
6.0%
M
15
Radical
Yes
Yes
No
2 yrs.
Dead
3.2%
M
16
Radical
Yes
Yes
Yes
2 yrs.
36.8%
F
17
Simple
Yes
Yes
No
1 yr.
Dead
2.4%
M
18
Radical
No
No
No
5 yrs.
Living
26.0%
F
19
Radical
No
No
No
7 yrs.
Living
26.0%
F
20
Radical
No
No
Yes
7 yrs.
Living
35.2%
F
21
Radical
No
No
No
6 yrs.
Living
22.8%
F
22
Radical
No
No
No
7 yrs.
Living
14.4%
U
23
Radical
No
No
No
5 yrs.
Living
5.2%
M
24
Radical
3 yrs.
Living
31.2%
F
25
Radical
Yes
No
No
7 yrs.
Living
10.4%
U
26
Radical
No
No
No
5 yrs.
Living
3.6%
M
27
Radical
Yes
Yes
No
4 yrs.
Living
11.6%
U
28
Radical
Yes
No
No
6 yrs.
Living
3.2%
M
29
Radical
Yes
Yes
3 yrs.
Living
39.5%
F
for January, 1966
4')
Table 3. Patients with Barr Negative (Male) Carcinomas
Dead
Living
Total
Hormone Therapy
(Testosterone or
Oophorectomy )
Cohn- Regele5
Wykoff
No Hormone
Therapy
Cohn- Regele5
Wykoff
2 13 16
16 6 17
3 19 7 23
were treated in similar fashion with radiation and
usual hormone therapy, 13 of 19 were dead in the
former as compared to 4 of 24 in the latter.
The clinical history in the 29 patients in our study
and the frequency of nuclear chromatin in tumor cells
are summarized in Table 4.
Discussion
The findings in our small, and probably not
statistically significant, study are compatible with
those described earlier by our European colleagues. A
definite correlation seems to exist between the cell
type of the carcinoma and its response to hormonal
therapy. These data would indicate that a Barr
negative tumor treated with androgens or oophorec-
tomy would be expected to deteriorate rapidly. A
Barr positive tumor might be expected to do well on
this same type of therapy.
It is not our purpose to recommend these findings
as a guide or timetable for treating this type of pa-
tient. We merely propose an interesting correlation,
which probably warrants further extensive investiga-
tion combined with a prospective study. It must be
pointed out that we cannot attempt to predict the
results of a similar study in which the histologic
classification is taken into consideration. The tech-
niques of preparing the slides and interpreting them
were not difficult and could be utilized in any general
hospital.
Summary and Conclusions
Our data and the findings of others suggest that
the five-year survival is shortened in patients with
breast carcinoma characterized by a low percentage
of Barr positive tumor cells when treated with an-
drogens or oophorectomy. Although further study is
indicated in this area, the use of androgens in a
patient with a Barr negative tumor cell type would
seem tenuous at this time.
References
1. Ehlers, P. N. : Uber die Unterscheidung des Mammacarcinoms
nach dem Zellkernmorphologischen geschlecht. Langenbeck Arch.
Klin. Chir., 295:940-943,. I960.
2. Ehlers, P. N. : Diagnose und Prognose des Mammakarzinom.
Zentralblatt fur Gynakologie, 84:1991-1999 (Dec.) 1962.
3. Ehlers, P. N. : Personal communication.
4. Regele, H., and Vagacs, H.: Uber die Hormonabhangickeit
maligner Mammatumoren. Klin. Med., 17:415-418 (July) 1962.
5. Regele, H.; Domanig, E., and Lorbek, W.: Aktuelle fragen
in der Hormontherapie des Mammacarcinoms. Chirurg, 34:199-201
(May) 1963.
6. Regele, H.; Kaufmann, F., and Wasl, H. : Zur Problematik
des "Sex-Chromatins” in Tumoren. Krebsarzt, 19:11-17, 1964.
7. Regele, H.: Personal Communication.
8. Ruef, J., and Ehlers, P. N. : liber 57 Beobachtete Doppel-
seitige Mamma-Carcinome. Langenbeck Arch. Klin. Chir., 30:115-
122, 1962.
9- Mitterauer, C., and Prenner, K.: Zellikernmorphologische
und Strahlenbiologische befunde bei Geschwulsten der Brustdruse.
Krebsarzt, 18:269-276 (July- Aug. ) 1963.
10. Hohmann, H. G., and Hernandez-Richter, J.: Zur Frage
der Ovarektomie beim Mammakarzinom unter beriicksichtgung des
Zellkernmorphologischen geschlechts. Munchen Med. Wschr., 105:
1464-1467 (July) 1963.
11. Klinger, H. P., and Ludwig, K. S.: A Universal Stain for
the Sex Chromatin Body. Stain Techn., 32:235-244 (Sept.) 1957.
12. Guard, H. R.: A New Technique for Differential Staining
of the Sex Chromatin, and the Determination of Its Incidence in
Exfoliated Vaginal Epithelial Cells. Am. J. Clin. Path., 32:145-
151 (Aug.) 1959.
13. Cuadrillero, C. B.: Stains for Sex Chromatin: Silver Im-
pregnation in Tissues and Blood Films. Stain Techn., 34:290-292
(Sept.) 1959.
14. Pearse, A. G. E.: "The Feulgen Reaction,” in Histochem-
istry, T heoretical and Applied, ed. 2, London: J. & A. Churchill,
Ltd., I960, appendix 8, pp. 822-823.
15. Spicer, S. S.: Differentiation of Nucleic Acids by Staining
at Controlled pH and by a Schiff-Methylene Blue Sequence. Stain
Techn., 36:337-340 (Nov.) 1961.
16. Pausegrau, D. G., and Peterson, R. E.: Improved Staining
of Sex Chromatin. Amer. J. Clin. Path., 41:266-272 (March) 1964.
DEATH BY DEFAULT. — The public must be protected of course, but isn’t
there such a thing as over-protection ? Certainly it is no problem to
prevent the introduction of any drugs with potentially harmful or mildly
harmful side-effects. It’s simple — just don’t develop any new drugs, or at least
make it very difficult for a new drug to be tested and/or marketed. The only
difficulty here is that many lives and the improved health of many others would
be lost by default, that is, drugs that could be of benefit would never be de-
veloped. This is just as wrong as allowing anything and everything to be pushed
onto the drug market. For the non-medically orientated it is quite easy to under-
stand the sad results of a thalidomide deformed baby but far less easy for
many to comprehend the equally sad results of those lives that can be lost by
default. — Joseph P. Schaefer, M. D., New Physician, 13:10, (Oct.) 1964.
50
The Ohio State Medical Journal
A Clinicopathological Conference
From The Ohio State University Hospital, Columbus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
COLIN R. MACPHERSON, M. D., President
Presented by
• Richard E. Brashear, M. D., Columbus, and
• Emmerich von Haam, M. D., Columbus;
Edited by Dr. von Haam.
PRESENTATION OF CASE
A WHITE HOUSEWIFE, aged 21 years, was ad-
mitted to Ohio State University Hospital with
^ the chief complaint of severe shortness of
breath. She had "lung trouble” at birth and had
asthma as a child. Since age 10 she had had many
hospitalizations elsewhere for shortness of breath
that occurred at rest, and her physical activity had
been severely limited because of dyspnea. Two years
prior to admission she delivered a 7-month premature
infant and noted no marked increase in her respira-
tory symptoms during the pregnancy. Beginning nine
months prior to admission the patient developed re-
current pedal edema, edema of the thighs, vulva and
abdomen, and had been bedfast at home during these
periods.
She had a chronic cough usually productive of
large amounts of purulent sputum and occasional
episodes of mild hemoptysis. Her medications for an
unknown period of time had included Meticorten®,
digoxin, and Aldactone®. About four weeks prior to
admission the patient was told that her liver was en-
larged, and she noted right upper quadrant tenderness,
clay-colored stools, and yellow skin and eyes that re-
mained for two weeks. The patient denied any al-
lergies, had no previous operations, and had had
whooping cough, measles and mumps in childhood.
There was no family history of diabetes, hypertension,
heart or lung disease.
Physical Examination
The patient was a frail, childlike white woman in
acute respiratory distress, showing cyanosis and shal-
low, rapid respirations. Her pulse rate was 120 per
minute and regular, blood pressure 80/60, respira-
tory rate 32 per minute and shallow. She was afeb-
rile. The skin had poor turgor, and an acneiform
rash was noted on the face. Examination of the head,
ears, eyes, nose and throat was not remarkable except
for a perforated anterior septum of the nose. Exami-
nation of the neck revealed no venous distention or
masses; the thyroid was not palpable. The chest had
an increased anteroposterior diameter and accessory
muscles were used in breathing. Coarse rales were
heard throughout the lung fields with tubular breath
Submitted October 26, 1965.
for January, 1966
sounds throughout and occasional inspiratory and ex-
piratory wheezes.
The point of maximal impulse of the heart was in
the fifth left intercostal space at the midclavicular
line. The rate was 120 per minute and regular.
No heaves or thrusts were described and no murmurs
or friction rubs were noted. A protodiastolic gallop
was noted on inspiration. The abdomen was soft
and not distended; there was no ascites present. The
liver was palpable 2 cm. below the costal margin.
The spleen was not palpable. Examination of the
extremities revealed 2 plus pitting edema of the
ankles and pretibial areas and peripheral cyanosis.
No clubbing was described. The neurological exami-
nation was within normal limits.
Laboratory Data
On admission, her hemoglobin was 11.4 Gm.; the
white blood cell count was 32,000 (neutrophils 75
per cent, lymphocytes 21 per cent, eosinophils 1 per
cent). The urine had a specific gravity of 1.009,
contained 50 mg. of protein, and was otherwise
normal. The blood chemistry findings were: C02
combining power 23 mEq./L., sodium 149 mEq./L.,
potassium 5.9 mEq./L., chlorides 99 mEq./L.; urea
nitrogen 24 mg./ 100 ml.; sugar 30 mg./lOO ml.; total
bilirubin 0.1 mg./lOO ml.; total protein 7.1 Gm./
100 ml. (4.6 Gm. albumin, 2.5 Gm. globulin);
plasma cortisol 20.3 mcg./lOO ml. Repeat fast-
ing blood sugars were 53 and 82 mg. Serum
protein electrophoresis was essentially normal except
for a slight increase in the gamma fraction. Re-
peated sputum cultures were negative for acid-fast
organisms and revealed only a light growth of normal
flora. Histoplasmin complement fixation and ag-
glutination tests were negative.
On chest x-ray, the heart was moderately enlarged
with prominence of the right ventricle and of both
pulmonary arteries. Both lung fields showed severe
51
emphysema with numerous large blebs and bullae.
There was partial consolidation of both upper lung
fields with upper retraction of both hilar areas; the
minor fissure was also retracted upward on the right.
Upper gastrointestinal examination revealed no lesions
of the esophagus, stomach or duodenum. Repeat chest
x-rays confirmed the cardiomegaly, the prominence of
the pulmonary artery segments, cystic changes of the
lungs, and linear fibrosis in both upper lung fields.
The electrocardiogram revealed right axis devia-
tion and probable right ventricular enlargement.
The results of pulmonary function studies were:
maximal breathing capacity 21.7 L./min. (23 per
cent), vital capacity 1,273 cc. (42 per cent), 1 sec.
forced expiratory volume 527 cc. (21 per cent).
Arterial gas studies done shortly after admission re-
vealed 02 saturation 83.9 per cent with an 02 content
of 13.63; C02 content of whole blood 61.5 (serum
71.2); pC02 54.1 mm. Hg.; pH 7.38. Sweat
chlorides were 8.51 mEq./L. Sweat chlorides ob-
tained on the patient’s brother and mother were
15.38 and 27 mEq./L., respectively.
Hospital Course
This severely dyspneic patient was started on inter-
mittent positive pressure therapy, was continued on
steroids, digitalis, and diuretics, and was started on
tetracycline. Initially, the patient showed improve-
ment on this course of therapy. It was decided that
a scalene node biopsy should be performed to aid in
the diagnosis of her chronic pulmonary problem.
After receiving barbiturate and Demerol® as pre-
operative medication, the patient became severely
cyanotic and hypotensive. Several days later scalene
node biopsy was performed and the pathology report
was that of an essentially normal lymph node.
Post operatively, a remarkable change was noted in
the patient’s behavior and she became definitely par-
anoid. She also developed a fever and penicillin
therapy was started. From that time on, her behavior
was very unpredictable; at times she would be co-
operative and normal, at other times frankly psy-
chotic with hallucinations. It was thought to be a
functional psychosis, probably schizophrenia, par-
anoid type. She progressively deteriorated and be-
came uncommunicative. During the succeeding days
she continued to follow this unpredictable course
and lapsed into periods of catatonia. She was main-
tained on intravenous fluids and antibiotics. The
respiratory status progressively worsened, necessitating
tracheostomy.
Approximately 24 hours prior to her death she
began to have ventricular tachycardia that rapidly went
to ventricular fibrillation and cardiac arrest. She
was resuscitated several times during the course of the
next 24 hours. The patient died after 33 days of
hospitalization.
CLINICAL DISCUSSION
Dr. Brashear: In essence, this was a 21 year
old housewife who was admitted here for the first
time with severe shortness of breath. She allegedly
had had lung trouble since birth. I want to comment
here that this is hard to evaluate. It seems she had
been in the hospital many times for shortness of
breath. "Many” times could have been two times,
it could have been ten times a year. It could have
been shortness of breath because of lung disease that
would show on an x-ray, or it could have been short-
ness of breath because of episodes of asthma with a
normal x-ray. Nine months before admission she de-
veloped some pumlent sputum, had some peripheral
edema, and was treated with the usual medications.
She continued along and four weeks before admis-
sion she had some type of episode in which her liver
got large and apparently she was jaundiced and had
some tenderness in the right upper quadrant.
On the examination here she appeared to be in
severe distress. She was cyanotic and they described
her as being pale and childlike. I would say from
this description that she was probably underdeveloped,
malnourished, and appeared chronically ill. She had
a perforated anterior nasal septum. I am not sure
why this was in there unless they are trying to suggest
that she had Wegener’s granulomatosis. I don’t
think she did, but I thought I’d mention it. Exami-
nation of her lungs and heart showed nothing really
spectacular. The liver was enlarged and she had
other findings of right-sided failure.
As far as the laboratory data go, she had an
elevated white count and a little protein in the urine.
Her blood electrolytes weren’t remarkable. The blood
urea nitrogen was up just a very little. Her blood
sugars were a little on the low side. Her gamma glob-
ulin was slightly up, which is interesting for several
reasons that I will mention later. The plasma cortisol
was within normal limits. The electrocardiogram
described cor pulmonale. The pulmonary function
studies revealed that she was indeed pretty sick. Her
vital capacity and maximum breathing capacity were
markedly decreased. She must have had a lot of lung
disease and she was unable to get much expansion
out of her lungs. The arterial blood studies show that
she was quite desaturated. She was also unable to
get rid of all the C02 she was producing and she
was just a little on the acid side. Her sweat chlo-
rides were not elevated.
While in the hospital she was given the usual
group of medicines, which didn’t help much, and they
decided to do a scalene node biopsy. This woman
was in very marginal respiratory condition and they
gave her some barbiturate and Demerol, which I
would anticipate was probably a touch too much and
it tipped her over on a rapid downhill course. They
managed to pull her through this decline in order to
snatch out a scalene node several days later, which
didn’t show much. She developed an acute toxic
psychosis, went on a downhill course and died. May
we see the films now?
Dr. Dunbar: The films of her chest demon-
52
The Ohio State Medical Journal
strate quite nicely pulmonary emphysema with large
bullous areas throughout the bases. In addition, one
has a feeling that there is considerable peribronchial
thickening throughout the more normal upper lung
fields, and the entire picture is quite consistent with
a diffuse pulmonary fibrotic process. It is a very nice
picture for chronic pulmonary disease with secondary
cor pulmonale with right ventricular and main pul-
monary artery enlargement due to obstruction of
blood flow through the lungs. Since she was a young
individual, it would make a fine diagnosis of cystic
fibrosis of the pancreas with chronic infection and
fibrosis of the lungs.
Dr. Brashear: I think the first thing that is un-
usual about this patient is that she was a 21 year old
woman who died of chronic lung disease. First I
thought of something of a congenital nature, such as
congenital bullae, but to have symmetrical congenital
bullae is not a very strong possibility. The other
thing that occurred to me was whether or not there
was some abnormality in the blood supply to the lower
lobes that had produced hypovascularization. This is
a remote possibility. There are recent case reports on
congenital absence of the pulmonary artery and on
congenital stenosis of the branches of the pulmonary
artery, and almost any branch or branches of the pul-
monary vessels can have stenosis. But it’s hard to
believe that she had bilaterally symmetrical lesions of
the pulmonary vessels causing hypovascularization.
There is the possibility that she had some type of
hypogammaglobulinemia and chronic infection, but
the protocol says that the gamma globulin was some-
what elevated. As far as congenital diseases go, I
don’t have much more to offer.
Neoplasm ?
As for the neoplasms, there is a history that covers
this long period since childhood, so I wouldn’t want
to consider this. As far as infection goes, again I
can’t think of anything that I would want to mention.
I have a lot of respect for tuberculosis; I think it
can mimic anything. But she was examined for
tuberculosis and no bacilli were found. Any other
infection I really can’t get too enthusiastic about.
So I end up with "miscellaneous” diseases and 1
shall spend some time talking about them. Again I
would mention Wegener’s granuloma just in passing
since I really don’t place much weight on it. The
other thing I thought about was sarcoid and this pa-
tient could indeed have had sarcoid. Sarcoid, in my
opinion, can give any type of x-ray; it can give nodes
alone, it can give miliar}’ disease, and some people
feel that it can produce cavities. To say something
is not sarcoid on the basis of a chest x-ray is dan-
gerous. Sarcoid usually begins around the age of
18 to 20 and so, just on the basis of age alone, the
diagnosis of sarcoid would be somewhat tenuous.
Also in sarcoid anywhere from 60 to 80 per cent of
the lymph nodes ought to be positive for sarcoid.
The first time I read this through my first two
diagnoses were sarcoid and fibrocystic disease of the
pancreas, and the second time I read it through I
thought only of fibrocystic disease, but the more I
read about fibrocystic disease the less probable this
diagnosis became. This is an exocrine disease that
involves the pancreas, liver, sweat and salivary glands.
Ninety per cent of the people with fibrocystic disease
die from respiratory failure. They develop episodes
of bronchial obstruction and infection, episodes of
severe dyspnea, and after this they develop obstruc-
tive emphysema with poor aeration of the alveoli,
decreased oxygen saturation and C02 retention not
unlike this patient. They also get septicemia when
they have these episodes of bronchial obstruction and
infection. They are also subject to episodes of mas-
sive atelectasis, and they are also subject to sudden
death from asphyxiation from great globs of mucoid
type secretions. About 2 per cent of people with
fibrocystic disease get liver disease, which may present
as cirrhosis, hepatosplenomegaly and portal hyper-
tension.
Fibrocystic Disease: Criteria
There are usually four diagnostic criteria to make
the diagnosis of fibrocystic disease. The first one is
pancreatic deficiency; 80 to 90 per cent of the people
have absence of pancreatic exocrine function. The
second criterion is pulmonary disease with obstruc-
tive emphysema and chronic bronchopneumonia,
which this woman did have. The third criterion for
the diagnosis is an abnormal sweat test, and only very
few patients do not have it. Her sweat test and the
sweat tests of her brother and mother were certainly
normal. The chloride level to be abnormal should
be around 60 to 70. The fourth diagnostic criterion
is the occurrence of the disease in siblings or in the
family history, which apparently she didn’t have.
So out of these four diagnostic criteria she had one for
certain and the pancreatic deficiency we really can’t say
a whole lot about.
The fate of the people with fibrocystic disease is
determined by their pulmonary disease. Most of the
people with fibrocystic disease do not live this long.
Out of one series of 550 patients only 106 survived
beyond the age of 10, and the oldest out of this
series was 24. Ninety per cent of them died from
pulmonary disease. I think fibrocystic disease in
this patient can be considered, but from a statistical
standpoint I think everything is really against it
except the clinical course and the chest x-ray.
I am now running out of possibilities and so I
come to the very loose term of pulmonary fibrosis.
The possibility that she did have fibrosis of some
type exists. Hamman and Rich described their
syndrome in 1933, 1935, and 1944 as a very peculiar
progressive diffuse fibrosis of the alveolar walls with
dyspnea and right heart failure. They only described
four cases, and their patients survived 31 days to 4
months. Some of the features of this diffuse inter-
stitial fibrosis are dyspnea, dry cough, rales at the
for January, 1966
53
bases, weight loss, clubbing of the fingers, and signs
and symptoms of right heart failure. The term
Hamman-Rich should be used for the acute fulminat-
ing form, which has a strong predilection for the
lower lobes with decrease in volume. Again it would
be hard for me to say that this woman had bilaterally
symmetrical diffuse interstitial fibrosis, but the pos-
sibility does exist.
There is an excellent review in the Quarterly Jour-
nal of Medicine of January, 1964 on diffuse inter-
stitial pulmonary fibrosis based on 45 patients. Dr.
Scadding in England, who was a visitor here a couple
years ago, has brought out a new term for diffuse
interstitial fibrosis. He recommends that this dis-
ease be called fibrosing alveolitis. In this manner
he wishes to indicate that it is primarily a disease
of the alveolar walls as opposed to an organizing
pneumonia with the exudate inside the alveoli. He
feels nevertheless that the Hamman-Rich syndrome
is still an appropriate term for patients with the rap-
idly fatal form of the illness. I am sure we are
going to hear more about the term fibrosing alveolitis.
After discussing all these things, I am not sure
what this patient had. Everything I have talked to
you about, I have, in my opinion, been able to rule out
reasonably well. She either had something very unus-
ual or she had something like a nonspecific chronic
lowgrade infection of some type that I have not been
able to figure out, or I could say that she probably
had the chronic form of fibrosing alveolitis. She
had it at a young age, if the history is valid, and it’s
been there for a long time. If the history is not
valid and this x-ray picture and her symptoms were
of a lot more recent onset, she may indeed have had
the Hamman-Rich syndrome. So that is probably
the diagnosis I would prefer at the present time.
General Clinical Discussion
Dr. Greenberger: It seems that you are plac-
ing a lot of reliance on the fact that the sweat test
was negative. It should be pointed out that this pa-
tient was on prolonged cortical steroid therapy. The
question could be raised, What effect might this have
on the sweat test?
Dr. Elizabeth Ruppert : Being on steroids will
not interfere with the sweat test if you have fibrocystic
disease. Adrenal insufficiency will give you abnormal
sweat electrolytes and give you a false positive.
Dr. Greenberger: There is one other thing
that remains a little mysterious and that’s the episode
of jaundice that apparently took place before she
came in, and I was wondering if you would care to
expand a little on this as to what you think the pos-
sibilities might be?
Dr. Brashear: Apparently when she was in the
hospital the bilirubin was reported as normal, and I
made some comment in passing about the fact that
cystic fibrosis does involve the liver on rare occasions.
Except for that, I really just don’t have much to add.
Dr. Greenberger: The possibilities would be
(a) that she had incidental virus hepatitis, (b) that
she might have received a drug and had transient in-
trahepatic cholestasis with dark urine and light stools
and transient jaundice, but this wouldn’t account for
the fact that her liver appeared to be enlarged. The
third possibility might be that she had an associated
episode of increased failure at the time.
Dr. Brashear: Oh, I think she definitely was
in right heart failure with a big, tender liver.
Dr. Saslaw: I would like to have this toxic en-
cephalopathy that she had discussed a little more.
Which toxins and what other types of things can
give these cerebral manifestations in a patient with
this disease?
Dr. Brashear: The psychiatrists I have known
to use the term toxic encephalopathy have used it to
describe people who are critically ill and become
psychotic, and they call it toxic psychosis probably
more for the sake of terminology than for the fact
that there is an actual toxin. This woman was hypoxic
and critically ill and I wouldn’t want to specify any
toxin. I just think this was a terminal event and
may have been due to the hypoxia.
Dr. Saslaw: The reason I asked that is because
it is mentioned that she showed catatonia. Classical
cases of catatonia have subsequently shown that they
had a cerebral lesion of some sort.
Dr. Atwell: Before the days of the sweat test
we probably would have been at a loss to make a
diagnosis here because actually it’s only since the
sweat test that many patients of this age have been
diagnosed as having cystic fibrosis. Certainly her
history of chronic recurrent infections goes along
with this condition as we know it now. There is no
description of the characteristics of the secretions
that she was putting out and this would be quite help-
ful in your diagnosis here. The sputum in these pa-
tients is so characteristic that almost by looking at it
you think of cystic fibrosis. It is so thick and sticky
that you can turn the box upside down and it won’t
even budge. The upper lobe distribution also is
something that would be compatible with cystic
fibrosis. In the teenagers that we have seen, almost
classically these people get peculiar and nondescript
infiltrations not unlike this, but it usually starts in the
right upper lobe for some reason or other.
Dr. Dunbar: If we see a 3 month old baby with
an atelectatic right upper lobe on an x-ray we say,
"Atelectasis of the right upper lobe, rule out cystic
fibrosis of the pancreas.”
Dr. Greenberger: Why don’t we go ahead and
observe the pathology and then I hope we will have
a little time for some questions afterwards.
CLINICAL DIAGNOSIS
1. Chronic fibrosing alveolitis.
2. Acute diffuse pulmonary fibrosis (Hamman-
Rich) .
3. Cor pulmonale with right heart failure.
54
The Ohio State Medical Journal
PATHOLOGICAL DIAGNOSIS
1. Cystic fibrosis involving lungs and pancreas.
2. Cor pulmonale with congestive heart failure.
DISCUSSION OF PATHOLOGY
Dr. von Haam: The autopsy showed an under-
developed, poorly nourished female with a puffy face,
marked cyanosis of the nail beds, and venous disten-
tion. The heart showed marked hypertrophy of the
right ventricle, which measured 7mm. in thickness.
The pulmonary arteries showed atheromatous plaques.
The lungs showed a few emphysematous blebs, con-
gestion at the bases, and diffuse areas of fibrosis bi-
laterally. The trachea and bronchi were filled with
tenacious mucus which could be easily pulled out with
the forceps from the smaller bronchi. The combined
weight of the adrenals was 6 Gm. and they showed
marked cortical atrophy.
Microscopic examination confirmed the marked
hypertrophy of the right heart muscle. Examination
of the bronchi showed a very hyperplastic papil-
lomatous mucosa with markedly increased mucus
excretion by the epithelial cells. The smaller bronchi
appeared ulcerated and surrounded by areas of inflam-
mation. There was no muscular hyperplasia present
as commonly found in asthma. Many areas of the
lung showed complete atelectasis with old and recent
hemorrhages. The lymph nodes showed diffuse reticu-
lum-cell hyperplasia and at the same time a pecu-
liar paucity of lymphocytes. Absence of lymphocytes
has been stressed in this condition as a cause for
subsequent infection. The small bile ducts were also
obstructed by mucus, which could explain the transi-
ent attack of jaundice. In the pancreas all small
ducts were obstructed by this very thick mucoid
material, but no atrophy of the acinar cells was as yet
noticeable.
In conclusion, we feel that we have indeed a case
of cystic fibrosis, involving primarily the lungs and
pancreas, that is remarkable in that it showed a nega-
tive sweat test and no clues in the family history.
Closing Remarks
Dr. Greenberger: Recently Dr. Rubin at the
University of Washington and others have shown that
rectal biopsy is a very reliable means of making the
diagnosis of cystic fibrosis, and they have reported that
about 6 0 to 80 per cent of their patients with known
cystic fibrosis have an abnormal rectal biopsy. The
crypts are dilated with very wide mouths and they
are filled with mucus. I think this case demonstrates
that one sweat test is probably not sufficient because
of the possibility of technical errors in making the
test. I think this is a very fascinating disorder and
one can raise the question as to what the basic path-
ophysiology is.
Dr. Ruppert: The recent knowledge I have
about this is that there is an abnormal mucoprotein
in the duodenal aspirate from people with cystic
fibrosis that forms an insoluble precipitate with al-
cohol and benzene.
Dr. Saslaw: I would like to ask Dr. Ruppert
if the trypsin test is still of some assistance in
screening.
Dr. Ruppert: Yes, we still do the trypsin test
and in a child after 4 to 6 months of age a trypsin
test is very worth while.
CYSTIC FIBROSIS. — No clearly demonstrable abnormality of adrenocorti-
cal function or corticosteroid metabolism was found in a series of 27
children with cystic fibrosis. Although there is no morphological adrenocortical
involvement in the pathology of cystic fibrosis of the pancreas, the following
observations in patients with cystic fibrosis are similar to those in patients with
altered [adrenocortical function or] corticosteroid metabolism or both: (1) of
patients studied to date, only those with Addison’s disease or panhypopituitarism
have a similar sweat electrolyte pattern, (2) steatorrhea and elevated sweat elec-
trolyte concentrations have been reported in association with adrenal insufficiency,
idiopathic hypoparathyroidism, and pernicious anemia, (3) corticotropin and cor-
ticosterone can lower viscosity of gastric secretions, and (4) the viscosity of
duodenal fluid decreased following the intravenous infusion of corticosterone in
a few patients with cystic fibrosis. If the abnormal sweat electrolyte pattern seen
in children with cystic fibrosis is causally related to adrenocortical function, it
may be caused by an end-organ resistance to normal levels of hormone. This
concept is supported by the following reported observations: the response to
salt restriction in normal subjects consists of increased urinary excretion of al-
dosterone and decreased concentration of sweat electrolytes, whereas subjects with
cystic fibrosis show no decrease in sweat electrolyte concentration although their
urinary aldosterone level increases. — Abstract: Dale D. J. Chodos, M. D., et al. :
American Journal of Diseases of Children, 110:76-80 (July) 1965.
for January, 1966
55
56
The Ohio State Medical journal
Hagyl
brand of ,
metronidazole
Flagyl eliminates the difficulties and frus-
trations that have long attended the treat-
ment of trichomonal infection.
These difficulties arose mainly from:
1) the failure of any previously known
agent to destroy the protozoan in para-
vaginal crypts and glands;
2) the failure of any previously known
agent to prevent reinfection by eradicat-
ing the disease in male consorts.
The introduction of Flagyl removed both
of these long-standing deficiencies. Hun-
dreds of published investigations in thou-
sands of patients have confirmed the ability
of Flagyl to cure trichomoniasis.
Correctly used, with due attention to re-
peat courses of treatment for resistant,
deep-seated invasion and to the presump-
tion of reinfection from male consorts,
Flagyl has repeatedly produced a cure rate
of up to 100 per cent in large series of
patients.
Nothing cures trichomoniasis like Flagyl.
Dosage and Administration
In women: one 250-mg. oral tablet t.i.d. for
ten days. A vaginal insert of 500 mg. is avail-
able for local therapy when desired. When the
inserts are used one vaginal insert should be
placed high in the vaginal vault each day for
ten days, and concurrently two oral tablets
should be taken daily.
In men: in whom trichomonads have been
demonstrated, one 250-mg. oral tablet b.i.d.
for ten days.
Contraindications
Pregnancy; disease of the central nervous sys-
tem; evidence or history of blood dyscrasia.
Precautions and Side Effects
Complete blood cell counts should be made
before and after therapy, especially if a sec-
ond course is necessary.
Infrequent and minor side effects include:
nausea, unpleasant taste, furry tongue, head-
ache, darkened urine, diarrhea, dizziness, dry-
ness of mouth or vagina, skin rash, dysuria,
depression, insomnia, edema. Elimination of
trichomonads may aggravate moniliasis.
Dosage Forms
Oral— 250-mg. tablets/Vaginal— 500-mg. inserts
SEARLE
Research in the Service of Medicine
for January, 1966
57
AMA Philadelphia Meeting . . .
Ohio Delegates Play Leading Roles in House of Delegates, Where
Some of the Fundamental Principles of Medicine Were Reaffirmed
IT was November 28 - December 1, 1965, in Phil-
adelphia but, as far as the Ohio State Medical
Association delegates to the AMA were con-
cerned, it was 1776 all over again.
Armed with resolutions and what might be called
"The Spirit of ’76,” the Ohio delegation successfully
advocated at the 1965 AMA Clinical Convention ad-
herence to those professional principles laid down by
the AMA’s founders in that same City of Independ-
ence nearly 119 years ago.
Ohio’s full complement of delegates and alternates,
led by Chairman John H. Budd, M. D., of Cleveland,
chalked up a perfect score when they gained House
approval of:
1. Reaffirmation of the "usual and customary fee”
as determined by the individual physician as the
basis for reimbursing physicians for not only medicare
services but also for government health programs at
all levels of government.
2. Changing a Board of Trustees recommendation
to read that the prevailing fee concept for medicare
is "noted” rather than "approved” or "recognized.”
3. A roundly applauded Ohio resolution pledging
full support of Edward R. Annis, M. D., AMA’s
nationally known speaker against Medicare, was sub-
mitted after reports in paramedical publications al-
leged "top AMA officials” had apologized privately
to Department of Health, Education and Welfare
officials for Dr. Annis’ speech at a Medicare con-
ference held by AMA in Chicago October 1, 1965.
Model Contract Tabled
4. An Ohio resolution directing that an AMA-
prepared model contract between hospitals and physi-
cians operating emergency rooms be withdrawn and
rewritten in keeping with House of Delegates policies,
particularly sections of the contract calling for hospi-
tals to bill for physicians’ services and providing for
a prevailing fee concept.
5. An Ohio resolution directing that AMA spokes-
men who advised HEW that Medicare utilization
committee "should” be composed of practicing physi-
cians correct immediately this statement to conform to
the House-established policies that such committees
"shall” be composed of practicing physicians.
6. An Ohio resolution instructing the AMA Board
of Trustees and officers to make every effort to en-
courage the voluntary health insurance industry not
to cancel senior citizen contracts, to improve contracts
to meet their varied needs, and not to confine the in-
dustry’s efforts to writing contracts around the Medi-
care Law.
7. An Ohio resolution calling for an AMA Com-
mittee on future planning and development to be
appointed to plan and develop where appropriate,
for legislation in the health field. (Was referred to
a newly created Committee on Planning and Develop-
ment for study, with instructions to report back to
the House in June, 1966.)
8. A resolution submitted by Dr. Meiling, re-
questing the Secretary of Defense to use maximum
58
The Ohio State Medical Journal
"air lift” capabilities to return to the United States
for the most effective care and treatment of American
casualties in South Viet Nam, rather than developing
in Japan a huge hospital complex for the same pur-
pose, was referred to the Board for study and report
back.
"Usual and Customary”
Ohio’s campaign at the Clinical Convention might
best be described as a war against contradictions.
Armed with the OSMA House of Delegates’ sup-
port of the "usual and customary fee” concept and
previous AMA House endorsements of that concept,
the Ohio delegation had as one of its primary targets
a Board of Trustees recommendation of approval of
the prevailing fee concept as well as an AMA Council
on Medical Service report, laudatory, but erroneous
and misleading, on so-called prevailing fees.
Evidence of attempts to pressure the Board by the
National Association of Blue Shield Plans was found
in the Board’s recommendation that the prevailing
fee program be approved. This report cited Blue
Shield’s meeting with the board — requested by
NABSP — to present the prevailing fee concept. It
also referred to the Council on Medical Service report.
NABSP Lobbies
As prominent as a shark in a goldfish bowl were
the forays of the NABSP shock troops through the
headquarters hotel lobby, meeting rooms and the
House of Delegates perimeter. They were so evident
that some delegates asked if the convention was an
AMA or a Blue Shield meeting.
The Council on Medical Service report added to the
confusion by mistakenly identifying the Blue Shield
prevailing fee program as a "usual and customary
fee” concept. (Ohio Medical Indemnity’s Newsletter
to all Ohio physicians November 17, 1965, clearly
explained the definite differences between the two
concepts.)
The Board had recommended House approval of
the concept, the Reference Committee on Insurance
and Medical Service recommended that it be recog-
nized rather than approved, but the House — on
motion of Ohio — changed the recommendation so
that the concept is merely "noted.”
Ohio Delegation
Ohio’s delegation, led by Chairman John H. Budd,
M. D., of Cleveland, chalked up a perfect score in
gaining House approval of Ohio resolutions and
amendments.
All OSMA delegates — Drs. Budd, George W.
Petznick, Cleveland; Carl A. Lincke, Carrollton;
Theodore L. Light, Dayton; Edmond K. Yantes, Wil-
mington; Paul F. Orr, Perrysburg; Charles A. Sebas-
tian, Cincinnati; Richard L. Meiling, Columbus;
Edwin H. Artman, Chillicothe, and all alternates —
H. T. Pease, Wadsworth, Robert S. Martin, Zanes-
ville; Kenneth D. Am, Dayton; Harry K. Hines,
Cincinnati; P. John Robechek, Cleveland; Robert E.
!llllli!l!lll!lll!llllllllllllll!l!lll!lll!l
Dr. Sherburne Memorialized at
AMA Philadelphia Meeting
At the 1965 AMA Clinical Convention November
28 - December 1 in Philadelphia, the House of Dele-
gates adopted in standing tribute an in memoriam
resolution presented by the OSMA delegation in hon-
oring Clifford C. Sherburne, M. D., Columbus, an
Ohio delegate from 1941 to 1961, who died Novem-
ber 13, 1965. Dr. Sherburne also was a past-presi-
dent of the Ohio State Medical Association, the
Columbus Academy of Medicine and Ohio Medical
Indemnity, Inc. The following resolution was
adopted by the AMA House:
PREAMBLE
Clifford C. Sherburne, M. D., of Columbus, Ohio,
a member of this House of Delegates for 20 years
(1941-1961), died November 13, 1965. As in all
of his activities and commitments, he served as a
member of this House with dedication and with an
unswerving sense of responsibility.
He displayed these same high qualities in his
tenure as President of the Ohio State Medical As-
sociation and as President of Ohio Medical Indemnity
(Blue Shield).
Doctor Sherburne was admired and profoundly
respected for his wholesome philosophy, his compas-
sionate understanding and his unfailing willingness
to serve whenever called. Therefore be it
RESOLVED, That this House of Delegates which
he served so diligently and loved so well observe a
moment of silence in honor of his memory; and be
it further
RESOLVED, That the deepest sympathy of this
House of Delegates as well as an official copy of this
Resolution be conveyed to his widow.
lllllllllllip
Tschantz, Canton; Frederick P. Osgood, Toledo; J.
Robert Hudson, Cincinnati; Philip B. Hardymon,
Columbus — were present and actively participating,
as were President Crawford and President-Elect
Meredith.
In the second session, Dr. Tschantz was seated as
a delegate in lieu of Dr. Yantes, and Dr. Pease was
seated in lieu of Dr. Petznick when those two dele-
gates had to leave the session because of previous
commitments.
The House also paid tribute in memoriam to the
late Clifford C. Sherburne, M. D., an Ohio delegate
for 20 years (1941-61) who died in Columbus No-
vember 13, 1965. An in memoriam resolution intro-
duced by Ohio and approved in standing tribute
appears on this page of The Journal.
As the result of paramedical press reports alleging
that top AMA officials had apologized to HEW of-
ficials for Dr. Annis’ speech October 1, given just
for January, 1966
59
prior to the House’s special session October 2-3 and
so well received that the House directed that tapes of
the speech be made available to members on re-
quest, Dr. Light presented the following resolution:
PREAMBLE
Dr. Edward R. Annis, by his dedication, his unselfish
willingness, and his outstanding abilities as a spokesman
for medicine, has made an enormous, inestimable contribu-
tion to the profession’s efforts to preserve America’s system
of medical care.
His complete devotion to this mission has gained for
medicine — both within and outside of the profession —
tremendous respect and support. He has caused the dis-
heartened to take heart, he has spread the light of truth
among the shadows of half-truths and innuendoes, and he
has spread knowledge and awareness among the unaware.
One of the most important and most significant addresses
in the history of modern medicine was that delivered by Dr.
Annis at the Medicare conference sponsored by the American
Medical Association in Chicago October 1, 1965. It was
so outstanding that this House of Delegates directed that
this speech be made available to the AMA membership.
Unfortunately, there have appeared in the medical news
media unsubstantiated reports that so-called "key AMA
leaders ' were apologizing privately to Federal officials for
Dr. Annis’ speech. Lest there be misunderstanding, be it
RESOLVED, That the House of Delegates of the Ameri-
can Medical Association heartily commends Dr. Edward R.
Annis for his leadership, his dedication and his tremendous
contribution to medicine’s campaign to preserve the world's
finest system of medical care, and this House of Delegates
calls on Dr. Annis to continue his mission and whole-
heartedly supports him to that end.
Ohio Scores Again
The resolution drew a standing ovation in the first
session of the House. The Reference Committee on
Reports of the Board of Trustees, heard resounding
applause after each of many witnesses testified in
whole - hearted favor of the resolution. Nobody
spoke in opposition to the resolution.
The Committee attempted to eviscerate the resolu-
tion by recommending adoption of only the "Re-
solved” portion. Dr. Light immediately moved and
the House overwhelmingly passed his motion that
the resolution be adopted in its entirety.
Another Ohio objective — to have rewritten to
conform with House of Delegates policies the AMA-
prepared model contract between hospitals and physi-
cians operating emergency rooms — was overwhelm-
ingly supported. The resolution directed that the
model contract be completely withdrawn, completely
rewritten and submitted to the House for approval
prior to future circulation.
The Ohio resolution cited, as examples, two specific
sections of the agreement that directly violated two
major policies of the House of Delegates (and of
OSMA). One section provided that the hospital
should bill for the professional services of the physi-
cians operating the emergency room. It is AMA
and OSMA policy that physicians should bill for
their own professional services.
Another section provided for a fee schedule
based on prevailing fees in the community and
nearby localities. AMA and OSMA policy pro-
vide for the usual and customary fee as determined
by the individual physician providing the professional
services.
Other House Actions
In other actions, the House:
• Referred to the Board of Trustees for further
study recommendations from the Committee on Hu-
man Reproduction for enactment of legislation to
legalize abortion and sterilization under certain
conditions.
• Tentatively approved, with final House action
to come at the 1966 Annual Convention next June in
Chicago, a $25 increase in AMA dues.
• Approved changing the delegate ratio in the
House of delegates to one per 1,250 members, when
the House size reaches 250 members. Present ratio
is one per 1,000 members, with total membership
nearing the 250 mark.
• Directed the AMA to seek a deletion in the
Medicare requirement that patient be hospitalized
before he is eligible for nursing home care.
• Authorized study of constitutionality and legal-
ity of Medicare and its rules and regulations, with
legal proceedings to be instituted where the Board
deems advisable.
• Directed the AMA Advisory Committee on
Medicare and the Heart Disease, Cancer and Stroke
program to seek HEW recognition of the differences
between utilization review and claims review.
• Disapproved an Association of American Medi-
cal Colleges report, particularly a section calling for
the AAMC to serve as spokesman for "organizations
concerned with education for health and medical
sciences,” a section downgrading organized profes-
sions and their associations and their role in profes-
sional education.
• Directed the Board to respond promptly to
public statements discrediting medicine.
• Urged the American Hospital Association to
assist hospitals in establishing a uniform system of
accounting.
• Called for continued efforts, through all ap-
propriate channels, to achieve distinctly separate bill-
ing of physicians fees and hospital fees.
• Urged creation of separate U. S. Cabinet post
for Secretary of Health.
• Accepted joint opinion of Judicial Council and
Council on Medical Service that physician who as-
sumes responsibility for intern’s or resident’s services
to a patient may ethically bill patient for services
performed under physician’s personal observation,
direction and supervision.
• Applauded as contributions of more than $463,-
000 were made to the AMA Education and Research
Foundation.
Also attending the meeting and assisting the Ohio
delegates were OSMA staff members Hart F. Page,
Charles W. Edgar, Herbert E. Gillen and W. Michael
Traphagan.
60
The Ohio State Medical Journal
American College of Surgeons . . .
Four - Day Sectional Meeting Scheduled in Cleveland
For Physicians and for Graduate Nurses, March 14-17
DOCTORS and graduate nurses are invited to
the twelfth annual joint Sectional Meeting
of the American College of Surgeons in
Cleveland, March 14-17, 1966. Headquarters hotel
for doctors is the Sheraton-Cleveland, and for nurses
the Statler Hilton. This is the College’s only four-day
meeting in 1966, and the only meeting with a pro-
gram for nurses. This joint meeting pioneered in
Cleveland in 1955.
Scope of the meeting approaches that of the an-
nual Clinical Congress. In addition to sessions in
general surgery there will be programs in the spe-
cialties of gynecology-obstetrics, neurosurgery, op-
thalmology, otorhinolaryngology, orthopedics, plastic
surgery, proctology, thoracic, urology and trauma. Ap-
proximately 50 industrial exhibits will be displayed.
Nurses sessions will include discussions on surgical
and nursing management of cerebral aneurysm, trends
in cardiac surgery, innovations in surgical specialties,
training and utilization of non-professional personnel
in the operating room, and the role of the professional
nurse in the operating room.
Local Chairmen
Dr. John H. Davis, Cleveland, is chairman of the
advisory committee on local arrangements for the
doctors’ sessions. Miss Joan Gowin, R. N., Cleve-
land, is chairman of the nurses’ planning committee.
As guests of the College, nurses pay no registration
fee.
Advance housing forms, giving hotel rates and reg-
istration information, may be obtained by writing to
College headquarters: Mr. T. E. McGinnis, American
College of Surgeons, 55 East Erie Street, Chicago,
Illinois 60611.
Dr. Robert J. Kamish, assistant director, Chicago,
is in charge of the College’s Sectional Meetings.
Speakers, moderators and panelists include numer-
ous Ohio physicians as well as persons from near
and far.
Following is a brief outline of days on which vari-
ous sessions are scheduled:
General Sessions — Monday, Tuesday and Wednes ■
day.
Orthopedic sessions — Monday and Tuesday.
Urology — Monday and Tuesday morning.
Otorhinolaryngology — Monday and Tuesday.
Plastic surgery — Monday.
Neurosurgery — Tuesday.
Thoracic surgery — Wednesday and Thursday.
Gynecology-Obstetrics — Wednesday and Thursday.
Ophthalmic surgery — Wednesday and Thursday.
Proctology — Wednesday.
Trauma — Thursday.
Sessions for graduate nurses will be held on Mon-
day, Tuesday and Wednesday in the Statler-Hilton
Hotel. Nurses also are invited to attend the session
on trauma on Thursday, in the Sheraton-Cleveland
Hotel.
Physicians Invited to Attend Annual
Ob - Gyn Lectures in Akron
The third annual Alven M. Weil Memorial Lec-
tureship has been scheduled in the Akron City Club,
Akron, Wednesday, March 9- The program will be-
gin at 4:00 P. M. with a three man panel presentation
on "Dysfunctional Labor” by D. Anthony D’Esopo,
M. D., Louis M. Heilman, M. D., and Charles H.
Hendricks, M. D.
Cocktails and dinner will follow the symposium
with dinner scheduled for 6:30 P. M., where the
featured speaker will be Dr. Louis M. Heilman, whose
topic will be "The Use of Electronics in Obstetrics
and Gynecology.”
The participants are all well-known in the specialty
of Obstetrics and Gynecology. Dr. Heilman is pro-
fessor and chairman of the Department of Obstetrics
and Gynecology, State University of New York,
Downstate Medical Center. Dr. D’Esopo is Clinical
Professor of Obstetrics and Gynecology, Columbia
University and Dr. Hendricks is assistant professor
of Obstetrics and Gynecology, Western Reserve Uni-
versity School of Medicine.
Reservations may be obtained by writing Summit
County Medical Society, Attention: Akron Obstetri-
cal & Gynecological Society, 437 Second National
Building, Akron, Ohio 44308. The Obstetrical &
Gynecological group is sponsoring the lectureship
under the direction of Richard J. Yoder, M. D.,
president, and Ronald B. Mitchell, secretary. Physi-
cians may call the Medical Society for details to help
with housing and other personal needs. Dinner re-
servations must be made in advance.
for January, 1966
61
Proceedings of the Council . . .
Tribute Is Paid to Deceased Past-President of OSMA; Several
Policy and Business Matters Acted on at November 21 Meeting
A MEETING of The Council of the Ohio State
Medical Association was held at 10 a. m.,
• November 21, 1965, at the Columbus head-
quarters office. All members of The Council were
present except Dr. Frederick T. Merchant, Marion,
Councilor of the Third District and Dr. William R.
Schultz, Wooster, Councilor of the Eleventh District.
Others attending were: Dr. Edmond K. Yantes, Wil-
mington, Dr. Richard L. Meiling, Columbus, dele-
gates, and Dr. Robert S. Martin, Zanesville, alternate
delegate, to the American Medical Association; Messrs.
Page, Edgar, Gillen, Traphagan and Moore, members
of the OSMA staff.
Minutes Approved
The minutes of the meeting of The Council held
September 18-19, 1965, were approved. Minutes of
a telephone conference of The Council, held October
29, 1965, were approved.
Tribute to Dr. Sherburne
Dr. Fulton presented the following resolution con-
cerning the death of Dr. C. C. Sherburne. The res-
olution was adopted by a standing vote and the Execu-
tive Secretary was instructed to include the text in the
minutes and to send a copy to Mrs. Sherburne.
In Memoriam
Clifford C. Sherburne, M. D.
President, Ohio State Medical Association,
1943-1944
The death of Clifford C. Sherburne, M. D., No-
vember 13, 1965, represents a great loss to his
profession, his community and his fellow man.
As a physician, he served his patients and his
profession unselfishly and with complete dedication.
As a citizen, he epitomized the meaning of citi-
zenship.
As a person, all who knew him admired and
respected him for his wholesome philosophy, his
compassion and his willingness to serve when
called.
As a modest and humble person, Dr. Sherburne
would be the first to deny these high qualities, but
these same qualities memorialize him in the minds
and hearts of all who had the good fortune to
know him.
Committee on Hospital Problems
The Council discussed a November 18 communica-
tion from William R. Morris, Ohio Director of In-
surance, requesting that the Executive Secretary and a
selected representative of the Ohio State Medical As-
sociation serve on a committee with him and with his
Deputy, dealing with hospital problems. Other as-
sociations to be represented, according to the letter,
are the Ohio Hospital Association; the Ohio Blue
Cross Plans; and the Ohio Association of Osteopathic
Physicians and Surgeons.
The Council authorized the participation of the
Ohio State Medical Association through whomever
the President may designate, and the Executive
Secretary.
Amendment to Resolution No. 5
The Council was asked for a clarification of the
last sentence of Resolution No. 5 (C65), to be in-
troduced by the Ohio Delegation at the 1965 Clinical
Session of the AMA, at the request of The Council,
as the result of action by the telephone conference
October 29, 1965.
The "resolved” paragraph of the resolution reads
as follows:
RESOLVED, That the House of Delegates instructs the
Officers and Board of Trustees of the American Medical
Association to make every effort to encourage the voluntary
health insurance industry not to cancel contracts but to con-
tinue offering improved contracts to persons 65 and older.
These contracts should not be written around the Medicare
Law.
Initially, The Council voted to delete the last sen-
tence, reading "These contracts should not be writ-
ten around the Medicare law.” Drs. Beardsley and
Tschantz voted in opposition to the motion.
The Council later voted to reconsider this action.
A motion was duly made, seconded and carried,
that the last line of the paragraph be deleted and, in
lieu thereof, the following sentence be substituted:
It is hoped that many types of contracts may be written to
meet the varied needs of our senior citizens and that efforts
not be confined to writing contracts around the Medicare
law.
Express Confidence in Dr. Annis
On motion duly moved, seconded and adopted,
the Ohio delegates to the American Medical Associa-
tion were authorized to prepare and to present at the
62
The Ohio State Medical Journal
1965 AM A Clinical meeting a resolution of confidence
in the opinions expressed by Dr. Edward R. Annis.
Dr. Wilson Recommended
The Council voted to recommend Dr. Rex H.
Wilson, Akron, chairman of the Committee on Oc-
cupational Health of the Ohio State Medical Associa-
tion, for membership on the Council on Occupational
Health of the American Medical Association.
Future Planning Committee
Dr. Richard L. Meiling presented a report from the
Future Planning Committee, recommending the ac-
ceptance of the proposal to lease space for a five-
year term in the "Columbus Center" building, 100
East Broad Street. The report was accepted for
information.
Members of The Council inspected space available
at the Huntington National Bank Building, 17 South
High Street and space available at the "Columbus
Center,” 100 East Broad Street.
Dr. Fulton presented a report comparing the fi-
nancial aspects and the various advantages and dis-
advantages of both locations.
After a lengthy discussion, on a motion by Dr.
Beardsley, seconded by Dr. Diefenbach, The Council
voted to negotiate a lease with the Huntington Na-
tional Bank at 17 South High Street, Columbus, Ohio.
Attest: Hart F. Page, Executive Secretary
Ohio State Medical Association
Cleveland Clinic Foundation
Offers Surgery Courses
The Cleveland Clinic Educational Foundation is
offering two courses on surgery of particular interest
to physicians, as well as a course on pediatrics, both
during January. Details may be obtained from Wal-
ter J. Zeiter, M. D., Director of Education, Cleve-
land Clinic Educational Foundation, 2020 East 93rd
Street, Cleveland, Ohio 44106.
On January 19 a course will be conducted on
"Vascular Surgery,” and on January 20, a course on
"Biliary and Pancreatic Surgery,” is scheduled. The
courses in surgery are offered as a unit.
On January 26 and 27, a course is offered on "Ad-
vance in Pediatrics.” On all courses offered by the
foundation, members of respective departments of
the clinic present the subject, as well as outstand-
ing guest speakers.
sjt sfc
A postgraduate course in Ophthalmology is being
offered by the Cleveland Clinic Educational Founda-
tion on January 12 and 13.
Dr. Frank C. Sutton, director of the Miami Valley
Hospital in Dayton, was presented the 1965 Medical
Award for Excellence in hospital administration at
the annual meeting of the American College of Hos-
pital Administrators in San Francisco.
New Provisions in OSMA Bylaws
Pertaining to Nomination
Of President-Elect
Attention is called to new provisions in the
Bylaws of the Ohio State Medical Association
pertaining to the nomination and election of the
President-Elect at the OSMA Annual Meeting.
The President-Elect and other officers are elected
by the House of Delegates, meetings of which
will be held during the Annual Meeting in
Cleveland, May 24 - 27.
Nominations of the President-Elect are to be
made 60 days in advance of the meeting at
which election takes place and information on
nominations published in The Journal, unless
these provisions are waived by a two-thirds vote
of the House of Delegates. The 60-day dead-
line is March 28.
The revised section in the OSMA Bylaws
pertaining to the procedure reads as follows :
Section 1 (a). Nomination of President-
Elect. Nominations for the office of Presi-
dent-Elect shall be made from the floor of the
House of Delegates, provided however that only
those candidates may be nominated whose names
have been filed with the Executive Secretary at
the time and in the manner hereinafter provid-
ed, unless compliance with such requirements
shall be waived as hereinafter provided. The
name of a candidate for the office of President-
Elect shall be filed with the Executive Secretary
of the Association at least sixty (60) days prior
to the meeting of the House of Delegates at
which the election is to take place. Promptly
upon filing of such candidate’s name, the Execu-
tive Secretary, if such candidate is eligible for
election, shall prepare and transmit this infor-
mation to each member of the House of Dele-
gates. No candidate may be presented at any
meeting of the House unless the foregoing re-
quirements of filing and transmittal have been
complied with or unless such compliance shall
have been waived or dispensed with by a vote
of at least two-thirds (J4) of the Delegates
present at the opening session of such meeting.
The Executive Secretary shall cause to be pub-
lished in The Journal in advance of such meet-
ing of the House of Delegates biographical
information on all eligible candidates meeting
the requirements of filing and transmittal.
for January, 1966
63
Deadline for Submission of Resolutions to Columbus
Office of the Association Is March 25
DELEGATES to the Ohio State Medical Association and County Medical Societies
planning to have resolutions submitted for consideration by the House of Dele-
gates at the 1966 Annual Meeting should be guided by the following Constitutional
requirements:
1. Resolutions, regardless of whether they have been submitted in advance and pub-
lished in The journal, must be introduced at the first session of the House of Delegates,
Tuesday evening, May 24, at the Sheraton-Cleveland Hotel, Cleveland.
2. When the resolution is introduced, copies in triplicate should be presented.
3. To be eligible for presentation, a resolution must have been filed with the Executive
Secretary of the Ohio State Medical Association, Columbus, at least 60 days prior to the
first session of the House of Delegates, namely, not later than March 25. This requirement
may be waived by a two-thirds majority of the House of Delegates.
4. Resolutions received will be published in The journal prior to the meeting. Also
copies of resolutions will be distributed to members of the House of Delegates to give them
an opportunity to discuss issues with their constituents and possibly receive voting intruc-
tions from their County Medical Societies.
OSU College of Medicine Announces
Short Courses for Physicians
A three- day course entitled "Electromyography IV,’’
is one of several refresher courses offered by the Ohio
State University College of Medicine.
Scheduled January 31 to February 2, this refresher
course is for physicians who wish to review their
understanding of the basic concepts of electrodiag-
nosis and familiarize themselves with the advances
in the field. Neuro-physiology, instrumentation and
clinical application will be included.
Additional information on this and other courses
offered by the College of Medicine may be obtained
by contacting the Center for Continuing Medical
Education, 320 W. Tenth Avenue, Columbus, Ohio
43210. Other courses include the following:
Otolaryngology Refresher Course, January 10-14.
Management of Diseases of the Colon, February 23.
Ninth Annual Postgraduate Course in Ophthal-
mology, March 7-8.
The Ohio State University College of Medicine
has been awarded a $132,029 grant from the U.S.
Public Health Service for study of the death mech-
anism in acute myocardial infarction. Dr. James V.
Warren, professor and chairman of the Department
of Medicine, will be the principal investigator in
the four-year project.
Blue Shield Plan Membership
Reaches All-Time High
Membership of the 85 Blue Shield Plans in the
United States, Canada, Puerto Rico, and Jamaica
increased 1,029,265 during the first three quarters
of 1965 to a record 57,286,041, the National Asso-
ciation of Blue Shield Plans reported.
Over half of the increase, 549,602, was acquired
in the second quarter. The addition of a new Plan
— Windsor, Ontario — contributed 263,445 members
to the second quarter gain.
Included in the total enrollment figure is the
membership of Medical Indemnity of America, Inc.,
a stock company wholly owned by the National As-
sociation of Blue Shield Plans.
During the first nine months of 1965, membership
gains were reported by 63 Plans, 20 had losses, and
two remained the same. Gains totaled 1,340,577,
while losses amounted to 311,312.
Third quarter gains of 438,856 were posted by 56
Plans, with 26 Plans reporting losses of 129,412.
Three Plans showed no change.
The 1.83 per cent enrollment increase in the first
nine months brought Blue Shield coverage in the
United States to 27 per cent of the population.
Blue Shield now covers 26.8 per cent of the Cana-
dian population, 1.4 per cent of the Jamaican popu-
lation, and 4.1 per cent of the population of Puerto
Rico.
64
The Ohio State Medical Journal
APPLICATION FOR SPACE, SCIENTIFIC AND HEALTH EDUCATION
EXHIBITS, OHIO STATE MEDICAL ASSOCIATION, 1966 ANNUAL MEETING,
SHERATON-CLEVELAND HOTEL, CLEVELAND, OHIO, MAY 24 - 28
1. Title of Exhibit:
2. Name(s) of Exhibitor (s) :
Institution (if desired):
3. Do you have a built-in exhibit?
4. Description of Exhibit: (Attach 200 word description to this blank)
5. Exhibit will consist of the following: (Check which)
Charts and posters ^ Photographs Drawings X-rays
Specimens Moulages Other material
(Describe)
6. Booth Requirements:
Amount of wall space needed?
Back wall Side walls
Square feet needed ?
Shelf desired? (yes or no)
7. Transparency Cases :
Needed? (yes or no)
If answer “yes,” give following information:
Number of transparencies to be shown and size of each
Booths will have a back wall and two side
walls. The side walls of all booths will be
six feet wide. Back wall and side walls
are eight feet high. If standard shelf is
used, only 5Y2 ft. will be available for ex-
hibit material. For most exhibits, a back
wall, eight feet long will be sufficient. With
the two 6 ft. long side walls, this gives a
total of 110 square feet of wall space.
(It is suggested that transparencies should be no larger than 10 by 12 inches in order to conserve space. For size
of view boxes which will be supplied by the Ohio State Medical Association if requested by you and how films
should be mounted, see pages 3 and 4 of folder “Regulations and Information, Scientific and Health Education
Exhibits, Ohio State Medical Association” which will be supplied to all applicants.
Date
Signature of Applicant
Mailing Address, Street
City, State, Zip Code
SEND APPLICATION TO: COMMITTEE ON SCIENTIFIC AND HEALTH EDUCATION EXHIBITS,
OHIO STATE MEDICAL ASSOCIATION, 79 EAST STATE STREET, COLUMBUS, OHIO 43215
DEADLINE FOR FILING APPLICATIONS, JANUARY 30, 1966
M. D.’s in the News
Dr. William S. Kiser, Cleveland, addressed the
Lorain Rotary Club where he described work being
done at the Cleveland Clinic in the field of organ
transplants.
❖
Dr. Esther C. Marting, director of oncology at
Christ Hospital, Cincinnati, discussed "New Devel-
opments in Cancer Control,” in one of a series of
public education programs sponsored by the Public
Library and Public Health Federation.
* ❖ #
Dr. Jack C. Lindsey spoke to members of the
Kenton Rotary Club on the subject of the patient-
doctor relationship.
* * *
Dr. William D. Monger, practicing physician of
Lancaster, has been elected a director of Motorists
Mutual Insurance Company, Columbus.
❖ ❖ *
Dr. George Packer, director, and Dr. R. A. Mc-
Lemore, president of the Clark County Medical Edu-
cation Foundation, described the operation of the
education program in the Springfield area at a meet-
ing of the staff of St. Charles Hospital in Toledo.
❖ ❖ ❖
Dr. Allen Walker, of Cleveland, recently discussed
"Sun Exposure” at a Ski Seminar sponsored by the
Chautauqua County (New York) Medical Society.
The program is believed to be the first of its kind held
for physicians and dealing with physical problems
in connection with skiing.
Hs % :j:
Dr. Claude S. Beck, Cleveland, was honored at
a dinner and reception, primarily attended by for-
mer patients of his who made the trip to Cleveland
from near and far.
❖ *
Lt. Colonel Benjamin W. Gilliotte, a practicing
physician in Zanesville, recently received a certificate
in behalf of his unit, the 522nd Medical Service
Flight at Lockbourne Air Force Base, citing the unit
for outstanding recruiting and for maintaining a
good retention program.
% %
Dr. Elden C. Weckesser, Cleveland, class of ’36,
is the new president of the Western Reserve Univer-
sity Medical Alumni Association. A practicing sur-
geon, he is clinical professor in the medical school,
and a director of the Academy of Medicine of
Cleveland. Other officers are Dr. Eugene A. Ferreri,
South Euclid, first vice-president; Dr. George M.
Wyatt, Iowa City, Iowa, second vice-president; and
Dr. William L. Huffman, Lakewood, secretary-
treasurer.
Bureau of Workmen’s Compensation
Desperately Needs Doctors
The Ohio Bureau of Workmen’s Compensa-
tion is desperately in need of physicians to work
on a full-time or part-time basis. Men are
needed to work in the medical section of the
Bureau, either in Columbus or in one of the
other cities where facilities are maintained.
Physicians are needed to help examine and
designate disability, especially percentage d's-
ability of workmen’s compensation cases. The
work also includes the writing of reports, re-
viewing of cases, evaluation of medical testi-
mony, reviewing bills on drugs, hospital costs,
nursing services, etc.
Physicians interested in either full-time or
part-time work in this line are invited to con-
tact Raymond B. Hudson, M. D., Chief Medi-
cal Officers, Bureau of Workmen’s Compensa-
tion, State of Ohio, 65 South Front Street,
Columbus, Ohio 43215.
It is interesting to note that a general increase
in salary has been authorized in the four cate-
gories of physicians’ positions. The salary scale
is as follows:
W. C. Physician I, PR 45 $ 860 to $1,020
W. C. Physician II, PR 49 $1,020 to $1,200
W. C. Physician III, PR 51 $1,100 to $1,320
W. C. Physician IV, PR 53 $1,200 to $1,440
Dr. Robert Kuba was guest speaker when members
of the Women’s Civic League met in Uhrichsville.
He discussed "Sex Education for Children.”
* * *
Dr. Nicholas G. DePiero, Cleveland, has been
named president-elect of the American College of
Anesthesiologists.
❖ * *
Dr. John C. Ullery, professor and chairman of
obstetrics and gynecology in the Ohio State Univer-
sity College of Medicine, has been awarded a renewal
grant of $11,505 from the U. S. Public Health Serv-
ice. It will support additional research on carbonic
anhydrase in endometrial tissue.
* * *
Dr. Charles L. Hudson, Cleveland, President-Elect
of the American Medical Association, was featured
speaker for a meeting in Lima sponsored by the
Optimist Club and including members of several
other local service clubs.
* * *
After participating in the International Pediatric
Congress in Tokyo, Dr. Frederic N. Silverman, pro-
fessor of pediatrics and radiology at the University
of Cincinnati, is serving a tour as visiting professor at
several children’s hospitals in Australia.
66
The Ohio State Medical Journal
7tta6e tyowi
HOTEL RESERVATIONS -NOW
FOR THE
1966 OSMA ANNUAL MEETING
CLEVELAND MAY 24-28
Leading Downtown Cleveland Hotels
and Prevailing Rates
SHERATON-CLEVELAND HOTEL
(Headquarters)
Public Square
Singles to $12.50
Doubles $14.50-16.50
Twins 17.00-22.50
AUDITORIUM HOTEL
1315 East 6th Street
Singles $ 6.00-10.50
Doubles 8.50-12.50
Twins 12.50-13.50
STATLER HILTON HOTEL
Euclid & East 12th Street
Singles $ 8.00-15.50
Doubles 14.00-17.50
Twins 16.00-30.00
All of the above rates
are subject to change
HOTEL RESERVATION BLANK
(Mail to Hotel of Choice)
(NAME OF HOTEL)
Cleveland, Ohio
(ADDRESS)
Please reserve the following accommoda-
tions during the period of the Ohio State
Medical Association Annual Meeting,
May 24 - 28 (or for period indicated)
I | Single Room
I | Double Room
] Twin Room
Other accommodations
Price range
Arriving May at A.M P.M.
PLEASE VERIFY MY RESERVATION
Name
Add ress
J
If you plan to share a room, please indicate name
of roommate so the hotel may avoid duplicate
reservations.
for January, 1966
67
Obituaries
Ad Astra
Henry Alexander Bradford, M. D., Denver, Col-
orado; University of Cincinnati College of Medicine,
1938; aged 52; died November 6. A native of Cin-
cinnati who took most of his medical training in that
city, Dr. Bradford began practicing in Colorado after
serving in the Army Medical Corps during World
War II. Among survivors are his widow and three
children.
Wayne Wilson Dutton, M. D., Athens; Medical
College of Virginia, 1947; aged 41; died November
23; member of the Ohio State Medical Association,
and the American Psychiatric Association. A resident
of Athens since about 1950, Dr. Dutton was on the
staff of the Athens State Hospital before going into
private practice in that city. Survivors include his
widow, Dr. Genevieve G. Dutton; his mother, a
brother and two sisters.
Lloyd King Felter, M. D., Cincinnati; University
of Cincinnati College of Medicine, 1921; aged 69;
died November 6; member of the Ohio State Medi-
cal Association, the American Medical Association
and the American Academy of Pediatrics; diplomate
of the American Board of Pediatrics. A practicing
physician of long standing in Cincinnati, Dr. Felter
specialized in pediatrics. Surviving are his widow,
a daughter and a sister.
A. Bruce Gill, M. D., Mount Dora, Fla.; Univer-
sity of Pennsylvania School of Medicine, 1905; aged 88;
died November 8. Long time a practitioner in Penn-
sylvania before his retirement, Dr. Gill maintained
close association with Muskingum College from which
he graduated in 1896. His widow survives.
Macy Ginsburg, M. D., Canton; Jefferson Medical
College of Philadelphia, 1921; aged 68; died Novem-
ber 17; member of the Ohio State Medical Associa-
tion. A practicing physician of some 40 years stand-
ing in Canton, Dr. Ginsburg was associated with the
Masonic Lodge, the Exchange Club and Temple
Israel. Survivors include his widow, a daughter, a
stepdaughter and two sons; also a brother.
Julien Shaw Jones, M. D., Lisbon; Western Re-
serve University School of Medicine, 1938; aged 58;
died November 27; member of the Ohio State Medi-
cal Association and the American Medical Association.
A general practitioner in Lisbon since 1944, Dr.
Jones moved there from Cleveland. He was a 32nd
Degree Mason and a member of the Kiwanis Club.
Survivors include his widow, a daughter, a son and
a sister.
R. P. McClain, M. D., Cincinnati; Howard Uni-
versity College of Medicine, 1913; aged 75; died on
or about Oct. 31. Out of public life for some years be-
cause of ill health, Dr. McClain was formerly active
in civic and political affairs of his area. A practicing
physician in Cincinnati for some 40 years, he was at
one time a prominent leader in the Negro community.
Girard E. Robinson, M. D., Bellpoint; College of
Physicians and Surgeons of Baltimore, 1903; aged
90; died November 13; member of the Ohio State
Medical Association, and an active participant in
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68
The Ohio State Medical Journal
at Merck Sharp & Dohme...
understanding
• • •
precedes development
The development of chlorothiazide and probene-
cid were events of major importance, but perhaps
even more important for the future was the Renal
Research Program by which they were developed.
When Merck Sharp & Dohme organized this pro-
gram in 1943, it was expressing in action some of
its basic beliefs about research:
• Many problems connected with renal structure
and function were still undefined or unsolved. The
Renal Research Program would begin its basic
research in some of these problem areas.
• From knowledge thusacquired might comeclues
to the development of new therapeutic agents of
significant value to the physician.
For example, the Renal Research Program put
fifteen years into this search before chlorothiazide
became available. But because these years had
first led to a greater understanding of basic
problems, the desired criteria for chlorothiazide
existed before the drug was developed.
Along with other research teams at Merck Sharp
& Dohme, the Renal Research Program continues
to add new understanding of basic problems —
understanding which will lead to important new
therapeutic agents.
©MERCK SHARP & DOHME Division of Merck & Co.. Inc., West Point, Pa.
where today’s theory is tomorrow’s therapy
for January, 1966
69
medical organization work on the county and state
levels. A physician in the Delaware County area
for virtually all of his career, Dr. Robinson continued
to practice until about a year ago. He was a past-
president of the Delaware County Medical Society,
served on numerous committees of the society, and
was a delegate to the OSMA House of Delegates. He
also served on numerous committees of the State As-
sociation. Civic activities included some 20 years
service on the County Board of Education and many
years on the County Board of Health, of which he
was a former president. He was a veteran of World
War I and a member of the Knights of Pythias.
Among survivors are two daughters and a son, Dr.
John Robinson, of Buffalo, N. Y.
Amos Boyer Sherk, M. D., Campbell; Starling
Medical College, Columbus, 1903; aged 84; died
November 8; member of the Ohio State Medical As-
sociation, the American Medical Association and the
American Academy of General Practice. A practicing
physician for more than 60 years, Dr. Sherk served
nearly all of his professional career in the Campbell
and Youngstown area. A member of the Methodist
Church, he is survived by his widow and a sister.
John Walter Smith, M. D., Grand Rapids, Ohio;
McGill University Faculty of Medicine, 1923; aged
68; died December 1; member of the Ohio State
Medical Association and the American Medical As-
sociation. A native of Canada, Dr. Smith took his
internship in Toledo and began practicing in the
Wood County community in the 1920’s. He was a
veteran of both World Wars. Affiliations included
memberships in several Masonic orders and the Pres-
byterian Church. Surviving are his widow, a niece
who grew up in the home, and a sister.
Harold Henry Teitelbaum, M. D., Youngstown;
Royal College of Physicians and Surgeons, Scotland,
1938; aged 57; died November 21; member of the
American College of Chest Physicians and American
Thoracic Society. A resident of Youngstown since
about 1950, Dr. Teitelbaum was superintendent of
the Mahoning Tuberculosis Sanitarium. His widow,
a son and a daughter survive.
Frank George Wellman, M. D., Cincinnati; Uni-
versity of Cincinnati College of Medicine, 1919;
aged 71; died November 12; member of the Ohio
State Medical Association and the American Medical
Association. Dr. Wellman’s practice in Cincinnati
extended over a period of more than 45 years. He
was a member of the Catholic Church. Surviving
are his widow, three daughters, a sister and three
brothers.
William Andrew Welsh, M. D., Youngstown;
Jefferson Medical College of Philadelphia, 1919;
aged 74; died November 27; member of the Ohio
State Medical Association and former member of the
American Medical Association. Dr. Welsh’s practice
in Youngstown extended over some 46 years and in-
cluded appointments as county home physician and
county jail physician. He was a member of the
Tippecanoe Country Club, the Presbyterian Church
and the Elks Lodge. Surviving are his widow and a
son.
Prescription Drug Manufacturers
Name Association President
The Board of Directors of the Pharmaceutical
Manufacturers Association announced the election of
C. Joseph Stetler, of Washington, as president of
the association, which represents 140 companies,
producers of 90 per cent of the nation’s prescription
drugs.
A native of Ohio, Mr. Stetler is an attorney and
former general counsel for the American Medical
Association, and former director of the AMA’s Legal
and Socio-Economic Division.
Mr. Stetler succeeds Dr. Austin Smith, who held
the first full-time office as president of the organ-
ization for about six years. Dr. Smith resigned
to accept an appointment by the Board of Directors
of Parke, Davis & Company, Detroit, to its vice-
chairmanship and to membership of its Executive
Committee.
Protect Your Family — Now — With the OSMA - PLAN
of comprehensive group major medical insurance sponsored by the
Ohio State Medical Association for its members and their families
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Also available to Ohio Physicians:
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70
The Ohio State Medical Journal
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responsive to topical triamcinolone, but the 0.5% Cream may be
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• • •
Activities of County Societies
First District
(COUNCILOR: ROBERT E. HOWARD, M. D., CINCINNATI)
BUTLER
Dr. Brady Randolph, chairman of the society’s
program committee, discussed school athletic programs
at the October meeting of the Butler County Medical
Society.
It was emphasized that Butler County has a physi-
cian present at every high school football game and
a follow-up system in case the designated physician
cannot be present.
HAMILTON
"The Physician as a Defendant” was the theme of
discussion for the December 14 meeting of the Acad-
emy of Medicine of Cincinnati in the headquarters
building. A mock trial was presented with members
of the Cincinnati Bar Association and Academy mem-
bers participating.
The meeting was a testimonial to the 50-year physi-
cians and awards were presented as part of the
program.
Second District
(COUNCILOR: THEODORE L. LIGHT, M. D., DAYTON)
CLARK
Dr. Henry M. Tardif was elected president of the
Clark County Medical Society during the annual elec-
tion of officers (November 15) in Hotel Shawnee.
Dr. Tardif has been a general practitioner in Spring-
field since 1949. He succeeds Dr. John F. Riesser,
retiring president of the society.
Other officers include Dr. Harold B. Elliott, presi-
dent-elect; Dr. Robert O. Cunningham, secretary; Dr.
Wesley E. Knaup, treasurer; Dr. Ernest H. Winter-
hoff, delegate to the Ohio State Medical Association,
and Dr. Charles J. Townsend, alternate delegate to
the Ohio State Medical Association.
Dr. C. Lowell Edwards, of Oak Ridge, Tenn., for-
mer member of the U. S. Public Health Service and
now chief clinician for the Medical Division of the
Oak Ridge Institute of Nuclear Studies, was featured
as speaker of the evening.
Speaking on "Medical Uses of Radioactive Isotopes
— Past, Present and Future,” Dr. Edwards told the
history of the new field of nuclear medicine and out-
lined some of the practical uses of radioactive isotopes
in medicine. — Springfield Daily News.
MIAMI
Dr. Aaron Weinstein, assistant director of the De-
partment of Radiology at the Veterans Administration
Hospital, Cincinnati, and assistant professor at the Uni-
versity of Cincinnati College of Medicine, was pro-
gram speaker for the November meeting of the Miami
County Medical Society. His subject was "Hands —
Reflectors of Disease.” The dinner meeting was held
at the Piqua Country Club.
MONTGOMERY
Dr. Edward R. Annis, Past-President of the AMA,
was speaker for the November 12 meeting of the
Montgomery County Medical Society in Dayton. Fol-
lowing a reception and dinner for physicians, their
wives and guests, Dr. Annis spoke on the topic,
"The Untold Story of Medicine.”
Third District
(COUNCILOR: FREDERICK T. MERCHANT, M. D., MARION)
ALLEN
Lima and area students in the 11th grade of high
school were invited to participate in "Medical-Health
Career Days” on November 13 in St. Rita’s and in
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72
The Ohio State Medical Journal
Lima Memorial Hospitals. Events at both hospitals
were sponsored by the Academy of Medicine of Lima
and Allen County.
Students were oriented in careers of medicine,
nursing, x-ray technology, practical nursing, physical
therapy, medical technology, pharmacy, dentistry,
dietetics, social work, speech therapy and occupa-
tional therapy. Representatives of these various fields
were invited to participate in the program. Also
parents, school counselors and school officials were
invited to attend.
HARDIN
The Hardin County Medical Society had its No-
vember meeting at San Antonio Hospital, where Dr.
Ivan J. Podobnikar discussed the various patient dis-
orders related to the field of the psychiatrist. A
psychiatrist in Lancaster, Dr. Podobnikar is associated
also with the Mental Health League in Bellefontaine.
SENECA
Officers for 1966 were elected at a dinner-meeting
of the Seneca County Medical Association Tuesday
(Nov. 17) evening at the New Riverview Inn, Tiffin.
Dr. Olgierd Garlo, Tiffin, was elected as president
and Dr. Lowell K. Good, Fostoria, as vice-president.
Dr. Leonard Gaydos, Tiffin, was elected as secretary-
treasurer. — Fremont News Messenger.
Fourth District
(COUNCILOR: ROBERT N. SMITH, M. D., TOLEDO)
LUCAS
The Inter-Hospital Postgraduate Lecture Series was
given November 11 and 12 by Dr. Ephraim Roseman,
professor of neurology, University of Louisville Medi-
cal School. The "Neurological Symposia,’’ included
discussions of cerebral localization, strokes, epilepsy,
meningitis, spinal cord diseases and dystrophies.
Hs %
The Academy of Medicine of Toledo and Lucas
County program for December contained the follow-
ing features:
December 2 — Specialties Section — Joint meet-
ing of Toledo OB-Gyn Society and Pediatric Society;
panel discussion on "Erythroblastosis.’’
December 3 — General Section — Annual commit-
tee reports by all committee chairmen; report of nomi-
nating committee.
Also joint meeting of Toledo Bar Association with
the Academy.
December 10 — Joint meeting of dentists and physi-
cians. Part of the program was the showing of a
film entitled, "Safety First, Second and Third.’’
* * *
For its 64th annual meeting, the Academy will
hear a talk by Dr. Nicholas P. Dallis, former Toledo
psychiatrist, who now devotes his full time to au-
thorship of three cartoon strips, Rex Morgan, M. D.,
Judge Parker, and Apartment 3-G. His topic will be
"The Mode of American Life.”
The January 12 meeting will be in the Commodore
Perry Hotel. A 6:00 p. m. social hour will be fol-
lowed by a banquet and the program.
Fifth District
(COUNCILOR: P. JOHN ROBECHEK, M. D„ CLEVELAND)
CUYAHOGA
A joint meeting of the Academy of Medicine of
Cleveland and the Cleveland Bar Association was
held on December 7 in the Manger Hotel. A social
hour and dinner preceded the program.
Speaker for the occasion was Dick Schapp, editor,
writer and syndicated columnist, whose topic was
"Image Makers and Image Shakers.”
Sixth District
(COUNCILOR: EDWIN R. WESTBROOK, M. D., WARREN)
MAHONING
The Mahoning County Medical Society conducted
its annual diabetes detection drive during the week of
November 14-20.
(see page 75)
TRUMBULL
The regular meeting of the Trumbull County Medi-
cal Society was held on November 17 at the Trumbull
Country Club. The meeting followed a social hour
and dinner.
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for January, 1966
73
Tenth District
(COUNCILOR: RICHARD L. FULTON, M. D., COLUMBUS)
FRANKLIN
The annual Specialty Society Day of the Academy
of Medicine of Columbus and Franklin County was
held on November 15 in the Sheraton -Columbus
Motor Hotel in downtown Columbus.
Speaker for the occasion was Dr. Peter H. Knapp,
Boston Mass., whose topic was "Psychophysiologic
Medicine: Science and Skill.”
Co-sponsors of the program were the Columbus
OB-Gyn Society, Central Ohio Academy of General
Practice and the Neuropsychiatric Society of Central
Ohio.
The annual Christmas Banquet of the Academy was
held at the Sheraton- Columbus Motor Hotel on De-
cember 4. Following a social hour, dinner and enter-
tainment by the Woman’s Auxiliary Glee Club,
members and guests enjoyed an evening of dancing.
* * *
The Academy of Medicine of Columbus and Frank-
lin County held its annual Christmas Banquet on
December 4 at the Sheraton- Columbus Motor Hotel.
Entertainment was furnished by the Herb Germain
Trio and by the Woman’s Auxiliary Chorus.
Seven physicians were presented the 50- Year Award
of the Ohio State Medical Association for a half
century of service in the medical profession.
Present to receive the awards were Dr. Henry A.
Minthorne, Dr. Rivington H. Fisher, and Dr. Wil-
liam N. Taylor. Not present at the meeting, but
authorized to receive the awards also are Dr. Joseph
M. Dunn, Dr. Philip J. Reel, Dr. William A. Mill-
hon, and Dr. James H. Warren.
* * *
KNOX
The Knox County Medical Society was a co-sponsor
of twelfth grade students, parents, young adult
teachers, youth workers, clergy, etc., in Mt. Vernon.
Dr. and Mrs. John C. Willke, Cincinnati, presented
the program on the subject, "Sex Education for Chil-
dren and Its Application to Dating and Marriage.”
The Willkes have given numerous lectures on that
field of education and have written a book entitled
The Wonder of Sex.
Dr. Albert B. Sabin, Cincinnati, was named win-
ner of the Albert Lasker Medical Research Award
for his clinical research and development of the live-
virus oral polio vaccine. The award carries with it
a $10,000 honorarium.
The 1966 American Industrial Health Conference
will be held April 25-28 in Detroit, Michigan, with
headquarters at the Sheraton Cadillac Hotel and
meetings in Cobo Hall, it has been announced by the
Industrial Medical Association and the American
Association of Industrial Nurses.
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The Ohio State Medical Journal
Mahoning County Health Care Symposium
This is one of several panel groups which participated in the Mahoning County Community Health Care Symposium,
this one discussing "Availability of Medical Facilities. From left, are: Luther Ihle, administrative assistant at South
Side Hospital; Kenneth W. Wisowaty, Department of Hospitals and Medical Services of the AM A; J. W . Tandatnick,
M. D., and B. C. Berg, M. D., panel moderators; and William B. Esson, administrator of South Side Hospital.
Youngstown Program Puts Meaning
Into Community Health Week
The press in Youngstown and in the surrounding
area gave excellent support to the "Community
Health Care Symposium” sponsored by the Mahon-
ing County Medical Society as a Community Health
Week Service.
The public meeting held in the Mural Room
Building was well attended, and those present heard
discussions by several panel groups representing the
various organizations and facilities involved in com-
munity health.
Dr. John J. McDonough, president of the Medical
Society, opened the meeting with a brief address.
Featured Luncheon speaker was Dr. J. Everett Mc-
Clenahan, medical director of McKeesport Hospital,
McKeesport, Pa. His topic was "Hospital Utilization.”
In addition to persons named in the above picture,
the following panel groups were represented to give
their views:
Panel on "Problems of Medical Personnel” — S.
V. Squicquero, M. D., moderator; Gene R. Payton,
Youngstown Hospital Association; Sister M. Char-
lene, director of nursing service at St. Elizabeth Hos-
pital; Miss Rae Glass, chief technologist in the De-
partment of Laboratories of Youngstown Hospital
Association.
Panel on "Problems of Rising Health Care
Costs” — C. W. Stertzbach, M. D., moderator; Don-
ald Surridge, D. O.; Mr. Wisowaty; Sister M. Con-
solata, administrator of St. Elizabeth Hospital; Mr.
Esson; Raymond Fine, Esq., Secretary of the Board of
Youngstown Osteopathic Hospital; Ralph (Bob)
White, Eastern Ohio Pharmaceutical Association.
Panel on "Role of the Third Party” — Jack
Schreiber, M. D., moderator; John B. Morgan, Jr.,
executive vice-president, Associated Hospital Serv-
ice; Ned F. Parish, assistant executive vice-president,
National Association of Blue Shield Plans; Arthur
Hess, director of the Health Insurance Division of
the Department of Health, Education and Welfare;
Louis Orsini, director of the Health Insurance Coun-
cil of America; Richard Shoemaker, associate director
of the Department of Social Security, AFL-CIO;
Russell Roth, M. D., chairman of the AMA Council
on Medical Sendees.
for January, 1966
75
New Members . . .
Following are names of new members of the Ohio
State Medical Association certified to the Headquar-
ters Office during November. List shows name of
physician, county and city in which he is practicing or
temporary addresses for those taking graduate work.
Allen
Hector A. Buch, Lima
Peter W. Reed, Lima
Dixie Lee Soo, Lima
Liang Yee Soo, Lima
Cuyahoga
Josephine Shou-Chen Chu,
North Olmsted
Gilbert Erlechman, Cleveland
Michael J. Eymontt,
Cleveland
Richard J. Harsa,
Chagrin Falls
William K. Littman,
Cleveland
Ratko Ljuboja, Cleveland
Mary E. Mohr, Cleveland
Thomas P. O’Malley,
North Olmsted
Dennis H. Smith, Cleveland
Robert D. Zaas, Cleveland
Franklin
Robert A. Gill, Jr., Columbus
Donald E. Hoffman,
Columbus
Albert L. Kunz, Columbus
Jerry G. Liepack, Columbus
Brant W. Tedrow, Groveport
Ronald C. Van Buren,
Columbus
Jefferson
Jack A. Scott, Steubenville
Lorain
Emanuel Onlayao, Elyria
Lucas
Thomas T. Bakondy, Toledo
Nicholas R. DeFronzo, Toledo
Montgomery
Sergio J. Alejandrino, Dayton
Robert E. Caporal, Dayton
John E. Carroll, Jr., Dayton
Richard J. Dobies, Dayton
Calvin L. Edwards, Dayton
Harley M. Ellman, Dayton
George R. Fronista, Dayton
Harry Fronista, Dayton
Philip C. Hughes, Dayton
Douglas P. Longenecker,
Englewood
Hsien-ming Meng, Dayton
Hugh D. Pittman, Dayton
John R. Scharf, Dayton
Douglas A. Shanahan, Jr.,
Dayton
James F. Sheridan, Dayton
James K. Skahen, Dayton
Robert A. Washing, Dayton
Summit
Glenn E. East, Akron
Jose M. Melian, Akron
Trumbull
Michael J. Casale, Warren
William Moskalik, Girard
John O. Vlad, Warren
Current Comments in the Field
Of the Drug Manufacturers
The following excerpts of comments from various
sources are presented in behalf of the Pharmaceutical
Manufacturers Association and drug manufacturing
firms in general.
❖ * *
How important is the patent system to the prevail-
ing health care picture? Here are a few examples.
In 48 years, Russia’s government-owned pharmaceuti-
cal industry has not developed a single new and
important drug. In 24 years, thanks in part to patent
protection, the American pharmaceutical industry has
come up with at least 75 new drug entities. Credit
(and a considerable amount is due) must go to a
competitive industry that thrives in a competitive
economy — motivated by the rewards and contribu-
tions to knowledge that the nation’s patent system has
always guaranteed. — Editorial in GP (32:5), No-
vember 1965.
^ ❖
Few, if any, new drugs or inventions have been
commercially developed in countries which do not
offer proper patent protection to the inventor. Of
the new drugs introduced in the United States from
1941 to 1964, 369 came from the United States,
44 from Switzerland, 33 from Germany, and 28
from the United Kingdom. Equally significant is
that 90 per cent of the 369 new drugs originating
in the United States came from company laboratories.
— Editorial in Michigan Medicine, (64:766), Octo-
ber 1965.
* * *
I maintain that an experienced observer can tell
whether a drug puts a patient to sleep, relieves pain,
stops a cough, relieves an itch, lifts a depression or
improves motility in arthritis without placebos and
double-blind controls. Reciprocally, I have seen
smart, young, relatively inexperienced investigators
completely miss the obvious with their sophisticated
technology. There is a place for sound, simple,
clinical observation and I hope general practitioners
will insist on having their data considered along with
the other. I have an idea that they will be right as
often as their younger, instrumented, double-blind
brethren. — Theodore K. Klumpp, M. D., in GP,
(32:203), November 1965.
An estimated two million Americans have diabetes
and don’t know it, the Health Insurance Institute re-
ported. Another two million know they have diabetes
and are being treated.
underachievers
A residential facility for Junior and Senior
High School males who need psychiatric
help with: ■ Problems of academic under-
I achievement and attendance . . . ■ Diffi-
culties in family-school-social adjustments.
Complete academic and therapy program for
I grades 7 through 12.
4 For information contact: Rita Burgett, Secretary
The Readjustment Center
Box 373, Ann Arbor, Mich.
Phone: (AC 313) 663-5522
76
The Ohio State Medical Journal
TREATMENT OF
4 Dosage Strengths
NEW DOUBLE BLIND STUDY*
NO. OF PATIENTS
■ ANDROID
□ PLACEBO
20
75% improvement in 8 weeks
(Rated Good to Excellent)
12
2
m
1
.
^ ■
POOR FAIR GOOD
* 1. Treatment of Impotence with a Methyltesto-
sterone-Thyroid Compound (Android) , M. H.
Diibin, Western Medicine, 5:67 Feb. 1964.
2. Methyltestosterone-Thyroid in Treating Im-
potence. A. S. Titeff, General Practice, Vol. 25,
No. 2, February, 1962, pp. 6-8.
3. Thyroid- Androgen Relations, L. Heilman, et
al., The Jrl. of Clin. Endocrinology and Me-
tabolism, August 1959.
4. Brochure Discussing Thyroid- Androgen Inter-
relationship.
Contra-indications: ANDROID® is not to be
used in malignancy of reproductive organs in
the male, heart disease, hyperthyroidism, hy-
pertension. In female, excessive use may pro-
duce virilizing effects.
EXCELLENT
REFER TO
Write for literature and samples
ANDROID®
Each yellow tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. (1/6 gr.) 10 mg.
Glutamic Acid 50 mg.
Thiamine HCI 10 mg.
ANDROID® H.P.
(High Potency)
Each red tablet contains:
Methyl Testosterone 5 mg.
Thyroid Ext. (Vi gr.) 30 mg.
Glutamic Acid 50 mg.
Thiamine HCI 10 mg.
Average Dose: One tablet 3 times daily
Available: Bottles of 100, 500 and 1000
ANDROID®-X
(Extra High Potency)
Each orange tablet contains:
Methyl Testosterone
Thyroid Ext. (1 gr.)
Glutamic Acid
Thiamine HCI
NEW
12:5 mg.
. . 64 mg.
. .50 mg.
. .10 mg.
Average Dose: 1 or 2 tablets daily
Available : Bottles of 60 and 500.
ANDROID® -PLUS
Each white tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. (54 gr.) 15 mg.
Thiamine HCI 25 mg.
Ascorbic Acid (Vit. C) 250 mg.
Glutamic Acid 100 mg.
Pyridoxine HCI 5 mg.
Niacinamide 75 mg.
Calcium Pantothenate 10 mg.
Vitamin B-12 2.5 meg.
Riboflavin .5 mg.
Average Dose: One tablet twice daily
Available: Bottles of 60 and 500 tablets.
The Brown Pharmaceutical Co. 2500 West 6th st., Los Angeles 57, Calif.
Cameron-Miller offers you
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SERVING THE MEDICAL PROFESSION SINCE 1915
for January, 1966
77
• • •
Woman’s Auxiliary Highlights
By MRS. S. L. MELTZER, Publicity Committee
Chairman, 2442 Dorman Dr., Portsmouth
^TTVNG out the old, ring in the new.” The old
year — passed into the mists of Time. The
^ new year — young, lusty, full of hope and
promise. Dare we hope that as doctors’ wives we can
in some small measure make it a more meaningful,
purposeful year? Yes, we can hope. And we can
do. If we really want to make the effort . . . We
are not miracle workers and we are limited in our
endeavors. But no matter the limit, we still have an
amazing area in which to soar, to grow, to accomp-
lish. The national Auxiliary says it so beautifully:
"Let the helping hands of the doctor’s wife reflect
and enrich his dedicated service.”
New Year’s resolutions may or may not be to your
liking. But it is well to reflect that by "resolving”
to do thus and so, we are conscious of our short-
comings and are at least making an effort to do some-
thing about them. I have, from time to time, heard
certain doctors’ wives comment "My husband is do-
ing all that is necessary for the medical profession.
I see no need to involve myself.” How wrong! How
wrong! There is a need and a place for every doc-
tor’s wife to help in serving her community. And
she can do it no more effectively than through her
auxiliary. I should like to suggest this resolution
for all doctors’ wives: "I resolve that I shall consider
the Woman’s Auxiliary to my husband’s County
Medical Society the most important organization to
which I can belong, and that, pridefully, I shall help
to further its work in the never-ending fight for
good health.”
Two State Chairmen Speak
Mrs. Virgil C. Hart, Health Careers chairman,
recommends a brand new exhibit particularly of in-
terest to high school and college students who have
an eye toward a medical career. She describes "A
Career in Medicine” as a colorful, well lighted dis-
play, easily assembled, featuring a literature rack for
pamphlets which are shipped with the exhibit. An
excellent feature for Health Careers Day. The ex-
hibit may be obtained from the American Medical
Association, 535 North Dearborn Street, Chicago,
and the only cost is that of transportation.
Mrs. Joseph Moran, Jr., Mental Health chairman,
speaks of the appalling percentage of mental illness
among teenagers and points out that local auxiliaries
have the challenge of finding out what the needs of
the individual communities are and then organizing
their forces to be of all possible assistance. She men-
tions "Mirror to the Mind” — a very fine educational
series that consists of 13 records made by Doctors
Annis and Menninger concerning mental health.
Ideally, they can be used by local radio stations as a
public service with one record being broadcast each
week for 13 consecutive weeks. These records are
available from the Radio and Communications Com-
mittee of the American Medical Association.
"Milestones to Maturity” are also effectively used
in many areas as an educational program for the
young people. They consist of eight letters for senior
high school students and are designed to educate the
youth in relation to problems of maturing. One thing
more — an effective Suicide Prevention Program has
been planned and executed by a former national
Mental Health chairman. Mrs. Moran points out
that this program can be established in any community
regardless of size, but it is necessary to have the
approval of the local County Medical Society. If
you are interested in further details, contact Mrs.
Moran at 2251 Townley Road, Toledo 43606.
Around the State
There’s a very newly installed president at the
Clark County auxiliary — Mrs. A. T. Anton, and a
newly appointed vice-president, Mrs. S. J. Glueck.
The group furnishes refreshments to the cerebral
palsy clinic and the Children’s Home. It also spon-
sors a nurse’s scholarship. Honorary members of the
auxiliary were honored recently at a luncheon at
Valley View Inn. They included Mrs. C. Evans, Mrs.
W. B. Patton, Mrs. M. S. Collins, Mrs. W. B. Quinn,
Mrs. A. Richard Kent and Mrs. H. B. Martin. At
its November meeting, the auxiliary met for a dessert
luncheon at the home of Mrs. Edwin Roberts. The
program featured the work of members who parti-
cipate in community activities. On the coming agenda
is the big project — the bazaar, proceeds of which
go to AMA-ERF.
A sale of handicraft items made by members of
the Columbiana Auxiliary netted over one hundred
dollars for the County School for Retarded Children.
The sale was held in conjunction with the regular
November meeting at the Salem Golf Club. Mrs.
Wade A. Bacon, president, introduced the two hon-
ored guests — Mrs. Herbert Van Epps, state presi-
dent, and Mrs. James Wychgel, state president-elect.
Mrs. Harold Martsolf, teacher at the Elkton School,
78
The Ohio State Medical Journal
Butazolidin alka
phenylbutazone 100 mg.
dried aluminum
hydroxide gel 100 mg.
magnesium trisilicate 150 mg.
homatropine
methylbromide 1.25 mg.
Usually works within 3 to 4 days
in osteoarthritis
The trial period need not exceed 1 week. In
contrast, the recommended trial period for
indomethacin is at least 1 month.
That’s why it’s logical to start therapy with
Butazolidin alka — you'll know quickly whether
or not it works. And usually, it will.
A large number of investigators have re-
ported major improvement in about 75% of
cases. Some patients have gone into remis-
sion. Relief of stiffness and pain may be fol-
lowed quickly by improved function and res-
olution of other signs of inflammation. And
Butazolidin alka is well tolerated, especially
since it contains antacids and an antispas-
modic to minimize gastric upset.
Contraindications
Edema, danger of cardiac decompensation;
history or symptoms of peptic ulcer; renal,
hepatic or cardiac damage; history of drug
allergy; history of blood dyscrasia. The drug
should not be given when the patient is se-
nile, or when other potent drugs are given
concurrently. Large doses are contraindi-
cated in patients with glaucoma.
Precautions
Obtain a detailed history and a complete
physical and laboratory examination, includ-
ing a blood count. The patient should be
closely supervised and should be warned to
report immediately fever, sore throat, or
mouth lesions (symptoms of blood dyscrasia);
sudden weight gain (water retention); skin
reactions; black or tarry stools. Make regular
blood counts. Use greater care in the elderly.
Warning
If coumarin-type anticoagulants are given
simultaneously, watch for excessive increase
in prothrombin time. Pyrazole compounds
may potentiate the pharmacologic action of
sulfonylurea, sulfonamide-type agents and
insulin. Carefully observe patients receiving
such therapy.
Adverse Reactions
The most common are nausea, edema and
drug rash. Hemodilution may cause mod-
erate fall in red cell count. The drug may
reactivate a latent peptic ulcer. Infrequently,
agranulocytosis, generalized allergic reac-
tion, stomatitis, salivary gland enlargement,
vertigo and languor may occur. Leukemia
and leukemoid reactions have been re-
ported but cannot definitely be attributed to
the drug. Thrombocytopenic purpura and
aplastic anemia may occur. Confusional
states, agitation, headache, blurred vision,
optic neuritis and transient hearing loss
have been reported, as have hepatitis,
jaundice, and several cases of anuria and
hematuria. With long-term use, reversible
thyroid hyperplasia may occur infrequently.
Dosage
The initial daily dosage in adults is 300-600
mg. daily in divided doses. In most in-
stances, 400 mg. daily is sufficient. When
improvement occurs, dosage should be de-
creased to the minimum effective level: this
should not exceed 400 mg. daily, and is
often achieved with only 100-200 mg. daily.
Also available: Butazolidin®,
brand of phenylbutazone
Tablets of 100 mg.
Geigy Pharmaceuticals
Division of Geigy Chemical Corporation
Ardsley, New York BU-3804 P
Geigy
presented an interesting account of the fine work
being done for retarded children.
The October meeting of the Columbiana group
featured a wig display by the Trans-World Wig
Company of Cleveland at the home of Mrs. R. J.
Starbuck. Beauticians from the Kaercher Beauty
Salon of Salem modeled the wigs. Mrs. R. J.
Bonistalli, president-elect, conducted the business
session in the absence of the president. Refreshments
were served by the hostess Mrs. Starbuck, assisted by
Mrs. J. R. Milligan, Mrs. G. A. Roose, and Mrs.
Liesel Falkenstein.
"Holiday in Rome"
A "Holiday in Rome” was simulated at the Roof
Garden of the Hotel Sheraton-Gibson in Cincinnati
when the Hamilton County group held its Decem-
ber dinner dance for the benefit of the philanthropic
fund. The annual Holiday Ball has provided nursing
scholarships each year since 1948. A Roman piazza
was created for the occasion. A splashing fountain
and weathered colonnade were accented by massive
urns holding magnolia greens. The traditional at-
traction of tourists on Roman holiday — the tossing
of coins into the fountain — was one of the evening’s
diversions. The collection was subsequently turned
over to "The Neediest Kids of All” Christmas Fund.
Mrs. John L. Thinnes was general chairman of the
black-tie affair. Strolling musicians in bright costume
moved among the tables during the dinner hour play-
ing Italian folk songs. For each table, Mrs. William
P. Jennings, Mrs. Roy H. Kile and their assistants
fashioned ceramic fountains of antique green spat-
tered with gold. These were centered on gold fil-
igree mats. Since doctors are on call even in the
ballroom, Mrs. Samuel Bauer enlisted a group of
hostesses who delivered telephone messages to the
physicians. These women were identified by gold
coins worn as pendants.
Mrs. Eugene P. Fromm served as invitations chair-
man; Mrs. E. A. Kindel, Jr., as reservations chairman
and Mrs. William H. Kroovand as ball treasurer.
Name tags were designed by Mrs. Robert E. John-
stone. Mrs. Robert Matuska was chairman of "ospi-
talita” for the evening. Mrs. John B. Toepfer is
president of the Hamilton doctors’ wives.
The Hancock auxiliary met recently at the Find-
lay Country Club and viewed the film "A Different
Drum” which features projects of AMA-ERF. A
question and answer session followed, headed by Mrs.
Thomas Darnall. Mrs. Robert Brown and Mrs. James
Miller were hostesses. Mrs. A. P. Carneiro, presi-
dent of the Jefferson County group, entertained the
members at a luncheon at the Steubenville Country
Club.
Mrs. C. L. Johnson spoke on "The Various Phases
of Medicare” at the November meeting of the Hardin
County women at San Antonio Hospital. During
the business session conducted by Mrs. Calvin Jack-
son, president, plans were made for the annual Mistle-
toe Ball in December. Mrs. Max Schnitker, program
chairman of the Lucas County auxiliary, arranged
the guest-day tea at which Mrs. Alexander Miller
spoke on Project Hope. Mrs. Miller is the wife of
a Cleveland orthopedic surgeon who has served as a
volunteer doctor on Hope and who at the present
time, is in South Viet Nam as a volunteer in an
undertaking administered by Project Hope and the
Agency for International Development.
On and On They Go!
The Mahoning County auxiliary had a tremen-
dously effective picture spread in the rotogravure
section of The Youngstown Vindicator. It all had
to do with its group of volunteer workers in conjunc-
tion with Diabetes Week, AMA-ERF, drug samples
for World Relief and the tuberculosis Christmas Seal
campaign. The picture layout was certainly publicity
at its very best. The Miami auxiliary held a tea
recently for junior and senior high school girls in-
terested in nursing careers.
A unique program was presented at Scioto
County’s 25th anniversary dinner party at Holiday
Inn — a presentation on and a demonstration of the
remarkable laser beam. The doctors of the Scioto
County Medical Society were the honored guests.
Kenneth Bartter of Marion, public relations man-
ager for the General Telephone Company of Ohio,
described the laser beam as a light beam with virtually
magic-like qualities. The telephone executive pre-
sented a broad, non-technical concept of how it works
in the fields of communication, medicine, industry,
THE WOMAN’S AUXILIARY TO THE OHIO STATE MEDICAL ASSOCIATION
President : Mrs. Herbert F. Van Epps
425 E. 15th St., Dover 44622
Vice-Presidents: 1. Mrs. A. L. Kefauver
4421 Aldrich PI., Columbus 43214
2. Mrs. M. W. Sloan, II
415 Towerview Rd., Dayton 45429
3. Mrs. Edward L. Doerman
3605 Laskey Rd., Toledo 43623
Past-President and Nominating Chairman :
Mrs. John D. Dickie
2146 Shenandoah Rd., Toledo 43607
President-Elect: Mrs. James Wychgel
3320 Dorchester Rd., Cleveland 44120
Recording Secretary : Mrs. J. W. Loney
15450 Hemlock Point Rd., Chagrin Falls
Corresponding Secretary : Mrs. C. Raymond Crawley
1507 Seven Mile Dr.,
New Philadelphia 44663
Treasurer: Mrs. R. L. Wiessinger
2280 W. Wayne St., Lima 45805
80
The Ohio State Medical Journal
Time after time, in patient after patient,
Percodan’s pain-killing action is fast, potent and
predictable. Enthusiasm for Percodan by physi-
cians is almost directly proportional to their expe-
rience with this analgesic formula. Just one
Percodan tablet usually brings relief within 5 to
15 minutes and maintains it for 6 hours or more.
It rarely causes constipation.
Average Adult Dose— 1 tablet every 6 hours.
Precautions, Side Effects and Contraindications
— The habit-forming potentialities of Percodan
are somewhat less than those of morphine and
somewhat greater than those of codeine. The usual
precautions should be observed as with other opi-
ate analgesics. Although generally well tolerated,
Percodan may cause nausea, emesis, or constipa-
tion in some patients. Percodan should be used
with caution in patients with known idiosyn-
crasies to aspirin or phenacetin, and in those with
blood dyscrasias.
Also available: Percodan®-Demi, each scored
pink tablet containing 2.25 mg. oxycodone HC1
(Warning: May be habit-forming), 0.19 mg. oxy-
codone terephthalate (Warning: May be habit-
forming), 0.19 mg. homatropine terephthalate,
224 mg. aspirin, 160 mg. phenacetin, and 32 mg.
caffeine.
throughout the wide middle range of PAIN..
£ndo
Literature on request
ENDO LABORATORIES INC. Garden City, New York
4.50 mg. oxycodone HC1 (Warning: May be habit-
forming), 0.38 mg. oxycodone terephthalate
(Warning: May be habit-forming), 0.38 mg. hom-
atropine terephthalate, 224 mg. aspirin, 160 mg.
phenacetin, and 32 mg. caffeine.
•U.S. Pats. 2.628,185 and 2.907,768
science and the military and then demonstrated its
amazing capability.
Mrs. Alden Oakes, Scioto president, presided at
the festivities. A special exhibit of scrapbooks,
photographs, posters and all manner of educational
presentation highlighted the projects of the group’s
25 years of existence.
The December meeting featured the annual Christ-
mas party traditionally held at the home of Dr. and
Mrs. Clyde M. Fitch in the form of a dessert lunch-
eon. Members brought toys for needy children.
There were also a bake sale and a book sale to swell
the treasury of the Ways & Means Committee.
A panel of Clergy and physicians discussed the
film "The One Who Heals,” following its showing
in November when the Sandusky County auxiliary
hosted the Ministerial Association, their wives, Cath-
olic clergy and physicians at the Nurses’ Home. The
group was welcomed by Mrs. Harold Keiser, presi-
dent. Discussing the film and answering questions
were the Rev. James Konrad, president of the Mini-
sterial Association, Father John Thomas, Dr. Richard
Wilson and Dr. Robert Gedert. Mrs. Howard Yost
headed the refreshment committee.
Medical Missionary
The Stark County auxiliary heard a distinguished
physician talk about an unusual experience at its
November luncheon at the. Arrowhead Country Club.
Dr. Igor Nikishin, Canton surgeon, discussed his
several weeks this summer in Honduras as a medical
missionary. He took part in the "Amigos de Hon-
duras” project initiated by the River Oaks Baptist
Church at Houston, Texas. Some 300 persons, many
of them teen-agers, formed their own "Health Corps”
and assisted by about 25 members of the AM-DOC
(American Doctors) organization undertook a medi-
cal treatment program for some two million Hon-
durans. During his rough truck trip to the city of
Santa Rosa de Copan where he was stationed at a
primitive hospital, Dr. Nikishin passed through sev-
eral villages. Of these he recalled: "We made our
way, bump by bump in complete silence, between
gray-white walls of mud mixed with straw, with
holes for doors and windows — these filled by men,
women and naked children, all with immensely pro-
truding stomachs. The villagers drank from a
nearby river where pigs and dogs splashed, or
straight from the gutter along the street.” The hospi-
tal at which Dr. Nikishin served was founded in
1917 and gets support from the government. Pa-
tients who are able pay 12l/2 cents on their first day,
the doctor said. Treatment is free to the penniless.
"Patients are placed two to a bed in the adult wards,”
he related, "and up to four children share each bed
in their section. Among other ailments, they are
treated for jaguar and machete wounds, burns, frac-
tures, malnutrition, anemia, parasites and infections.”
Happy New Year!
Happy New Year on behalf of your State Board.
There is a favorite quotation of mine (author un-
known) that seems to fit this occasion — "Thine own
wish, wish we thee.”
The Ohio State University College of Medicine
has received a grant of $26,457 for planning a
university-wide interdisciplinary program in mental
retardation. The planning will be a joint effort of
representatives from the College of Education, School
of Social Work and the College of Medicine. Dr.
Lloyd R. Evans, assistant dean of the College of
Medicine, will direct the project.
This year’s winner of the Gorgas Medal, presented
annually by the Association of Military Surgeons of
the U. S. is Lt. Colonel Edward L. Buescher, a 1948
graduate of the University of Cincinnati College of
Medicine, and now stationed at the Walter Reed
Army Medical Center. The award consists of a
medal, scroll and honorarium established by Wyeth
Laboratories.
Accredited by The Joint Commission on Accreditation of Hospitals.
WINDSOR HOSPITAL
A NONPROFIT CORPORATION
— ESTABLISHED 7 8 9 8 —
Chagrin Falls, Ohio 44022
247-5300 (Area Code 216)
A hospital for the treatment
of Psychiatric Disorders
Booklet available on request.
JOHN H. NICHOLS, M. D., Medical Director G. PAULINE WELLS, R. N., Admin. Director HERBERT A. SIHLER, Jr., Pres.
MEMBER: American Hospital Association — National Association of Private Psychiatric Hospitals — Ohio Hospital Association
82
The Ohio State Medical Journal
State Association Officers and Committeemen
Headquarters Office: Room 1005, 79 East State Street, Columbus 43215. Telephone 221-7715
Henry A. Crawford, President Lawrence C. Meredith, President-Elect Robert E. Tschantz, Past-President
1058 Hanna Bldg., Cleveland 44115 205 Elyria Block, Elyria 44035 515 Third Street, N. W„ Canton 44703
Philip B. Hardymon, Treasurer
350 East Broad St., Columbus 43215
Mr. Hart F. Page, Executive Secretary Mr. Charles W. Edgar, Director of Public Relations
and Assistant Executive Secretary
Mr. W. Michael Traphagan, Administrative Assistant Mr Herbert e Gillen> Administrative Assistant
Perry R. Ayres, Editor Mr. R. Gordon Moore, Executive Editor
THE COUNCIL
First District, Robert E. Howard, 2600 Union Central Bldg., Cincinnati 45202 ; Second District, Theodore L. Light, 2670 Salem Ave.,
Dayton 45406; Third District, Frederick T. Merchant, 1051 Harding Memorial Pky., Marion 43305 ; Fourth District, Robert N. Smith,
3939 Monroe St., Toledo 43606 ; Fifth District, P. John Robechek, 10525 Carnegie Ave., Cleveland 44106 ; Sixth District, Edwin R.
Westbrook, 438 North Park Ave., Warren; Seventh District, Benj. C. Diefenbach, 30 S. 4th St., Martins Ferry; Eighth District, Robert
C. Beardsley, 2236 Maple Ave., Zanesville ; Ninth District, George N. Spears, 2213 So. Ninth St., Ironton ; Tenth District, Richard
L. Fulton, 1211 Dublin Rd., Columbus 43212 ; Eleventh District, William R. Schultz, 1749 Cleveland Rd., Wooster 44691.
COMMITTEES
COMMITTEES
Committee on Education — Thomas E. Rardin, Columbus, Chair-
man (1966) ; Clyde W. Muter, Warren (1970) ; Thomas S. Brow-
nell, Akron (1969) ; John G. Sholl, Cleveland (1968) ; Elmer R.
Maurer, Cincinnati (1967).
Judicial and Professional Relations Committee — Frank F. A.
Rawling, Toledo, Chairman (1968) ; Homer A. Anderson, Colum-
bus (1970) ; Chester H. Allen, Portsmouth (1969) ; David Fish-
man, Cleveland (1967) ; Paul A. Mielcarek, Cleveland (1966).
Committee on Public Relations and Economics — Frederick P.
Osgood, Toledo, Chairman (1969) ; Luther W. High, Millers-
burgh (1970) ; John H. Budd, Cleveland (1968) ; John J. Cranley,
Cincinnati (1967) ; Horace B. Davidson, Columbus (1966).
Committee on Scientific Work — Samuel Saslaw, Columbus,
Chairman (1968) ; Jack Schreiber, Canfield (1970) ; Walter J.
Zeiter, Cleveland (1970) ; John D. Battle, Jr., (1969) ; Harold
J. Schneider, Cincinnati (1969) ; Isador Miller, Urbana (1968) ;
William Hamelberg, Columbus (1967) ; F. A. Simeone, Cleveland
(1967) ; Ralph K. Ramsayer, Canton (1966) ; G. Douglas Talbott,
Dayton (1966).
Committee on Care of the Aging — Charles W. Stertzbach,
Youngstown, Chairman ; James O. Barr, Chagrin Falls ; Dwight
L. Becker, Lima ; Robert A. Borden, Fremont ; Edwin W.
Burnes, Van Wert; Philip T. Doughten, New Philadelphia;
Robert B. Elliott, Ada ; George T. Harding, Sr., Worthington ;
Roger E. Heering, Columbus ; M. Robert Huston, Millersburg ;
John S. Kozy, Toledo; Francis M. Lenhart, Defiance; Harold
E. McDonald, Elyria ; H. W. Porterfield, Columbus ; Elliot W.
Schilke, Springfield ; Bernard A. Schwartz, Cincinnati ; Clar-
ence V. Smith, Canton; Joseph B. Stocklen, Cleveland; Don P.
VanDyke, Kent; William M. Wells, Newark; Roger Williams,
Columbus.
Committee on Cancer — Arthur G. James, Columbus, Chairman ;
Thomas D. Allison, Lima ; Andrew M. Barone, Lima ; William
F. Boukalik, Cleveland ; William J. Flynn, Youngstown ; Douglas
P. Graf, Cincinnati; Stanley O. Hoerr, Cleveland; William A.
Newton, Jr., Columbus ; W. D. Nusbaum, Lancaster ; Arthur E.
Rappoport, Youngstown; Carl A. Wilzbach, Cincinnati.
Committee on Eye Care — Arthur D. Collins, Cleveland, Chair-
man ; Martin J. Cook, Springfield ; Thomas L. Edwards, Lima ;
Robert H. Magnuson, Columbus ; Russell J. Nicholl, Cleveland ;
Claude S. Perry, Columbus; Norman W. Pinschmidt, Gallipolis ;
Barnet R. Sakler, Cincinnati ; Robert L. Willard, Toledo.
Committee on Hospital Relations — William R. Schultz, Woo-
ster, Chairman ; L. A. Black, Kenton ; L. Fred Bissell, Aurora ;
Oscar W. Clarke, Gallipolis ; Robert M. Craig, Dayton ; John
V. Emery, Willard ; Harvey C. Gunderson, Toledo ; Philip B.
Hardymon, Columbus ; Middleton H. Lambright, Cleveland ;
Lloyd E. Larrick, Cincinnati; Joseph S. Lichty, Akron; James
C. McLarnan, Mt. Vernon ; Ben V. Myers, Elyria ; Robert A.
Tennant, Middletown ; V. William Wagner, Port Clinton ; Wil-
liam A. White, Canton.
Committee on Insurance — David A. Chambers, Cleveland,
Chairman ; William F. Bradley, Columbus ; Walter A. Daniel,
Tiffin; Chester R. Jablonoski, Cleveland; William A. Knapp,
Zanesville; Marvin R. McClellan, Cincinnati; William Neal,
Archbold ; Oliver Todd, Toledo ; Robert E. Tschantz, Canton ;
Allan L. Wasserman, Dayton; John W. Wherry, Elyria; Wil-
liam A. White, Canton.
Committee on Laboratory Medicine — Horace B. Davidson, Co-
lumbus, Chairman; William H. Benham, Columbus; John B.
Hazard, Cleveland ; Melvin Oosting, Dayton ; Arthur E. Rap-
poport, Youngstown; William Sinclair, Cleveland; Gilbert B.
Stansell, Toledo; Philip B. Wasserman, Cincinnati.
Committee on Legislation — James T. Stephens, Oberlin, Chair-
man ; Donald R. Brumley, Findlay ; George D. J. Griffin, Cin-
cinnati ; Jack L. Kraker, Lancaster ; Maurice F. Lieber, Canton ;
Ralph F. Massie, Ironton ; James C. McLarnan, Mt. Vernon ;
Robert E. Rinderknecht, Dover; John H. Sanders, Cleveland;
Carl R. Swanbeck, Sandusky ; William W. Trostel, Piqua.
Committee on Maternal Health — Anthony Ruppersberg, Co-
lumbus, Chairman ; Otis G. Austin, Medina ; Raymond E. Bar-
ker, Columbus ; William D. Beasley, Springfield ; Keith R.
Brandeherry, Gallipolis ; Thomas E. Byrne, Mentor ; C. Ray-
mond Crawley, Dover ; Mel A. Davis, Columbus ; Marion F.
Detrick, Jr., Findlay; John P. Garvin, Columbus; Richard P.
Glove, Cleveland; Robert A. Heilman, Columbus; John F. Hil-
labrand, Toledo ; Robert E. Johnstone, Cincinnati ; Albert A.
Kunnen, Dayton; James F. Morton, Zanesville; Ralph K. Ram-
sayer, Canton; Robert E. Swank, Chillicothe ; Densmore Thomas,
Warren ; Robert S. VanDervort, Elyria.
Committee on Medicine and Religion — George W. Petznick,
Cleveland, Chairman ; John D. Albertson, Lima ; Eugene F.
Damstra, Dayton ; Francis M. Lenhart, Defiance ; Ralph W.
Lewis, Portsmouth; J. Kenneth Potter, Cleveland; Charles A.
Sebastian, Cincinnati ; John R. Seesholtz, Canton ; William B.
Smith, Zanesville; James T. Stephens, Oberlin; Donald J. Vin-
cent, Columbus ; Don G. Warren, West Lafayette.
Committee on Mental Health — Wendell A. Butcher, Columbus,
Chairman ; Homer A. Anderson, Columbus ; E. H. Crawfis,
Cleveland; Max D. Graves, Springfield; Charles W. Harding,
Worthington ; Warren G. Harding, II, Columbus ; Henry L.
Hartman, Toledo ; J. Robert Hawkins, Cincinnati ; William H.
Holloway, Akron; Nathan B. Kalb, Lima; Thomas E. Rardin,
Columbus ; Philip C. Rond, Columbus ; Victor M. Victoroff,
Cleveland; John A. Whieldon, Columbus.
Committee on Disaster Medical Care — Thomas D. Allison,
Lima, Chairman ; Thomas P. Bowlus, Toledo ; Nino M. Cam-
ardese, Norwalk; Drew L. Davies, Columbus; John H. Davis,
Cleveland ; Gregory G. Floridis, Dayton ; Robert D. Gillette,
Huron ; Robert S. Heidt, Cincinnati ; N. J. M. Klotz, Wads-
worth ; Thomas W. Morgan, Gallipolis ; Sterling W. Obenour,
Jr., Zanesville; Vol K. Philips, Columbus; Elden C. Weckesser,
Cleveland; (Liaison with the American Medical Association)
Wendell A. Butcher, Columbus.
Military Advisory Committee — Drew L. Davies, Columbus,
Chairman ; A. A. Brindley, Maumee ; Ralph G. Carothers, Cin-
cinnati ; Homer D. Cassel, Dayton ; Henry A. Crawford, Cleve-
land ; Walter L. Cruise, Zanesville ; Charles R. Keller, Mans-
field ; Ralph W. Lewis, Portsmouth ; Edward L. Montgomery,
Circleville ; Frank T. Moore, Akron ; Earl Rosenblum, Steuben-
ville.
Committee on Occupational Health — Rex H. Wilson, Akron,
Chairman ; Drew J. Arnold, Columbus ; William W. Davis, Co-
lumbus ; Winfred M. Dowlin, Canton ; Harold M. James, Day-
ton ; H. W. Lawrence, Middletown ; Daniel M. Murphy, Marion ;
Anthony M. Puleo, Cleveland; George W. Wright, Cleveland;
H. P. Worstell, Columbus.
Committee on Poison Control — John A. Norman, Akron,
Chairman; William G. Gilger, Cleveland; Mason S. Jones, Day-
ton: James H. Bahrenburg, Canton; Edward V. Turner, Co-
lumbus; William M. Wallace, Cleveland; Hugh Wellmeier,
Piqua; John A. Williams, Cincinnati.
Committee on Radiation — Charles M. Barrett, Cincinnati,
Chairman; Eldred B. Heisel, Columbus; George F. Jones, Lan-
caster; Carey B. Paul, Jr., Columbus; Thomas C. Pomeroy, Co-
lumbus ; Denis A. Radefeld, Lorain ; Eugene L. Saenger, Cin-
cinnati; Robert E. Schulz, Wooster; John P. Storaasli, Cleve-
land; Robert P. Ulrich, Troy; Robert L. Wall, Columbus; John
Robert Yoder, Toledo; James G. Kereiakes, Ph. D. (Advisory
Member, Special Consultant), Cincinnati.
for January, 1966
83
State Association Officers and Committeemen (Continued)
Committee on Rural Health — Robert E. Reiheld, Orrville,
Chairman ; Chester J. Brian, Eaton ; J. Martin Byers, Green-
field ; Walter A. Campbell, Coshocton: E. Joel Davis, East Can-
ton ; Victor R. Frederick, Urbana ; Benjamin W. Gilliotte, Zanes-
ville ; Jerry L. Hammon, West Milton; Jasper M. Hedges, Circle-
ville; Luther W. High, Millersburg ; E. D. Mattmiller, Athens;
John R. Polsley, North Lewisburg ; Leonard S. Pritchard, Co-
lumbiana; Harold C. Smith, Van Wert: Kenneth W. Taylor,
Pickerington ; Edmond K. Yantes, Wilmington.
Committee on Scientific and Educational Exhibit — Charles V.
Meckstroth, Columbus, Chairman ; Harvey C. Knowles, Jr., Cin-
cinnati ; W. Arnold McAlpine, Toledo ; Arthur E. Rappoport,
Youngstown; Arnold M. Weissler, Columbus; Walter J. Zeiter,
Cleveland; Robert E. Zipf, Dayton.
Committee on School Health — Charles H. McMullen, Loudon-
ville. Chairman; Walter Felson, Greenfield; Paul D. Hahn, New
Philadelphia; Howard H. Hopwood, Cleveland; Dale A. Hudson,
Piqua ; Howard J. Ickes, Canton ; Charles L. Kagay, Dayton ;
Lawrence L. Maggiano, Warren ; Robert C. Markey, Bowling
Green; Robert J. Murphy, Columbus; Carey B. Paul, Jr., Colum-
bus; Carl L. Petersilge, Newark; William H. Rower, Ashland;
Thomas E. Shaffer, Columbus ; Aubrey L. Sparks, Warren ;
Albert E. Thielen, Cincinnati; Homer B. Thomas, Gallipolis.
Committee on Traffic Safety — N. J. Giannestras, Cincinnati,
Chairman; Howard W. Brettell, Steubenville; Drew L. Davies,
Columbus; Clark M. Dougherty, New Philadelphia; Wesley L.
Furste, Columbus; Thomas W. Morgan, Gallipolis; Lester G.
Parker, Sandusky; Thomas N. Quilter, Marion ; Stewart M.
Rose, Columbus; John F. Tillotson, Lima ; Robert C. Waltz,
Cleveland; Paul L. Weygandt, Akron; Robert E. Zipf, Dayton.
Committee on Workmen's Compensation — H. P. Worstel], Co-
lumbus, Chairman; A. L. Berndt, Portsmouth; Thomas H.
Brown, Jr., Toledo; Charles A. Browning, Jr., Bellefontaine ;
Oscar W. Clarke, Gallipolis ; Frederick A. Flory, Columbus ;
Lawrence T. Hadbavny, Cleveland ; Clyde O. Hurst, Portsmouth ;
Edmund F. Ley, Tiffin ; Joseph Lindner, Sr., Cincinnati ; John
D. Osmond, Jr., Cleveland; James G. Roberts, Akron; George
L. Sackett, Sr., Painesville ; Joseph H. Shepard, Columbus;
William V. Trowbridge, Cleveland; Rex H. Wilson, Akron;
Frederick A. Wolf, Cincinnati; James N. Wychgel, Cleveland.
OSMA Members of the Joint Advisory Committee on Athletic
Injuries — -Robert J. Murphy, Columbus; John R. Jones, Toledo;
Sol Maggied, West Jefferson; Charles H. McMullen, Loudonville ;
Carey B. Paul, Jr., Columbus; Thomas E. Shaffer, Columbus;
Don A. Kelly, Cleveland ; Marvin R. McClellan, Cincinnati ;
Walter A. Hoyt, Jr., Akron.
OSMA Members of the Joint Committee on School Bus Driver
Examinations — Carey B. Paul, Jr., Columbus; Thomas N. Quil-
ter, Marion ; Stewart M. Rose, Columbus.
DELEGATES AND ALTERNATES
Delegates and Alternates to the American Medical Association
— George W. Petznick, Cleveland; H. T. Pease, Wadsworth, alter-
nate ; Carl A. Lincke, Carrollton ; Robert S. Martin, Zanesville,
alternate ; Theodore L. Light, Dayton ; Kenneth D. Arn, Dayton,
alternate ; Edmond K. Yantes, Wilmington ; Harry K. Hines,
Cincinnati, alternate; John H. Budd, Cleveland; P. John Robe-
chek, Cleveland, alternate; Richard L. Meiling, Columbus; Rob-
ert E. Tschantz, Canton, alternate; Paul F. Orr, Perrysburg ;
Frederick P. Osgood, Toledo, alternate; Charles A. Sebastian,
Cincinnati ; J. Robert Hudson, Cincinnati, alternate ; Edwin H.
Artman, Chillicothe ; Philip B. Hardymon, Columbus, alternate.
Delegate to take office Jan. 1, 1966, Frederick P. Osgood,
Toledo; alternate, Robert N. Smith, Toledo.
County Societies' Officers and Meeting Dates
First District
Councilor: Robert E. Howard, Cincinnati 45202
2600 Union Central Bldg.
ADAMS — Gary J. Greenlee, President, Farmers National Bank
Bldg., Manchester; Stanley H. Title, Secretary, Seaman.
BROWN — John A. Powell, President, 117 Cherry St., George-
town ; Kevin C. McGann, Secretary, 121 N. Main St., George-
town. 3rd Sunday, monthly.
BUTLER — Marvin J. Rassell, President, 55 Picadilly Dr., Hamil-
ton ; Mr. Charles G. Greig, Executive Secretary, 110 N. 3rd St.,
Hamilton. 4th Wednesday.
CLERMONT — Cecil F. Barber, President, State Route 133, Feli-
city 45120 ; Phillips F. Greene, Secretary, Route 1, Box 509,
New Richmond 45157. 3rd Wednesday monthly, except July
and August.
CLINTON— Nathan S. Hale, President, 576 W. Main St., Wil-
mington ; Mary R. Boyd, Secretary, Box 629, Wilmington.
4th Tuesday, 6 p. m., monthly, Clinton Memorial Hospital.
HAMILTON — Robert M. Woolford, President, 320 Broadway,
Cincinnati 45202 ; Mr. Edward F. Willenborg, Executive
Secretary, 320 Broadway, Cincinnati 45202. Monthly meet-
ing dates, 1st Tuesday ; Academy, 3rd Tuesday, except June,
July and August.
HIGHLAND — Thomas C. Sharkey, President, 216 S. High St.,
Hillsboro ; Kenneth L. Upp, Secretary, 528 South St., Greenfield.
1st Wednesday, every other month.
WARREN — O. Willard Hoffman, President, 20 E. Fourth St.,
Franklin ; Ray E. Simendinger, 901 Broadway St., Lebanon.
Second District
Councilor: Theodore L. Light, Dayton 45406
2670 Salem Ave.
CHAMPAIGN — Isador Miller, President, 848 Scioto St., Urbana ;
Fred R. Denkewalter, Secretary, 848 Scioto St., Urbana. 2nd
Wednesday, monthly.
CLARK — Henry M. Tardif, President, 2608 E. High Street,
Springfield 45505 ; Mrs. Marion L. Wilcoxson, Executive
Secretary, Hotel Shawnee, Room 207, Springfield 44501. 3rd
Monday monthly, except June, July and August.
DARKE — Edward H. Kirsch, President, 261 East Main Street,
Gettysburg; Delbert Blickenstaff, Secretary, South West St.,
Versailles. 3rd Tuesday, monthly.
GREENE — R. David Warner, President, Medical Associates
Bldg., 140 Roger St., Xenia ; Mrs. C. K. Elliott, Executive
Secretary, 225 Pleasant St., Xenia. 2nd Thursday, monthly,
except July and August.
MIAMI — Gerard F. Wolf, President, 145 Sunset Drive, Piqua ;
Jack P. Steinhilber, Secretary, 145 Sunset Drive, Piqua. 1st
Tuesday, monthly.
MONTGOMERY — Charles E. O’Brien, President, 600 Fidelity
Building, Dayton 45402 ; Mr. Robert F. Freeman, Executive
Secretary, 280 Fidelity Medical Building, Dayton 45402. 1st
Friday monthly October through May — 1st Wednesday June.
PREBLE — W. C. Clark, Jr., President, 228 N. Barron St., Eaton ;
John D. Darrow, Secretary, 1302 N. Aukerman St., Eaton.
SHELBY — George J. Schroer, President, 322 Second Ave., Sid-
ney; Alfonsas Kisielius, Secretary, Ohio Bldg., Sidney.
Third District
Council : Frederick T. Merchant, Marion 43305
1051 Harding Memorial Pky.
ALLEN — Carl H. Zinsmeister, President, 729 W. Market Street,
Lima 45801 ; Thomas D. Allison, Secretary, 401 Metropolitan
Bank Building, Lima 45801. 3rd Tuesday monthly.
AUGLAIZE — J. R. Romaker, President, 114 W. Main St., Cri-
dersville ; Herbert S. Wolfe, Secretary, Box 238, New Knox-
ville. 1st Thursday, monthly except July.
CRAWFORD — Don E. Ingham, President, 201 N. Market Street,
Galion 44833 ; Johnson H. Chow, Secretary, 1040 Devonwood
Drive, Galion 44833. Called meetings.
HANCOCK — Thomas W. Darnall, President, 1809 South Main
Street, Findlay; Herbert L. Queen, Secretary, 827 Woodworth
Drive, Findlay. 3rd Tuesday, monthly.
HARDIN — Glen B. VanAtta, President, 900 East Franklin
Street, Kenton ; J. J. Roget, Secretary, Belle Center. 2nd
Tuesday, monthly, except June, July and August.
LOGAN— Richard A. Firmin, President, Zanesfield ; Gerald
Munn, Secretary, 120 E. Sandusky Ave., Bellefontaine. 1st Fri-
day, monthly.
MARION — James A. McGlew, President, 399 E. Church St.,
Marion ; Lester E. Wall, Secretary, 317 S. Main St., Marion.
1st Tuesday, monthly.
MERCER — R. Duane Bradrick, President, Rockford 45882. 3rd
Thursday monthly. (Secretary not definite as of December 10,
1965.)
SENECA — James A. Murray, President, 502 Van Buren St.,
Fostoria ; Lowell K. Good, Secretary, 133 W. North St.,
Fostoria.
VAN WERT — Harold C. Smith, President, Medical Arts Bldg.,
Van Wert; Donald E. Hughes, Secretary, Van Wert County
Hospital, Van Wert. 4th Tuesday, monthly.
WYANDOT — Franklin M. Smith, President, E. Saffle Ave., Box
68, Sycamore ; Robert E. Goyne, Secretary, 482 N. 7th St.,
Upper Sandusky. 2nd Tuesday, monthly.
Fourth District
Councilor: Robert N. Smith, Toledo 43606
3939 Monroe St.
DEFIANCE — John W. Cullen, President, Box 218, Defiance; Wil-
liam S. Busteed, Secretary, Box 218, Defiance. 1st Saturday,
monthly.
FULTON — Benjamin H. Reed, Jr., President, 101 Adrian St.,
Delta; Richard L. Davis, Secretary, 137 S. Fulton St., Wau-
seon. 2nd Tuesday, March, June, September and December.
HENRY — Thomas F. Moriarty, President, 515 Avon Place,
Napoleon ; Gamble S. Hall, Secretary, 834 Strong St.,
Napoleon. 1st Tuesday, monthly.
LUCAS — R. Philip Whitehead, President, 424 W. Woodruff Ave.,
Toledo 43602 ; Mr. Robert W. Elwell, Executive Secretary,
3101 Collingwood Blvd., Toledo 10. 3rd Tuesday.
OTTAWA — Robert Reeves, Route 1, Oak Harbor; Kenneth L.
Akins, Secretary, 208 W. Third St., Port Clinton. 2nd Thurs-
day, monthly.
PAULDING — Don K. Snyder, President, Payne ; Roy R. Miller,
Secretary, 220 W. Perry St., Paulding. Meetings as called.
84
The Ohio State Medical Journal
PUTNAM — John R. Brown, President, 135 South Hickory Street,
Ottawa ; Oliver N. Lugibihl, Secretary, Pandora. 1st Tuesday
monthly.
SANDUSKY — J. L. Zimmerman, President, Memorial Hospital,
Fremont ; Mrs. Patsy J. Askins, Executive Secretary, Me-
morial Hospital, Fremont 43420. 3rd Wednesday, monthly.
WILLIAMS — Donald F. Cameron, President, Central Drive,
Bryan ; John E. Moats, Secretary, Central Drive, Bryan.
WOOD — Roger A. Peatee, President, 140 S. Prospect Street,
Bowling Green 43402 ; William B. Elderbrock, Secretary,
Health Service, Bowling Green State University, Bowling
Green 43402. 3rd Thursday monthly.
Fifth District
Councilor: P. John Robechelc, Cleveland 44106
10525 Carnegie Ave.
ASHTABULA — Harmon O. Tidd, President, 362 Rogers Place,
Ashtabula; William F. Doran, Secretary, 241 Mill St., Con-
neaut. 2nd Tuesday, monthly.
CUYAHOGA — William F. Boukalik, President, 20030 Scottsdale
Blvd., Cleveland; Mr. Robert A. Lang, Executive Secretary,
10525 Carnegie Avenue, Cleveland 6.
GEAUGA — Bruce F. Andreas, President, 400 Downing Drive,
Chardon 44024; Arturo J. Dimaculangan, Secretary, 8400 May-
field Road, P. O. Box 277, Chesterland 44026. 2nd Friday
monthly.
LAKE — Robert W. Colopy, President, 89 E. High Street, Paines-
ville 44077 ; Mrs. Owen A. McLaren, Executive Secretary,
7408 Cadle Avenue, Mentor 44060. 4th Wednesday evening
monthly, January, May, March, September and November
unless otherwise ordered by Council.
Sixth District
Councilor: Edwin R. Westbrook, Warren 44481
438 North Park Ave.
COLUMBIANA — Peter Cibula, President, 356 E. Lincoln Way,
Lisbon ; Ernst P. Schaefer, Secretary, 412 N. Lincoln Ave.,
Salem. 3rd Tuesday, monthly.
MAHONING — John J. McDonough, President, 1005 Belmont
Ave., Youngstown 44504 ; Mr. Howard C. Rempes, Executive
Secretary, 1005 Belmont Ave., Youngstown 44504. 3rd
Tuesday, monthly, except July and August.
PORTAGE — George R. Sprogis, President, Hiram College, Hi-
ram; William Brinker, Secretary, 141 East Main Street, Kent.
3rd Tuesday at 9 P.M., monthly.
STARK — Harold J. Bowman, President, 515 - 3rd St. N. W.,
Canton 44703; Mr. J. H. Austin, Executive Secretary, 405
Fourth St., N. W., Canton 44702. 2nd Thursday, monthly.
SUMMIT — James G. Roberts, President, 655 West Market Street,
Akron 44303 ; Mr. Sidney H. Mountcastle, Executive Secretary,
437 Second National Building, 159 South Main Street, Akron
44308. 1st Tuesday monthly.
TRUMBULL — John Schlecht, President, Trumbull Memorial
Hospital, Warren ; Mrs. Kay Ticknor, Executive Secretary,
318 N. Park Ave., Warren. 3rd Wednesday, monthly.
Seventh District
Councilor: Benj. C. Diefenbach, Martins Ferry 43935
30 S. 4th St.
BELMONT — Robert N. Lewis, President, 100 W. Main SLreet, St.
Clairsville; Bertha M. Joseph, Secretary, 100 S. 4th St.,
Martins Ferry. 3rd Thursday, monthly.
CARROLL — Jack L. Maffett, President, 264 SouLh Lisbon Street,
Carrollton; Thomas J. Atchison, Secretary, 292 East Main
Street, Carrollton. 1st Thursday, monthly.
COSHOCTON — Don G. Warren, President, 600 E. Main St.,
West Lafayette; H. W. Lear, Secretary, 133 S. 4th St.,
Coshocton. 2nd Tuesday, monthly.
HARRISON — Elias Freeman, President, 259 Jamison Ave.,
Cadiz; Richard W. Weiser, Secretary, Main and Cadiz Sts.,
JEFFERSON — Jacob R. Cohen, President, 341 Market Street,
Steubenville 43952 ; Irving Dreyer, Secretary, P. O. Box 308,
Steubenville 43952. 4th Tuesday monthly except December,
January, February.
MONROE— Byron Gillespie, Secretary, S. Main St., Woodsfield.
TUSCARAWAS — S. H. Winston, President, 658 Boulevard,
Dover; G. W. Johnston, Secretary, 658 Boulevard, Dover.
2nd Thursday, monthly.
Eighth District
Councilor : Robert C. Beardsley, Zanesville 43705
2236 Maple Ave.
ATHENS — Robert E. Main, President, 400 East State Street,
Athens ; Lester A. Hamilton, Secretary, 400 East State Street,
Athens. 2nd Tuesday at noon, monthly.
FAIRFIELD — George W. LeSar, President, 216 Harmon Avenue,
Lancaster 43130 ; Stephen R. Hodsden, Secretary, 1423 West
Market Street, Baltimore 43105. 2nd Tuesday monthly.
GUERNSEY — M. Hnatiuk, President, 24 Mill St., Senecaville ;
Dayle O. Snyder, Secretary, 840 Wheeling Ave., Cambridge.
LICKING — Carl L. Petersilge, President, 104 Hudson Avenue,
Newark 43055 ; Robert P. Raker, Secretax-y, 317 N. Granger
Street, Granville 43023. 4th Tuesday monthly.
MORGAN — A. H. Whitacre, President, Chesterhill ; Henry
Bachman, Secretary, Box 199, Malta.
MUSKINGUM — Paul A. Jones, President, 838 Mai’ket Street,
Zanesville 43701 ; Myron Powelson, Secretary, 2825 Maple
Avenue, Zanesville 43705. 2nd Tuesday monthly.
NOBLE — F. M. Cox, President, Caldwell; E. G. Ditch, Secretary,
Caldwell. 2nd Tuesday, monthly.
PERRY— O. D. Ball, President, 203 N. Main St., New Lexing-
ton ; Michael P. Clouse, Secretary, W. Main St., Somerset.
WASHINGTON — Donald Fleming, President, Vincent: Archbold
M. Jones, Jr., Secretary, 326 Third St., Marietta.
Ninth District
Councilor: George N. Spears, Ironton 45638
2213 S. 9th St.
GALLIA— -Leonard Harris, President, Holzer Clinic, Gallipolis •
James A. Kemp, Secretary, Holzer-Clinic, Gallipolis. Quar-
terly meetings at called times.
HOCKING— Jan S. Matthews, President, 9 E. Second St.,
Logan ; Howard M. Boocks, Secretai’y, Route 3, Logan. 1st
Tuesday, monthly.
— A- Hambrick, President, Wellston ; John C.
r~?~?nnan’ Secretary, Oak Hill. Meeting date varies.
LAWRENCE — Vallee W. Blagg, President, 1805 S. 4lh St,
fronton ; George Newton Spears, Secretary, 2213 S. 9th St.,
Ironton. Quarterly meetings.
MEIGS — Selim J. Blazewicz, President, Lasley St., Pomeroy ;
Roger P. Daniels, Secretary, 110 Ebenezer St., Pomeroy. Ap-
proximately once monthly.
PIKE — A. M. Shrader, President, E. Water St., Waverly ; K.
A. Wilkinson, Secretary, 330 E. North St., Waverly ’ 1st
Tuesday, monthly.
SCIOTO — Chester H. Allen, President, 1405 Offnere Street
Portsmouth 45662 ; Erich Spiro, Secretary, 1735 Waller Street’
Portsmouth 45662. 2nd Monday in February, April and Octo-
ber; December meeting and summer meeting decided by the
Council and members notified one month in advance.
VINTON — Richard E. Bullock, President, 203 S. Market St
McArthur; David Caul, Secretary, 107 W. Main St., McArthur!
Called meetings.
Tenth District
Councilor: Richard L. Fulton, Columbus 43212
1211 Dublin Rd.
DELAWARE — Robert S. Caulkins, President, 265 West Lincoln
Avenue, Delaware; Tennyson Williams, Secretary, Box 266,
Delaware. 3rd Tuesday at 6:30 P.M., monthly.
FAYETTE — Thomas J. Hancock, President, 220 E. Market St.,
Washington C. H. ; Marvin H. Roszmann, Secretary, 1005 E.
Temple St., Washington C. H. 2nd Friday, monthly.
FRANKLIN — Joseph A. Bonta, President, 1607 Neil Avenue,
Columbus 43201 ; Mi’. W. “Bill” Webb, Jr., Executive Secre-
tary, 79 East State Street, Room 601, Columbus 43215. 3rd
Tuesday monthly.
KNOX — Richard L. Smythe, President, Medical ArLs Building,
Mt. Vernon ; Robert E. Sooy, Secretary, 426 WoosLer Road,
Mt. Vernon.
MADISON — Francis E. Rosnagle, President, 98 Flax Dr., Lon-
don; Jack Grant, Secretary, Madison County Hospital, London.
Quartei’ly 2nd Wednesday of month.
MORROW — Joseph F. Ingmii-e, President, 28 West High Street,
Mt. Gilead; Frank Sweeney, Secretary, 46 South Main Street,
Mt. Gilead. 1st Tuesday, monthly.
PICKAWAY — V. D. Kerns, President, 143 E. Main Street,
Circleville 43113 ; Carlos Alvarez, Secretary, 147 Pinckney
Street, Circleville 43113. 1st Friday evening monthly, except
months of July and August.
ROSS — Joseph McKell, President, 174 W. Main Sti-eet, Chilli-
cothe 45601 ; Lowell O. Smith, Secretary, 217 Delano Avenue,
Chillicothe 45602. 1st Thursday evening monthly.
UNION — Malcolm Maclvor, President, 110 N. Court St.,
Marysville; May B. Zaugg, Secretary, 130 N. Maple St.,
Marysville. 1st Tuesday of February, April, October and
December.
Eleventh District
Councilor: William R. Schultz, Wooster 44691
1749 Cleveland Road
ASHLAND — Henry C. Chalfant, President, 309 Arthur Street,
Ashland 44805 ; H. W. Smith, Secretary, 414 Samaritan Ave-
nue, Ashland 44805. 1st Thursday monthly.
ERIE— Fred Lavender, President, 1218 Cleveland Road, San-
dusky ; Robert D. Gillette, Secretary, P. O. Box 127, Huron.
Alternate 3rd Tuesday and Thursday, monthly.
HOLMES — Owen F. Patterson, President, 8 N. Clay St., Mil-
lei’sburg ; William A. Powell, Secretary, W. Adams St.,
Millersburg. 2nd Wednesday, monthly.
HURON — William B. Holman, President, 257 Benedict Ave.,
Norwalk ; Earl R. McLoney, Secretary, 267 Benedict Ave.,
Norwalk. 2nd Wednesday evening of February, April, June,
August, October and December.
LORAIN — John W. Wherry, President, 632 Cleveland St.,
Elyria ; Mrs. Gladys Davidson, Executive Secretary, 428 West
Ave., Elyria. 2nd Tuesday.
MEDINA — Myrl A. Nafziger, President, Albrecht Building,
Wadsworth 44281 ; Mr. A. Dana Whipple, Executive Secretary,
320 East Liberty Street, Medina, Ohio 44256. 3rd Thursday
monthly.
RICHLAND — Stanley L. Brody, President, 327 Park Ave W.,
Mansfield; Wendell M. Bell, Secretary, 480 Glessner Ave.,
Mansfield. 3rd Thursday, monthly.
WAYNE — Howard MacMillan, President, 1740 Cleveland Road,
Wooster 44691 ; R. J. Watkins, Secretary, 1736 Beall Avenue,
Wooster 44691. 2nd Wednesday monthly, January, February,
April, September, November and December.
for January, 1966
85
Table of Contents
( Continued From Page 3 )
Page
19 Spring Pediatrics Course Offered by Ohio State
University
19 Professional Placement Service for Nurses Is
Maintained
24 Regular Medical Expense Insurance on Increase
24 Ohio Among Top States in Number of Health
Insurance Groups
30 Two Ohioans Scheduled to Participate in
Washington Diabetes Program
59 Dr. Sherburne Memorialized at AMA
Philadelphia Meeting
6l Physicians Invited to Attend Annual OB-Gyn
Lectures in Akron
63 Cleveland Clinic Foundation Offers Courses
64 OSU College of Medicine Announces Courses
64 Blue Shield Plan Membership Reaches All-Time
High
66 M. D.’s in the News
66 Bureau of Workmen’s Compensation
Desperately Needs Doctors
68 Obituaries
70 Prescription Drug Manufacturers Name
Association President
72 Activities of County Medical Societies
Mahoning County Health Care Symposium
(Page 75)
76 New Members of Association
76 Current Comments in the Field of the Drug
Manufacturers
78 Woman’s Auxiliary Highlights
80 Roster of Officers of the Woman’s Auxiliary
to OSMA
83 Roster of OSMA Officers and Committeemen
84 Roster of County Medical Society Officers and
Meeting Dates
86 The Journal’s Advertisers in This Issue
87 Classified Advertisements
The Southwestern Ohio Society of Family Physi-
cians sponsored a seminar on "Gastroenterology —
New Considerations of Old Problems” on December 5
in cooperation with the University of Cincinnati Col-
lege of Medicine.
JOURNAL ADVERTISERS
Advertisers in The Journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The Journal,
and help make it a quality publication. In return we
place their messages on the desks of Ohio’s physicians.
Please familiarize yourself with their services and pro-
ducts, and let them know that you see their advertising
in The Journal.
In This Issue :
Abbott Laboratories 11 - 12 - 13 - 14
Allergy Laboratories of Ohio, Inc 74
Ames Company, Inc Inside Back Cover
Appalachian Hall 10
Blessings, Inc 68
Brown Pharmaceutical Company, The 77
Burroughs Wellcome & Co. (USA) Inc 88
Cameron-Miller Surgical Instruments Co 77
Chicago Medical Society 20
Daniels-Head & Associates, Inc 70
Endo Laboratories, Inc 81
Geigy Pharmaceuticals, Division of
Geigy Chemical Corporation 79
Glenbrook Laboratories (Bayer Aspirin) 6
Harding Hospital 20
Health-Mor, Incorporated (Filter Queen) 27-29
Hynson, Westcott & Dunning, Inc 1
Inland Steel Company 87
Lederle Laboratories, A Division of
American Cyanamid Company 4-5, 26, 71
Lilly, Eli, and Company 32
Medical Protective Company, The 10
Merck Sharp & Dohme, Division of
Merck & Co., Inc 69
North, The Emerson A., Hospital 7
Parke, Davis & Company Inside Front Cover
Readjustment Center, The 76
Roche Laboratories, Division of
Hoffmann-LaRoche Inc Back Cover
Roerig, J. B. & Company,
Division, Chas. Pfizer & Co 21
Searle, G. D., & Company 56 - 57
Smith Kline & French Laboratories 22
Turner & Shepard, Inc 72
Tutag, S. J., & Company 23
U. S. Vitamin & Pharmaceutical Corporation.... 15
Wallace Laboratories 24-25, 31
Warner- Chilcott 16 - 17
Wendt-Bristol Company, The 73
Windsor Hospital 82
Winthrop Laboratories 2
86
The Ohio State Medical Journal
OHIO STATE MEDICAL
^carnal
VOL. 62 FEBRUARY, 1966 NO. 2 g
OSMA OFFICERS gj
President H
Henry A. Crawford, M. D. g
1058 Hanna Bldg., Cleveland 44115 g
President-Elect g
Lawrence C. Meredith, M. D. g
205 Elyria Block, Elyria 44035 g
Past-President g
Robert E. Tschantz, M. D. j
515 Third St., N. W., Canton 44703 g
T reasurer g
Philip B. Hardymon, M. D. g
350 E. Broad St., Columbus 43215 g
EDITORIAL STAFF
Editor
Perry R. Ayres, M. D.
Managing Editor and
Business Manager
Hart F. Page
Executive Editor and
Executive Business Manager
R. Gordon Moore
OSMA EXECUTIVE STAFF
Executive Secretary
Hart E. Page
Director of Public Relations and
Assistant Executive Secretary
Charles W. Edgar
Administrative Assistants
W. Michael Traphagan
Herbert E. Gillen
Address All Correspondence: H|
The Ohio State Medical Journal g
79 E. State Street jj
Columbus, Ohio 43215 M
Published monthly under the direction of The
Council for and by members of The Ohio State
Medical Association, 79 E. State Street, Columbus,
Ohio 43215, a scientific society, nonprofit organi-
zation, with a definite membership for scientific
and educational purposes.
Subscription, $6.00 per year to non-members;
single copy, 50 cents (outside Continental U.S.,
$7.50 and 75 cents).
Entered as second class matter July 5, 1905, at
the Postoffice at Columbus, Ohio, under the Act
of Congress of March 3, 1879; Acceptance for
mailing at special rate of postage provided for in
Section 1103, Act of Oct. 3, 1917. Authority
July 10, 1918.
The Journal does not assume responsibility for
opinions expressed by the essayists. Advertisers
must conform to policies and regulations estab-
lished by The Council of the Ohio State Medical
Association.
Table of Contents
eage Scientific Section
125 Emotional Problems of Children Attending a Heart
Clinic. Bernard Schwartz, M. D., Cincinnati;
Brian J. McConville, M. D., Kingston, Ontario,
Canada, and Sandra Tonkin, B. A., Cincinnati.
129 Abstracts from Regional Meeting of American College
of Physicians.
137 Predicting Severity of Erythroblastosis. Lucius F.
Sinks, M. D., Cambridge, England; Colin R. Mac-
pherson, M. D., J. Philip Ambuel, M. D., Colum-
bus; Warren E. Wheeler, M. D., Lexington, Ken-
tucky; William E. Copeland, M. D., and William
C. Rigsby, M. D., Columbus.
141 What About Nose Drops in Kids? Controlled Study
of Xylometazoline — A New Nasal Decongestant.
H. P. Sengelmann, M. D., Columbus.
143 A Clinicopathological Conference from The Ohio
State University Hospital, Columbus, Ohio.
118 The Historian’s Notebook: Levi Rogers. Frontier
Doctor, Pastor, and Statesman. (Part I.) Phil-
lips F. Greene, M. D., New Richmond.
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
Special Features
94 Ohio’s Vital Statistics
104 World Impact of American Medical Journalism
112 Three of 54 Ohio Senior Physicians Honored in 1965
News and Organization Section
150 Proceedings of The Council
159 Application for Space in the Scientific Exhibit,
1966 OSMA Annual Meeting
160 1966 Annual Meeting Highlights a New Look
165 Hotel Reservation Form for OSMA Annual Meeting
168 New Drug Abuse Law
170 OMPAC Memberships Rolling In
(Continued on Page 190)
STONEMAN PRESS, COLUMBUS, OHIO
[printed"!]
IN U-S-A-J]
in respiratory infections
for broad-spectrum performance
above and beyond the activity of
ordinary' tetracyclines
greater potency
lower mg intake per day
600 mg versus 1,000 mg
higher activity
higher activity levels with less peak-and-valleyfluctuation
(Adapted from Sweeney, W. M.; Dornbush, A. C. and Hardy, S. M.: Demethylchlor-
tetracyclineand Tetracycline Compared Amer. J.Med. Sci. 243:296 (Mar ) 1962 )
1-2 days’extra”
activity
It’s made for b.i.d.
Effective
wide
of
sunlight
m
in
range
— respiratory, urinary tract and others — in th
young and aged— the acutely or chronically ill-
when the offending organisms are tetracycline-
sensitive.
Side effects typical of tetracyclines include glos-
sitis, stomatitis, proctitis, nausea, diarrhea, vagi-
nitis, dermatitis, overgrowth of nonsusceptible
organisms, tooth discoloration (if given during
tooth formation) and increased intracranial pres-
sure (in young infants). Also, very rarely ana-
phylactoid reaction. Reduce dosage in impaired
renal function. Because of reactions to artificial
exposure
, ouwuu ww warned to
ect exposure. Stop drug immediately at
sign of adverse reaction, it should not
iken with high calcium drugs or food; and
d not be taken less than one hour before,
hours after meals.
Capsules, 150 mg and 75 mg of demethylchlor-
tetracycline HCI.
Tablets, fiim coated, 300 mg and 150 mg of
demethylchlortetracycline HCI.
Average Adult Daily Dosage .* 150 mg q.i.d. or
300 mg b.i.d.
LEDERLE LABORATORIES, A Division of AMERICAN CYANAMID COMPANY, Pearl River, N. Y.
Ohio’s Vital Statistics
• • •
Interesting Information Is Included in the Annual
Statistical Report of the Ohio Department of Health
"^HE 1964 Annual Report on "Vital Statistics’’
being a summary of information compiled by
the Ohio Department of Health’s Division of
Vital Statistics was recently released by Dr. Emmett
W. Arnold, Department director.
T
Population
In 1964, the July 1 estimate of population for
Ohio was 10,425,175, an increase of 158,971 or 1.5
per cent over the 10,266,204 estimate for July 1,
1963. An excess of births over deaths (net natural
increase) accounted for 115,871 or approximately 73
per cent of this increase.
The 1964 mid-year population estimates for the
State, counties and cities were used to compute rates
based on population shown in this report.
Live Births
There were 209,480 live children born to mothers
residing in Ohio during 1964, 3,103 fewer than were
born in 1963. This is the seventh consecutive year
that the actual number of births has been less than
the preceding year’s total. The live birth rate was
20.1 per 1,000 population in 1964, slightly less
than the 20.7 rate in 1963 and the lowest in the
State since the rate of 19.2 in 1945.
During 1964, there were 108,467 male and 102,013
female resident births in Ohio. The sex ratio of
1,063 males for every 1,000 females was slightly
higher than the sex ratio of 1,058 males to 1,000
females in 1963.
White births totaled 187,096 in 1964. This is
a decrease of 1,871 from the 189,967 white births
in 1963. Nonwhite births decreased 432 in num-
ber from the previous year. The number of nonwhite
births for 1963 and 1964 were 22,6l6 and 22,384,
respectively. The white birth rate decreased from
20.2 in 1963 to 19.6 per 1,000 white population in
1964. The nonwhite rates showed a very slight de-
crease from 26.8 in 1963 to 26.2 per 1,000 nonwhite
population in 1964. The nonwhite birth rate is 34
per cent higher than the white rate for the year 1964.
Natural Increase
For the calendar year 1964, the natural increase
in the population (excess of births over deaths) was
112,925 giving a total resident birth rate which ex-
ceeded the death rate by 10.9 per 1,000 population.
For the white population, the rate of increase was
10.4 per 1,000 and for the nonwhite population,
16.5 per 1,000.
In 1964, there were 205,188 single and 4,292
plural resident live births in Ohio; 4,220 were bom
in twin deliveries and 72 were born in higher order
deliveries. The plurality rate of 20.5 per 1,000
live births was similar to the rate of 20.0 in 1963.
Illegitimate live births increased from 11,561 in
1963 to 12,775 in 1964. The illegitimacy ratio of
61.0 per 1,000 live births represents a 12 per cent
increase over the ratio of 54.4 in 1963.
Over 25 per cent of the total number of live births
to resident mothers of Ohio were first born children,
and about 22 per cent were second births.
Women between the ages of 20-29 years were re-
sponsible for over 60 per cent of the total number of
live births. Mothers in the age group 20-24 years
represented 36 per cent of this figure, while 26 per
cent is accounted for by those in the age group 25-29
years. There were 289 births to mothers under 15
years of age and 215 births to mothers 45 years of
age and over.
Premature Births
Premature births, those with a birth weight of
2,500 grams or less, totaled 16,514 or 7.9 per cent
of all Ohio resident live births in 1964. The pre-
mature birth rate of 78.8 per 1,000 live births,
showed no appreciable difference from the 1963
premature rate of 78.4.
In 1964, the number of resident fetal deaths re-
ported were 2,953 - — -30 less than were reported in
Ohio during the year 1963. The fetal death rate of
14.1 per 1,000 live births was the same for both of
the years 1963 and 1964.
Infant Deaths
Ohio’s resident infant deaths decreased from 4,938
in 1963 to 4,614 in 1964. The infant death rate
per 1,000 live births also showed a decline from
23.2 in 1963 to 22.0 in 1964. The nonwhite infant
death rate of 35.6 per 1,000 live births was 74.5
per cent higher than the white death rate of 20.4 per
1,000 live births.
Deaths peculiar to early infancy accounted for
2,971 or 64.4 per cent of the 4,6l4 deaths under one
94
The Ohio State Medical Journal
WHAT DOCTOR
WOULDN'T
LIKE TO
SAVE TIME?
NOW! Apply SEVEN antigens AT ONCE with this
NEW ALLERGY TEST KIT
This modern-method allergy testing kit saves you time . . . allow-
ing you or your nurse to apply seven different antigens to the skin
at one time. The easy three-step kit contains 42 Antigens, selected
for their clinical significance in your area. After applying drops, skin
is punctured superficially through the drops. Reactions will appear in
10 to 15 minutes. It’s economical, fast . . . allowing you to manage
allergy diagnosis with minimum time and cost.
Write or phone today for price list and information on
therapeutic allergens.
ALLERGY
LABORATORIES
OF OHIO, INC.
150 EAST BROAD STREET — COLUMBUS 15, OHIO
for February, 1966
95
year of age. Congenital malformations were the
cause of 759 infant deaths. There were 494 deaths
due to diseases of the respiratory system, 105 due
to accidents, and 93 due to disease of the digestive
system.
Neonatal deaths (those occurring within the first 27
days) accounted for 3,560 or 77.1 per cent of all in-
fant deaths for the year 1964 in Ohio. In 1963,
3,775 or 76.4 per cent of the infant deaths were re-
ported as neonatal deaths.
Maternal Deaths
In Ohio, the 58 maternal deaths in 1964 resulted
in a resident maternal death rate of 2.8 per 10,000
live births, slightly lower than the 63 deaths with the
rate of 3.0 per 10,000 live births in 1963.
Deaths — All Causes
There were 96,555 deaths among residents of Ohio
in 1964, a decrease of 412 over the 1963 total of
97,967. The crude death rate of 9-3 per 1,000
population in 1964 differed slightly from the 1963
rate of 9.5.
Marriages and Divorces
The year 1964 showed an increase of 1,304 mar-
riages over the previous year. There were 74,979
marriages performed in Ohio in 1964 representing a
marriage rate of 7.2 per 1,000 population.
In Ohio, there were 25,053 divorces and annul-
ments reported for the year 1964, an increase of 5.6
per cent over the 23,731 granted in 1963.
Life Insurance Research Fund
Helps Projects in Ohio
Several Ohio research projects have been promoted
by grants from the Life Insurance Medical Research
Fund, according to the annual report marking the
20th anniversary of the fund. Among Ohio projects
mentioned in the report are the following:
Metabolism of Catecholamines in Septic Shock,
Thomas E. Gaffney, University of Cincinnati College
of Medicine, $18,700.
Mechanisms of Action of Vasoactive Peptides,
Especially Angiotensin, Dr. Philip A. Khairallah,
Cleveland Clinic Foundation, $24,200.
Factors Influencing Cardiac Output in Man, Dr.
James V. Warren, Ohio State University College of
Medicine, $11,000.
Intracardiac Valve Prostheses, Dr. Frederick S.
Cross, St. Luke’s Hospital, Cleveland, $7,700.
Biosynthesis of Cholesterol Precursors, Harry Rud-
ney, Western Reserve University School of Medicine,
$20,240.
Dr. G. W. Ryall, Shaker Heights, recently pre-
sented a paper on "The Classification of Headaches
and Their Relation to Allergy,’’ at the International
Congress of Otolaryngology in Tokyo, Japan. The
stopover in Japan was made while Dr. and Mrs.
Ryall were on a trip around the world.
Current Comments in the Field
Of the Drug Manufacturers
The following excerpts of comments from various
sources are presented in behalf of the Pharmaceutical
Manufacturers Association and drug manufacturing
firms in general.
$ $ $
A new dmg may not be shipped across state bor-
ders for administration to a human until the sponsor
of the drug (who may be the investigator) has filed
a request for exemption for such use with the FDA.
He must describe and identify the source of the drug
and its manufacturer; he must describe previous ani-
mal studies with the drug to show that it is reasonably
safe to initiate human studies; he must give evidence
of his professional qualifications and his facilities for
investigation.
Finally, the investigator must certify that he will
obtain consent from the persons receiving the drug
except where this is not feasible or, in the investi-
gator’s best judgment, is contrary to the best interest
of the subjects. The sponsor must also make progress
reports at appropriate intervals, not exceeding a pe-
riod of one year. He must promptly report any
adverse effect which is reasonably regarded as due
to the drug. He must maintain records for a period
of two years after the drug has been approved or
disapproved, or after his investigations have been
discontinued. — Joseph F. Sadusk, Jr., M. D. to As-
sociation of Military Surgeons, November 17, 1965.
❖ * *
Since there is no such thing as an absolutely safe
dmg, nor is there a dmg that will prove effective
in every patient in which it is used, the best we can
achieve is a balance; that is, where potential benefit
outweighs potential risk. It should be stressed that
the benefit-risk ratio is not a constant. The scientist
can afford a larger risk in a severe disease for which
there is no completely effective therapy, for example,
in leukemia, than he can in a relatively benign dis-
order. — FDA Commissioner George P. Larrick in
Emory University Quarterly, (21:95), Summer 1965.
^ ^
Drugs of the future will be better tolerated by
patients and will act with greater specificity. In the
field of radiology, new agents will facilitate x-ray
diagnostic procedures of the brain. Space medicine
research promises to bring a beneficial fall-out of
drugs for use in vestibular malfunctions, protection
from harmful radiation, and reduction in fatigue.
Other exotic areas of research may produce com-
pounds that offer protection from extreme heat, and
others from extreme cold. A pill that would repel
insects is another possibility. The future of drug re-
search was never brighter. The results will add to
man’s longevity, and will reduce the discomfort,
suffering, and disability of disease. — Austin Smith,
M. D., in Emory University Quarterly, (21:141),
Summer 1965.
96
The Ohio State Medical Journal
coughing ahead . . .
Clear the Respiratory Tract with Robitussin
Much more than just a slogan, "clear the tract" reflects the dependable
antitussive-expectorant action of the three Robitussin formulations.
All contain glyceryl guaiacolate, the time-tested expectorant
that greatly enhances the output of lower respiratory tract fluid.
Increased RTF volume exerts a demulcent effect on the tracheobronchial
mucosa, promotes ciliary action, and makes thick, inspissated
mucus less viscid and easier to raise. Glyceryl guaiacolate is safe,
non-narcotic, and almost universally accepted by patients of all ages.
NOW!
FORMULAS
THREE
ROBITUSSIN®
ROBITUSSIN
FORMULATIONS
ROBITUSSIN
ROBITUSSIN A-C
ROBITUSSIN-DM
in each 5 cc. teaspoonful:
Glyceryl guaiacolate
(Alcohol 3.5%)
100 mg.
ROBITUSSIN® A-C
EXPECTORANT
•
•
•
(exempt narcotic)
in each 5 cc. teaspoonful:
Glyceryl guaiacolate
100 mg.
Pheniramine maleate
7.5 mg.
DEMULCENT
•
•
•
Codeine phosphate
10.0 mg.
(warning: may be habit forming)
(Alcohol 3.5%)
COUGH SUPPRESSANT
•
•
ROBITUSSIN® -DM
new, non-narcotic
in each 5 cc. teaspoonful:
Glyceryl guaiacolate
100 mg.
ANTIHISTAMINE
•
Dextromethorphan hydrobromide 15 mg.
Robitussin and Robitussin-DM are avail-
able at pharmacies everywhere on your
LONG-ACTING
•
prescription or recommendation.
(6-8 hours)
A. H. Robins Company, Inc. Richmond, Va.
OUR PHOTO:
Engine No. 89 of the Monadnock, Steamtown
& Northern Railway pulls a trainload of
steam enthusiasts through the New England
AH-
ROBINS
countryside between Bellows Falls and Chester, Vermont.
ONE OF THE ROBUUSSII' FORMULAS
11:47 pm 11:53 pm 12:06 am
The meaningful pause. The energy
it gives. The bright little lift.
Coca-Cola with its never too sweet
taste, refreshes best. Helps people
meet the stress of the busy hours.
This is why we say
TRAOE-MARK (g)
things go
better,i
.-with
Coke
JVppaladjiait |SjaIl
Established 1916
Asheville, North Carolina
An institution for the diagnosis and treatment of psychiatric and neurological illnesses,
rest, convalescence, drug and alcohol habituation. There are ample facilities for classification
of patients
Insulin coma, electroshock, psychotherapy, occupational and recreational therapy are employed. The
hospital is equipped with complete laboratory facilities, including electroencephalography and x-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town in the beautiful Smoky
Mountain Range, an ideal location for rehabilitation.
WM. RAY GRIFFIN, Jr., M. D. MARK A. GRIFFIN, Sr., M. D.
ROBERT A. GRIFFIN, M. D. MARK A. GRIFFIN, Jr., M. D.
For rates and further information write APPALACHIAN HALL, Asheville, N. C.
100
The Ohio State Medical Journal
She's on a diet.
She's discouraged.
She needs your help.
You can encourage her
with DEXAMYL®
brand of dextroamphetamine
sulfate and amobarbital
/Dexamyl/ is the mood-lifting
anorectic; it not only assures
unexcelled control of appetite
but also improves outlook.
Formula: Each 'Dexamyl' Spansule®
(brand of sustained release capsule)
No. 1 contains 10 mg. of Dexedrine®
(brand of dextroamphetamine sulfate)
and 1 gr. of amobarbital, derivative
of barbituric acid [Warning, may be
habit forming]. Each 'Dexamyl' Span-
sule capsule No. 2 contains 15 mg. of
Dexedrine (brand of dextroampheta-
mine sulfate) and IV2 gr. of amobarbi-
tal [Warning, may be habit forming].
Principal cautions and side effects:
Use with caution in patients hyper-
sensitive to sympathomimetics or
barbiturates and in coronary or
cardiovascular disease or severe hy-
pertension. Insomnia, excitability and
increased motor activity are infre-
quent and ordinarily mild. Before
prescribing, see SK&F product Pre-
scribing Information. Smith Kline &
French Laboratories, Philadelphia Sfc
for February, 1966
101
“Sponsored Funds"" Putting Strain
On Medical School Finances
The total dollar amount of medical school expen-
ditures from funds for regular operations (expendi-
tures for sponsored programs excluded) reached a
new high in 1964, according to a report of the Di-
vision of Operational Studies of the Association of
American Medical Colleges.
Expenditures for regular operations of a medical
school are derived from funds that are under the con-
trol of the medical school and serve as the primary
support of education and sendee functions of the
school. The source of these funds is mainly from
tuition and fees, state and city appropriations and
subsidies, unrestricted gifts and grants, endowment
income, transfers from general university funds, and
income from the service activities of the school.
Expenditures from funds for regular operating pro-
grams have shown steady annual increases but in
spite of this fact medical school deans and university
administrative officers are finding it progressively
more difficult to meet the increasing costs of educa-
tion, service, and research activities.
The marked growth in sponsored funds, devoted
mainly to research and research training, has also
placed an increased financial burden on the medical
schools because sponsored funds (restricted gifts and
grants) rarely, if ever, completely support programs
for which the funds are designated.
However, benefit to the regular operating programs
is derived from the utilization of personnel and
facilities that are supported by sponsored program
expenditures.
The funds available to medical schools for the
support of their regular operating programs are con-
sidered as "hard cash” income and constitute the pri-
mary source of support for growth and development.
In the five year period from 1959 to 1964 the
annual level of expenditures from funds for regu-
lar operating programs has increased from $175
million to $286 million. In 1959, individual school
expenditures ranged from $648,000 to $5,956,000.
In 1964, school expenditures ranged from $939,000
to $8,811,736.
The number of schools that have expenditures of
more than $3 million from funds for regular operat-
ing programs has grown from 15 in 1959 to 44
in 1964.
Even with the increases already achieved there re-
main several inadequately financed schools. Fur-
thermore, the fulfillment of the predicted increased
manpower requirements will demand significantly
greater expenditures.
Dr. Harman A. Shecket, Cleveland, was elected
a trustee of the American College of Gastroenterology,
at the fall meeting of the organization in Bal Harbour,
Florida.
DEPROL
meprobamate 400 mg. +
benactyzine hydrochloride 1 mg.
Indications: ‘Deprol’ is useful in the manage-
ment of depression, both acute (reactive) and
chronic. It is particularly useful in the less
severe depressions and where the depression is
accompanied by anxiety, insomnia, agitation,
or rumination. It is also useful for management
of depression and associated anxiety accom-
panying or related to organic illnesses.
Contraindications: Benactyzine hydrochloride
is contraindicated in glaucoma. Previous aller-
gic or idiosyncratic reactions to meprobamate
contraindicate subsequent use.
Precautions: M eprobamate— Careful super-
vision of dose and amounts prescribed is
advised. Consider possibility of dependence,
particularly in patients with history of drug or
alcohol addiction; withdraw gradually after use
for weeks or months at excessive dosage. Abrupt
withdrawal may precipitate recurrence of pre-
existing symptoms, or withdrawal reactions in-
cluding, rarely, epileptiform seizures. Should
meprobamate cause drowsiness or visual dis-
turbances, the dose should be reduced and
operation of motor vehicles or machinery or
other activity requiring alertness should be
avoided if these symptoms are present. Effects
of excessive alcohol may possibly be increased
by meprobamate. Grand mal seizures may be
precipitated in persons suffering from both
grand and petit mal. Prescribe cautiously and
in small quantities to patients with suicidal
tendencies.
Side effects: Side effects associated with recom-
mended doses of ‘Deprol’ have been infrequent
and usually easily controlled. These have in-
cluded drowsiness and occasional dizziness,
headache, infrequent skin rash, dryness of
mouth, gastrointestinal symptoms, paresthesias,
rare instances of syncope, and one case each of
severe nervousness, loss of power of concen-
tration, and withdrawal reaction (status epilep-
ticus) after sudden discontinuation of excessive
dosage.
Benactyzine hydrochloride— Benactyzine
hydrochloride, particularly in high dosage, may
produce dizziness, thought-blocking, a sense of
depersonalization, aggravation of anxiety or
disturbance of sleep patterns, and a subjective
feeling of muscle relaxation, as well as anti-
cholinergic effects such as blurred vision, dry-
ness of mouth, or failure of visual accommoda-
tion. Other reported side effects have included
gastric distress, allergic response, ataxia, and
euphoria.
Meprobamate— Drowsiness may occur and,
rarely, ataxia, usually controlled by decreasing
the dose. Allergic or idiosyncratic reactions are
rare, generally developing after one to four
doses. Mild reactions are characterized by an
urticarial or erythematous, maculopapular rash.
Acute nonthrombocytopenic purpura with pe-
ripheral edema and fever, transient leukopenia,
and a single case of fatal bullous dermatitis
after administration of meprobamate and pred-
nisolone have been reported. More severe and
very rare cases of hypersensitivity may produce
fever, chills, fainting spells, angioneurotic
edema, bronchial spasms, hypotensive crises (1
fatal case), anuria, anaphylaxis, stomatitis and
proctitis. Treatment should be symptomatic in
such cases, and the drug should not be reinsti-
tuted. Isolated cases of agranulocytosis, throm-
bocytopenic purpura, and a single fatal instance
of aplastic anemia have been reported, but only
when other drugs known to elicit these con-
ditions were given concomitantly. Fast EEG
activity has been reported, usually after exces-
sive meprobamate dosage. Suicidal attempts
may produce lethargy, stupor, ataxia, coma,
shock, vasomotor and respiratory collapse.
Dosage: Usual starting dose, one tablet three or
four times daily. May be increased gradually
to six tablets daily and gradually reduced to
maintenance levels upon establishment of relief.
Doses above six tablets daily are not recom-
mended even though higher doses have been
used by some clinicians to control depression
and in chronic psychotic patients.
Supplied: Light-pink, scored tablets, each con-
taining meprobamate 400 mg. and benactyzine
hydrochloride 1 mg.
Before prescribing, consult package circular.
®. Wallace Laboratories / Cranbury, N. J.
102
^\XN V
Ss/Q
4t
^iVSIO^
I
' COMPLEX
TRY DEPROE meprobamate 400 mg. +
benactyzine hydrochloride 1 mg.
FOR DEPRESSION
American Medical Journalism
• • •
The World Is Looking to the U. S. for Medical Leadership
As Indicated by Widespread Demand for AMA Publications
UNTIL about a generation ago, the United
States imported more medical knowledge
than it exported. In popular fancy, the
American doctor was seen learning at the feet of a
bearded European professor.
Today it is different. U. S. medical science and
medical education have come of age and the United
States is a net exporter of medical theory and tech-
nique. In medicine as in many other fields the world
looks to the United States for leadership. Com-
munist nations pay us the compliment of pirating
from American medical publications.
American medical journals are an important means
of disseminating up-to-the-minute medical knowledge
throughout the world. They supplement the other
major vehicle for exportation of medical knowledge:
medical education. Thousand of foreign doctors have
been educated in American medical schools and hos-
pital postgraduate programs since the end of World
War II and most of them probably stay in contact
with American medicine through medical journals.
123 Countries
The weekly Journal of the American Medical As-
sociation, is distributed to more than 8,000 paid
foreign subscribers in 123 countries. The 10 monthly
AMA specialty journals (dermatology, surgery, in-
ternal medicine, diseases of children, environmental
health, general psychiatry, neurology, ophthalmology,
otolaryngology, and pathology) go to more than
16,000 paid foreign subscribers. Nearly 2,000 copies
of the AMA News go to selected foreign subscribers,
and Today’s Health, the AMA medical publication
for laymen, has a paid foreign circulation of nearly
10,000.
Thus, the publications of the AMA alone have
a paid foreign circulation of nearly 40,000. (Total
domestic and foreign Journal circulation is 212,504
per week; total specialty journal circulation is 222,307
per month.)
To a British physician on Harley Street, JAMA
and the specialty journals may be necessary check-
points in a week of "keeping up with the journals.”
British physicians, like American, probably read 10
to 20 medical publications regularly. To a physician
practicing in Southeast Asia, though, a single copy
of JAMA at the local hospital may be a most valued
contact with current medical thought.
Some underdeveloped nations receive only one or
two copies of JAMA through paid subscriptions, and
these often go to a hospital; but the AMA Depart-
ment of International Health estimates that nearly
every English-speaking doctor and medical techni-
The Ohio State Medical Journal
Is Circulated Abroad
The Ohio State Medical Journal, although it
is slanted primarily for physicians in Ohio, has
a substantial circulation outside of the con-
tinental limits of the United States.
In addition to copies going to Ohioans in the
Armed Forces overseas, The Journal is mailed
each month to the following places: Virgin
Islands (2), Switzerland, Sweden, South Africa
(2), Poland, the Philippines, Iran, the Nether-
lands (2), Mexico (2), Lebanon, Indonesia,
India (3), Hawaii (2), Italy, West Germany,
Finland, England (3), Chile, the Canal Zone,
Canada (7), Brazil and Australia.
This makes 38 copies of The Ohio State
Medical Journal going outside of the contin-
ental limits of the U. S. each month, or 456
copies a year. If other states are sending their
medical journals overseas in the same propor-
tion, the total may have a considerable impact
on medical thinking and medical training
abroad.
cian having access to the "hospital copy” makes an
attempt to read every issue. The estimate is made
on the basis of conversations with foreign doctors
visiting the U. S., and with U. S. physicians returning
from service in underdeveloped nations.
Multiple Readership
Nearly every major medical school and medical
library in the world also gets at least one copy of
JAMA for teaching and reference. Information volun-
teered to the AMA Department of International
Health by foreign physicians indicates that a single
library copy of JAMA may go through the hands of
40 or more readers.
Through JAMA, the AMA specialty journals, and
other professional publications physicians in Iron
104
The Ohio State Medical Journal
TRESSCAPS B and C vitamins in therapeutic amounts ... help the body
lobilize defenses during convalescence. ..aid response to primary therapy,
he patient with a severe infection, and many others undergoing physio-
)gic stress, may benefit from STRESSCAPS.
Stress Formula Vitamins Lederle
Each capsule contains:
Vitamin B i (as Thiamine Mononitrate) 10 mg.
Vitamin B2 (Riboflavin)
10 mg.
Niacinamide
100 mg.
Vitamin C (Ascorbic Acid)
300 mg.
Vitamin B6 (Pyridoxine HCI
2 mg.
Vitamin B12 Crystalline
4 mcgm.
Calcium Pantothenate
20 mg.
Recommended intake: Adults, 1
capsule
daily, for the treatment of vitamin deficien-
cies. Supplied in decorative ‘‘reminder"
jars of 30 (one month's supply)
(three months' supply).
and 100
EDERLE LABORATORIES, A Division of AMERICAN CYANAMID COMPANY Pearl River, N.Y.
Curtain countries keep in close touch with American
medical trends.
A number of Communist nations, including isola-
tionist Albania, Bulgaria, the Soviet Union, and Main-
land China, receive from one to a dozen copies of
JAMA weekly. Most of the copies go to medical
schools, where, according to the AMA Circulation
and Records Department, they often are duplicated
for wider distribution. Although the published mat-
erial in JAMA is protected by copyright, the Soviet
Union and some other Communist states do not
recognize copyright regulations.
As an indication of the extent to which the Soviet
Union duplicates JAMA, only six paid-subscription
copies are sent to the USSR but nearly every Russian
physician who visits the United States confides that
he is a regular JAMA reader.
Medical Missionaries
Hundreds of American medical missionaries in
foreign lands receive JAMA and other AMA publi-
cations free of charge. The AMA furnishes the
publications as a means of permitting these dedicated
doctors to stay abreast of medical developments and
remain in contact with main currents of American
medicine, despite their isolation from medical cen-
ters. JAMA circulation to some countries — the
Congo and New Guinea, for example - — - is all or
nearly all of this non-paid type.
Some examples of JAMA paid-subscription cir-
culation throughout the world: 1,135 copies go to
Canada. More than 200 of these are to Montreal,
and hundreds more to Toronto, Ottawa, and other
major centers of Canadian population. In the vast
northern areas of Canada a number of doctors are
served by a hospital "single copy”: one such example
is the single copy of JAMA sent to Whitehorse
General Hospital, Whitehorse, Yukon Territory.
Paid-subscription circulation of all AMA publications
in Canada is 12,045. (Canada has about 22,600
physicians, according to World Health Organization
statistics.)
The four JAMA copies going to Afghanistan are
received by two U. S. Peace Corps physicians, a
UNICEF Public Institute in the Ministry of Health,
and an American medical team operating on funds
from a private U. S. organization.
A single copy to Ocean Island in the Central
Pacific is received by the British Phosphate Com-
mission. Four Bulgarian medical institutions get five
paid-subscription copies.
Circulation in Viet-Nam (six paid-subscription
copies and many more free copies) is divided among
hospitals, individual Vietnamese doctors, medical mis-
sions, American physicians serving in Project Viet-
Nam, and the American Embassy in Saigon.
The 10 foreign nations with highest JAMA cir-
culation are Canada, 1,135; Italy, 777; Japan, 671;
England, 346; India, 338; Holland, 318; Mexico,
298; France, 275; West Germany, 260; Sweden, 250.
When elderly patients display symptoms of apathy,
mental confusion, memory lapses . . . consider LEPTINOL
Leptinol is a useful medication that deters senile mental
deterioration by stimulating the cerebral vasomotor and
respiratory centers . . . increasing pulmonary ventilation
and the supply of blood and oxygen to the brain.
Non-addicting Leptinol also is valuable in long-term
treatment, since patients do not establish a tolerance.
Each LEPTINOL bi-layer tablet contains: PENTYLENE-
TETRAZOL, 100 mg., NIACIN, 50 mg., THIAMINE HYDRO-
CHLORIDE, 1 mg., ASCORBIC ACID, 20 mg. DOSE: one or
two tablets, 3 times daily. Leptinol produces such a sense
of well-being, patients should be cautioned not to exceed
recommended dose which offers maximum effectiveness.
Side Effects: — overdosage may produce tremor, convulsions
or respiratory paralysis.
Caution should be taken when treating patients with a low
convulsive threshold.
Write for detailed literature and
starter Leptinol doses.
Vofe
THE VALE CHEMICAL COMPANY, INC.
Pharmaceuticals — Allentown, Pa
106
The Ohio State Medical Journal
The '‘Pain Is Gone
Despite introduction of synthetic substitutes, efficacy of
‘Empirin* Compound with Codeine remains unchallenged.
‘Empirin^Compound with Codeine Phosphate gr.1/2 No. 3
Each tablet contains: Codeine Phosphate gr. V2 (Warning— May be habit forming), Phenacetin gr. 2V2,
Aspirin gr. 31/2, Caffeine gr. 1/2.
Keeps the Promise of Pain Relief
BURROUGHS WELLCOME & CO. (U.S.A.) INC., TUCKAHOE, N.Y.
for February, 1966
111
Three of 54 Ohio Senior Physicians Honored in 1965
Shown at the Stark County Medical Society meeting, these physicians display the 50 -Year gold button and Certifi-
cate of Distinction presented in behalf of the Ohio State Medical Association. From left, are Dr. Howard S. Myers,
of Massillon; Dr. Loren L. Frick, North Canton; and Dr. C. J. Schirack, of Canton.
Ohio Honors 54 Senior Physicians
With Certificates of Distinction
Several years ago The Council of the Ohio State
Medical Association authorized the issuance of 50-
Year Awards to physicians in good standing in the
profession who had served with distinction as mem-
bers of the profession over a period of a half century
or more. In 1965, Certificates of Distinction and
gold buttons were issued to 54 doctors who had be-
come eligible for the awards in that year.
In most instances the awards were presented by
Councilors of respective Districts at meeting of County
Medical Societies.
The certificate reads as follows: "Certificate of
Distinction — 50 Years in the practice of medicine.
The Ohio State Medical Association is honored to
have the privilege of awarding this Certificate of
Distinction to (doctor named) in recognition of his
devotion to his patients, his contributions to the
health and wealth of the public, and his allegiance
to the principles of the medical profession as a prac-
titioner of the art and science of Medicine for Fifty
or more years.’’ Certificates are signed by the OSMA
President and Executive Secretary.
The three physicians pictured above were honored
at the annual meeting of the Stark County Medical
Society. (See write-up under Mahoning County in
the Activities of County Medical Societies for more
details about them and the presentation.)
112
The Ohio State Medical Journal
Ohio Workmen's Compensation
Actuarial Report on Funds
T
^HE Ohio Bureau of Workmen’s Compensation
during a recent two-year period paid out more
than $19 million for medical services to injured
workers, according to actuarial reports of the agency.
During the calendar year 1963, the Bureau paid
out for medical services to injured Ohio workers
$9,175,391.97, including a small amount for dental
services.
Other payments during that year, exclusive of
compensation payments, included the following
amounts: For hospital care and nursing, $15,411,-
937.74; for funeral expenses, $158,995.55; for mis-
cellaneous costs, $72,010.52; a total, including medi-
cal services, of $24,818,335.78.
These amounts include payments covering treat-
ment of injured private and public employees as well
as similar costs for occupational disease claims.
The number of claims filed for 1963 was 305,-
780; or 0.25 per cent less than in the previous year.
Medical-only claims numbered 232,286, or 76.0 per
cent of claims filed.
The average amount paid out for medical-only
claims increased from $22.67 in 1962 to $25.51 in
1963.
Figures for 1964
For the calendar year 1964, the Bureau paid out
for medical services to injured workers $9,820,389.16,
including some dental services. Other payments that
year included the following amounts: For hospital
care and nursing, $16,210,449-72; for funeral ex-
penses, $141,655.53; for miscellaneous costs, $95,-
739.07; a total including medical services of $26,-
268,233.48.
The number of claims filed for 1964 was 346,114,
or 13 per cent more than in 1963. Medical-only
claims numbered 270,901, or 78.3 per cent of claims
filed.
The average amount paid out for medical-only
claims increased from the $25.51 figure of 1963 to
$28.3 6 in 1964.
Drug Company Takes Steps To Keep
Damaged Products Off Market
Smith Kline & French Laboratories has arranged
with the nation’s principal salvage companies for the
return of Smith Kline & French products damaged
by fire or other mishap or acquired by salvage com-
panies as a result of bankruptcies.
A spokesman for the company said this policy has
been adopted so that possibly damaged SK&F pro-
ducts will not be distributed and also to help keep
SK&F products from unintentionally getting into un-
authorized dmg distribution channels.
What To Write For
Directory of Health Facilities Planning Agencies.
The 196-page directory lists existing planning agen-
cies by location with information about each. Single
copy available without cost to physicians and certain
organizations. Address, Department of Hospitals and
Medical Facilities, American Medical Association,
535 N. Dearborn Street, Chicago, Illinois 60610.
❖ ❖ ❖
Characteristics of Residents in Institutions for
the Aged and Chronically 111, Statistics on age, sex,
color, length of stay, and selected health character-
istics, based on data collected April-June, 1963. Pub-
lic Health Sendee Publication No. 1000 — Series 12
— No. 2. Order from Superintendent of Documents,
U. S. Government Printing Office, Washington, D. C.,
20402; price 40 cents.
H: H* H*
Aging Center in Sinai Hospital. One of a series
entitled "Portraits in Community Health,” being an
illustrated description of the services at Sinai Hospital
of Baltimore. Public Health Service Publication No.
1344-2, for sale by the Superintendent of Documents,
U. S. Government Printing Office, Washington, D. C.
20402 — Price 20 cents.
^ ^ ^
Immunization Information for International
Travel, revised June, 1965. Order from the Superin-
tendent of Documents, Government Printing Office,
Washington, D. C., 20402; 35 cents a copy.
* * *
Quackery’s Gray Area, a discussion of mail order
treatment of epilepsy. One of several pamphlets
available from the Epilepsy Foundation, 1419 H
Street, N. W., Washington, D. C. 20005.
He
Planning Kitchens for Handicapped Homemak-
ers. An 82-page monograph based on extensive re-
search in this field. Order from Publications Unit,
Institute of Physical Medicine and Rehabilitation,
New York University Medical Center, 400 East 34th
Street, New York, N. Y. 10016.
^ ^ ^
Cancer of the Prostate. This is the ninth in a
series of ten U. S. Public Health Service pamphlets on
cancer of different body sites, prepared for the public.
Other pamphlets in the series deal with cancer of
the breast, uterus, skin, bone, lung, stomach, larynx,
colon and rectum. Single copies of "Cancer of the
Prostate” (PHS Publication No. 1352) are avail-
able without charge from the Public Health Service,
Washington, D. C. 20201. Quantities may be or-
dered from the Superintendent of Documents, Gov-
ernment Printing Office, Washington, D. C. 20402,
at five cents a copy or $2.75 per hundred.
for February, 1966
117
The Historian's Notebook
Levi Rogers
Frontier Doctor, Pastor and Statesman
PHILLIPS F. GREENE, M. D.*
PART I
ON APRIL 4, 1815, Doctor Levi Rogers died
suddenly in his 47th year. More than 60
years later, the Clermont County historian,
H. J. Bancroft wrote of him, "In his death the spark
of life departed from one of the brightest of the
medical profession that ever lived in Ohio. Hardly
a household existed in the county where Levi Rogers
was not known in terms of kind affection and loving
memory, . . . being a noted physician of skill, cul-
ture and extensive practice.’’1 As one reviews the
record of his life this eulogy appears wholly deserved.
He was indeed a most remarkable and lovable man,
one of the ablest and most versatile of his day.
Levi Rogers was born about 1769, probably in
South Jersey near Philadelphia. As a young man he
was a circuit riding preacher of the Methodist Epis-
copal Church. His name first appears in the general
minutes for 1792; "remaining on trial. Appointed
to the Bethel N. J. circuit.” He was 23 years old.
The general minutes for 1793 state: "received into
full connection. Appointed to the Bristol, Pa. cir-
cuit.” In 1794 he was placed in charge of the Bur-
lington, New Jersey circuit and given an assistant
preacher to aid him. In 1795 he is listed as "lo-
cated,” which, in his case, meant he had resigned as
a preacher to take up other work.
In 1795 he married Anna George, the only child
of John and Sarah George of Gloucester, New Jersey.
About this time he began the study of medicine. He
and his bride may have lived with her parents. By
1797 he was attending the medical lectures at the
University of Pennsylvania. His name appears in
the class list of Dr. Benjamin Rush for 1797-1798.
He also studied under Drs. Shippen, Wise, Wister,
and Barton. He seems to have taken but the one
year. He is listed in the official records of the
University of Pennsylvania Medical School among
the nongraduates. In 1798 he began the practice of
medicine on his own in Galaway Township, Glou-
cester County, N. J., not far from the present Atlantic
City.
His father-in-law’s illness in 1797 and death the
winter of 1800-1801 probably influenced this move,
*Dr. Greene, New Richmond, is a member of the staff, Brown
County Hospital at Georgetown; Yale in China, emeritus Professor
of Surgery.
Submitted February 3, 1965.
for he had intended a second year at the University
which would have led to an M. D. degree. Levi
Rogers was designated the executor of John George’s
will. It was probated February 12, 1801. He and
his wife inherited the George farm of 152 acres.
While young Dr. Rogers was building up a prac-
tice of medicine he was also reading law and preach-
ing too. His name appears in the official records for
1801 as a justice of the peace for Gloucester County.
Levi Rogers seems to have gotten off to a good start
in South Jersey and to have had every prospect of
advancement.
However, his heart was set on moving to the new
state of Ohio. On February 3, 1802 he sold the
George farm for $1866.70. He and his wife had
bought an adjoining acre in 1801 for $12. In 1804
they sold this for $20, and with this sale the name
of Levi Rogers drops out of the Gloucester County
records.
Moves to Clermont County, Ohio
Early in 1804 they moved to Williamsburg, the
county seat of Clermont. On Feb. 14, 1804 Levi
bought for $16 lot No. 460. This was a quarter
acre standing at the top of the hill overlooking the
valley of the East Fork of the Little Miami River.
It was a heavily wooded area sloping to the south,
including at its lower end a brook. About the middle
of this lot I found a lovely little spring from which
a rill ran down to the brook. This lot was about a
quarter of a mile from the main settlement. What
a beautiful spot for their new home ! And they loved
it dearly.
Levi built a house "made of rond-poles. The door
was so low that one must stoop to pass through. The
poles were covered with clapboards held in place
by more poles on the outside. Floor it had none but
Mother Earth. Light was obtained through greased
paper stretched across 'chinks.’ Heat was secured
and cooking performed in a clay fireplace. Such, for
a time, was the abode of that gentleman and scholar,
Dr. Levi Rogers.”2
He thus became the first resident physician of Wil-
liamsburg. Here he set up his office as a "doctor of
physic and chirurgery,” a lawyer and a minister of the
gospel.
During the next two years he bought ten additional
118
The Ohio State Medical Journal
lots for which he paid a total of $185. Six of them
were on the same block as his first purchase. The
others were in the main settlement. The Williams-
burg Chair Factory now stands on two of these lots.
When in 1814 he sold all his Williamsburg property,
he was paid $300, a gain of 68 per cent.
Government Positions
The contrast between the enforcement of law and
order as he had known it in New Jersey and what
he found in Ohio caused Levi to ponder what he, as
a citizen of the new state, should undertake. The
first need was bringing offenders to court. So in
1805 when he had been but a year in Clermont
County, he stood for the office of sheriff and was
elected. In 1807 he was re-elected for another two
years. Realizing that the prosecution of cases after
they had been brought to justice at the court left
much to be desired, he stood for the office of pro-
secuting attorney, resigning as sheriff in August 1808
in order to run for this office. He was duly elected
and became the prosecuting attorney the Spring Term
of 1809, subsequently serving several terms.
Ohio State Senator
In 1811 he was elected senator from Clermont
County to the Ohio General Assembly. The 1811-
1812 Assembly was the Tenth and sat at Zanesville
from December 2, 1811 to February 21, 1812. Levi
Rogers arrived on December 10th, was duly sworn
in and plunged into the work of the Senate with his
usual vigor. The next day he was sent by the Senate
with a message to the House that, "the Senate con-
curred in their bill urging the Governor to consider
the defenseless situation of Ohio and to notify Con-
gress.” Sending a new member with a message was
the customary procedure for officially introducing him
to the other chamber. It was especially fitting that
this was Rogers’ first official assignment, for the
"defenseless situation of Ohio” was one of Levi’s
chief concerns. He considered that war with Britain
was imminent, that Ohio would be attacked from
Canada, and that the Ohio Militia was "unorganized
and unruly.” Throughout his two years in the Senate
he took a responsible part in all that related to the
War of 1812.
In his first session he worked hard for a bill "to
regulate the commissioning of officers for the Ohio
Militia,” and another "to regulate the discipline of
the Militia.” The first became deadlocked 12-12 and
the second bill lost 11-12.
When the 11th session of the Ohio General As-
sembly met in Chillicothe (December 7, 1812 -Feb-
ruary 9, 1813) Levi Rogers was a recognized leader
in the war effort. On December 31st the Assembly
appointed General Duncan McArthur of the House
and Dr. Levi Rogers of the Senate to confer with
Governor Meigs "on the problem of arms for the
Ohio Militia.” About this same time General Mc-
Arthur moved in the House and Levi Rogers spon-
sored in the Senate "A memorial that we view with
astonishment and regret the refusal of the Govern-
ments of Massachusetts and Connecticut to furnish
financial and military support in the prosecution of
the war, as asked by the President of the United
States.” The Senate vote was 13-13.
Rogers was chairman of a committee to "encour-
age volunteers for military service,” chairman of an-
other committee "to bring in a bill to increase the
efficiency of the militia,” and member of the com-
mittee of three "for devising additional taxes for the
support of the war.”
Finally, Dr. Rogers offered his services as an Army
Surgeon to the Federal Government. His friend
Gen. Duncan McArthur recommended him to the
Department of War, and Congress confirmed his ap-
pointment as Surgeon of the 19th Infantry U. S.
Army on January 28, 1813. Rogers did not receive
his official notice of this appointment until March
4th, 1813.
Ohio’s Permanent Seat of Government
Second only to his interest in the war effort was
his concern that Ohio’s permanent seat of government
be wisely chosen. Almost every area had its "fav-
ored site” but the two top contenders were Chilli-
cothe and the "high land on the East Bank of the
Scioto opposite Franklinton.” Rogers, recognized
as an intelligent, able man who had no prejudicial
connection with either Franklin or Ross County, was
made chairman of a committee to choose a site. This
appointment, coming when he had been a member
of the Senate less than a month reflects both the con-
fidence he inspired in his associates and the desire of
others to escape the responsibility of directing this
very hot issue.
(To Be Continued in March Issue)
References
1. Everts, L. J.: History of Clermont County, Ohio, Philadel-
phia: J. B. Lippincott Co., 1880, p. 142.
2. Ibid, p. 144.
ATTENTION PROGRAM CHAIRMEN: We are most anxious to receive
for consideration manuscripts, abstracts, or news items based upon lectures,
symposia, etc., presented to Ohio physicians or those presented by Ohio physicians
to other groups. — The Editor.
for February, 1966
121
Time after time, in patient after patient,
Percodan’s pain-killing action is fast, potent and
predictable. Enthusiasm for Percodan by physi-
cians is almost directly proportional to their expe-
rience with this analgesic formula. Just one
Percodan tablet usually brings relief within 5 to
15 minutes and maintains it for 6 hours or more.
It rarely causes constipation.
Average Adult Dose— 1 tablet every 6 hours.
Precautions, Side Effects and Contraindications
— The habit-forming potentialities of Percodan
are somewhat less than those of morphine and
somewhat greater than those of codeine. The usual
precautions should be observed as with other opi-
ate analgesics. Although generally well tolerated,
Percodan may cause nausea, emesis, or constipa-
tion in some patients. Percodan should be used
with caution in patients with known idiosyn-
crasies to aspirin or phenacetin, and in those with
blood dyscrasias.
Also available: Percodan@-Demi, each scored
pink tablet containing 2.25 mg. oxycodone HC1
(Warning: May be habit-forming), 0.19 mg. oxy-
codone terephthalate (Warning: May be habit-
forming), 0.19 mg. homatropine terephthalate,
224 mg. aspirin, 160 mg. phenacetin, and 32 mg.
caffeine.
throughout the wide middle range of PAIN.
Cndo
Literature on request
ENDO LABORATORIES INC. Garden City, New York
Each scored yellow Percodan* Tablet contains
4.50 mg. oxycodone HC1 (Warning: May be habit-
forming), 0.38 mg. oxycodone terephthalate
(Warning: May be habit-forming), 0.38 mg. hom-
atropine terephthalate, 224 mg. aspirin, 160 mg.
phenacetin, and 32 mg. caffeine.
•U.S. Pats. 2.628,185 and 2,907,768
Emotional Problems of Children
Attending a Heart Clinic*
BERNARD SCHWARTZ, M. D., BRIAN J. McCONVILLE, M. D.,
and SANDRA TONKIN, B. A.
RECENTLY, there has been considerable interest
in the general topic of prevention in the
- fields of medicine and of social science. In
psychiatry, this interest is proven by the rapid growth
of concepts and practices in community mental health.
In describing this, Beliak1 (1964) says that "com-
munity psychiatry can best be defined as the resolve
to view the individual’s psychiatric problems within
the frame of reference of the community and vice
versa.”
Following on this, the medical and psychology
staffs at the Max and Martha Stern Heart Clinic be-
came more interested in the "total diagnosis” of chil-
dren attending this Clinic for investigation of sus-
pected heart lesions. For years it had been the con-
viction of the senior author (B. S.) that children
who were given the label of having organic heart dis-
ease faced considerable emotional problems. Further-
more, children who had heart murmurs or other
evidence of cardiac abnormalities but who were finally
assessed as having no "organic” heart lesions were
placed in a position of chronic anxiety about their
actual status with respect to activity, further life pat-
terns, and so on. The plight of these children had
been recognized at this Heart Station for some time
and it has been customary to provide them with a
letter which reassured both themselves and other in-
terested persons about the tme state of their "heart
condition.”
Caplan2 (1964), who has an especial interest in
the prevention of emotional disorders in children, has
*This Clinic is under the auspices of the Cincinnati Health De-
partment, and is subsidized by the Max and Martha Stern Heart
Fund, also aided by the Southwestern Ohio Heart Association.
Submitted October 13, 1965.
The Authors
• Dr. Schwartz, Cincinnati, is Director, Max and
Martha Stern Heart Station; Senior Attending
Physician, Jewish Hospital; Assistant Clinical Pro-
fessor of Medicine, University of Cincinnati School
of Medicine.
• Dr. McConville, Kingston, Ontario, Psychiatric
Consultant, Max and Martha Stern Heart Station in
Cincinnati, is a member of the staff. Department of
Psychiatry, Queens University, Kingston.
• Miss Tonkin, Cincinnati, Graduate Teaching
Assistant, Department of Psychology, University of
Cincinnati, is Graduate Assistant in Psychology,
Max and Martha Stern Heart Station.
remarked that all physicians who deal with children
"probably feel that the mental health of children and
their families is an integral part of pediatric practice.
It is certainly not a topic which has to be restricted
to the practice of child psychiatrists and psycholo-
gists.” Writing about the rehabilitation of chroni-
cally ill children, he thinks the physician "should
capitalize on the strengths of the children and reduce
their disability to realistic levels, and should try to
avoid the extra disability produced by superadded
irrational fantasies and stereotyped global helpless-
ness or by fantasies of general crippling.”
Socioeconomic Consideration
At this point, it might be instructive to comment
further on the type of child seen at this Clinic. The
children usually come from the lower socio-economic
125
neighborhood adjacent to the Clinic, which is situated
in one of the downtown "core” areas of Cincinnati.
The white children are often of migrant Appalachian
stock. The father is infrequently employed at labor-
ing jobs but is present in the family, usually in a
dominant position. The mother is prematurely aged
from having too many children too soon and tends
to show evidence of repression and masochism. Both
boys and girls mature early and often have marked
sexual concerns. The Negro children have a some-
what different background. The father is often ab-
sent or non-providing; he may be present in the home
at intervals but drinks often and withdraws under
tension. The mother is the more "powerful” mem-
ber of the family. She often makes the decisions and
collects the welfare payments. The society is on the
whole a matriarchal one. The children have a less
obvious interest in sexuality but often show concern
about whether food or love will be available. (The
above comments are, of course, gross generalizations
and are only intended to provide some flavor of the
groups from which these children come.) As a
whole, both groups are given to acting out behavior,
and psychosomatic concerns are prominent.
As we got to know these children better in terms
of the "total diagnosis,” we were impressed with the
frequency with which they showed patterns of anxi-
ety or other emotional upset related to their sup-
posed heart lesions. For example, one teenager, a
white girl with no serious cardiac disease, came in
with complaints of chest pain and shortness of breath,
which were not related to exercise but apparently to
the recent onset of menses and to the mutual concern
which she and her mother felt about the daughter’s
achieving puberty. Another, a Negro boy who had
no demonstrable heart disease complained of severe
chest pain. He could be reassured about this, but his
rage toward his father (which this symptom rep-
resents) had to be dealt with in several psychotherapy
sessions. As a third example, a little girl with a defi-
nite congenital heart defect was so afraid of hospi-
talization and operation that her total personality
showed signs of severe constriction.
Procedure
As a result of these preliminary observations, we
decided to construct a study which might evaluate
further some of the emotional factors associated with
heart disease in these children.
We, therefore, chose to investigate three groups.
Group I consisted of children who finally proved to
have organic heart lesions (the "organic” group).
Group II consisted of children who were referred be-
cause of some cardiac sign or symptom but after the
usual cardiac tests, proved to have no evidence of
organic heart disease and, therefore, no life threaten-
ing cardiac problem (the NOHD group). Group III
consisted of children from a nearby day center, who
had no known or suspected heart disease (the "normal
or "control” group). Normality in this instance re-
fers only to the status of the heart and does not imply
normality in any other sense, i. e., a child could be
classified as normal in our study if his heart were
normal even though he might have signs of abnor-
mality in other areas such as mental health.
Fifteen children were selected for study. Five
had definite organic lesions; five had had suspected
organic lesions, but were diagnosed as having no
organic heart disease; and the remainder had no ac-
tual or suspected cardiac lesions.
Each child was given an intensive psychiatric and
psychological evaluation which consisted of a psychi-
atric interview;* a short form of the Wechsler Intel-
ligence Scale for Children (WISC) ; the Rorschach
or inkblot test; the House-Tree-Person (HTP) test;t
and the "Heart-Inside A Person (HIAP) test.t
Group I (the organic group)
We felt that the group with definite heart disease
might have been exposed to some or all of the
following:
1. Moderate decrease in activity
a. from doctor’s orders or
b. because of some physical distress on exertion;
2. Current or impending cardiac examination or
operation; and
3. Personal or family trauma arising from the above.
In their fantasies, the organic group showed
marked somatic concerns but, on direct questioning,
denied any concern about their health and their bodies.
This indicates both their anxiety and their use of
denial in coping with that anxiety. Anxiety about
the heart and its functions was denied particularly
except in one psychotic child. These children were
further characterized by their general constriction,
negativeness, fragmentation, and limited body
awareness.
Case Report from Group I
The following case history is illustrative of the
organic group.
R. W. is a 12 year old Negro boy in the sixth grade and
a B student. He is the third in a sibline of six and has
two brothers and three sisters.
He was first referred at the age of 9, when routine school
examination disclosed a systolic heart murmur.
On examination at the Clinic the patient was described as
a well-built boy who showed no symptoms of unusual fatigue
or dyspnea. He did not appear ill. There was a slight bulge
in the precordium. On auscultation a systolic ejection mur-
mur was heard over the pulmonic area. The second sound
over this area showed increased splitting, which narrowed dur-
ing expiration. There was an early diastolic third sound along
the left sternal border followed by a diastolic murmur, which
was not of blowing quality.
The electrocardiogram showed a slightly prolonged P-R
interval (0.2 sec.), and precordial leads showed an RSR
pattern in lead Vi, suggesting outflow tract hypertrophy of
*The psychiatric interview was given to both experimental groups
but was not given to the normals. The psychiatrist, however, eval-
uated the tests for all three groups.
fThis is a test in which the subject is asked to draw a house, a
tree, and a person (no instruction as to the sex of the person to be
drawn is given and we requested that the subject draw a person of
the opposite sex when the first picture had been completed).
JThis consists of an outline of a person: the subject is asked to
draw a heart inside.
126
The Ohio State Medical Journal
the right ventricle. Later phonocardiography confirmed the
auscultation findings. Similarly, cardiac fluoroscopy con-
firmed evidence of increased pulsation of the right descend-
ing pulmonary artery consistent with a left-to-right shunt.
There was no definite evidence of left atrial or left ventric-
ular enlargement. The enlargement of the right ventricle
was equivocal. The clinical picture suggested atrial septal
defect, and it was felt that the defect was small.
When seen subsequently, the patient continued to be
asymptomatic and gave no complaints on interrogation.
On psychiatric study, R. W. proved to be a very attrac-
tive and verbal Negro boy. He said that he had a heart
murmur and that his heart had "too many beats.”
He denied worrying about his heart even though he said
that it "keeps him alive." There is no restriction in his
athletic performance.
On further questioning he did admit to being " a little
worried” about the "little hole in the heart.”
Things at home were "satisfactory” but then he looked
sad and said that his father had died when he was 10.
(It emerged later that his father had been ill for three
years and had finally died from the effects of abdominal car-
cinoma.) He missed his father a lot and cried "sometimes.”
His mother was a "nice lady” and he got on well with
the siblings. His main problems were that they had dif-
ficulty getting enough to eat (on Social Security) and that
he had no "daddy” and wished that he did. For his three
wishes he wanted a bike, a basketball, and a basketball
hoop, three masculine objects which indicated at some level
he hoped to overcome his depression and wanted to do
things appropriate for his age. However, there was a
quality of hopelessness about these longings. He had some
indefinite plans to be married eventually and had a girl-
friend his own age.
He was given a diagnosis of mild anxiety neurosis with
unresolved grief and depression about his father’s death.
There was marked denial of stressful and threatening events,
especially in terms of his heart. Indeed, it was striking
how he had "walled off” his concerns about his heart so
that other areas involving mastery and strength could de-
velop to a limited extent. His depression seemed to center
about his feelings about the loss of his father and about
his own outlook in terms of his heart condition. It was
felt that he needed a chance to ventilate his feelings and
overcome his depression by talking about his fears about
his heart and about his anger at his father for dying.
On psychological examination the patient seemed listless
and apathetic. This was due in part to depression that he
was still experiencing about the death of his father and was
undoubtedly reflected in his test results.
His estimated I. Q. score was 75, but it was felt that
under better conditions he might raise this to the normal
range, which would be more in keeping with his school
grade record. Nothing bizarre or peculiar was noted, but
he did show some underlying concern for words with ag-
gressive connotations.
His Rorschach is meager, seven responses in all. He
showed great difficulty in comprehending what was expected.
For example, when asked to trace his finger around the
outline of the chest response to card I, he ran his finger
around his own chest. It was noted that three out of the
seven responses were anatomy responses, which is unusual
for a record of this size. His other responses were of good
form and no bizarre tendencies were noted.
His HTP is quite descriptive. His house is described as
being made of glass indicating possible feelings of insecurity
about his home situation or about his own body. The hu-
man figures are both in fighting positions reflecting perhaps
both his own aggression and the perceived aggression of
others toward him. The barrenness of the tree, tall limbs
stretching up with no leaves or fruit, might indicate the
young boy’s needs left unsatisfied.
In the HIAP his heart is a relatively healthy looking
valentine and is described accurately as to function and as
being in a healthy condition.
Group II (NOHD)
The NOHD children generally appear to have
manifest diffuse anxiety which is centered around
their own bodies. There is an apparent hyper-
responsiveness to humans, but this is expressed
through fear of grown-ups and rage over dependency.
These children also show a fear of growing up or
adulthood and a general fear of the unknown which
encompasses both fears of growing up and fear of
sexuality.
Case Report from Group II
The following case history is illustrative of the
NOHD group.
M. G., a 12 year old Negro boy, has an older and a
younger sister. He comes from a lower class family. His
father is a technician in a nearby hospital.
The boy came to the Clinic complaining that "they heard
a strange noise in my chest.” The referring physician, who
had seen the boy during routine school examinations, had
heard a precordial murmur.
On examination at the Clinic, the physician found a
normal, well-developed boy of 11 years of age. A grade
II systolic ejection type murmur was heard best in the third
intercostal space along the left sternal border. It was not
present after exercise. There were no other physical ab-
normalities.
An electrocardiogram and a chest roentgenogram were
normal. Repeated physical examination confirmed the origi-
nal impression of "no organic heart disease.” A pos-
sible atrial septal defect was considered in the differential
diagnosis, but no supporting evidence was found.
On psychiatric examination M. G. appeared as a bright
and attractive Negro boy who related very easily to the
examiner. He said that the doctor had "heard a strange
noise in my chest." This had come "from my heart."
"People who have noises in their hearts get operated on."
"The heart pumps air and you need a heart to live.” Dr.
S. had recently told him that his problem wasn't major, and
he felt much better about this.
Some examples of the topics and responses of the inter-
view are as follows: M. G. had "no feelings" about being
the only boy. He said his father was nice and never grouchy
(although his eyes filled with tears when he said this).
His mother was nice, and he helped her with the dishes.
He described two wishes:
1. He would like to go to college and to do engineering
and sports. He also thought of being an F. B. I. agent.
2. He would like "nothing to happen to my heart."
If he were an animal, he would like to be a dog, be-
cause a dog always gets along with people and people al-
ways like him.
In his daydreams, he dreamed of passing his exams and
of what he is going to do when he grows up.
On the basis of this and other material, he was given a
diagnosis of "childhood neurosis with open anxiety centered
about the heart. Other features are denial and rationaliza-
tion.” It was commented that M. G. seems to be extremely
concerned about himself and his heart. He equates failure
of his heart with death, and he is clinging to the idea
that nothing "major” is wrong with him. He tends to deny
feelings, especially anger, and wants to be loved and taken
care of. However, this denial does not lead to an overall
constriction of his personality. One of his ways of pleasing
is to do well in school. This mechanism could be useful,
since he is a bright boy who could achieve well there. He
tends to think of increasing knowledge as a "shield against
danger” rather than as a sign of increasing competence and
skill. Nevertheless, he is able to plan ahead, and his neurosis
is not so incapacitating as to impede further maturation.
On psychological examination, the patient appeared as a
bright, cooperative 12 year old. His estimated I. Q. is
135, which puts him in the superior range. There was
nothing abnormal noted in his responses on the WISC, but
he did demonstrate high achievement needs evidenced
through a tremendous desire to give all the possible right
answers to the questions.
His Rorschach indicates a great need for empathic rela-
tions with a male identification figure. He is overly con-
cerned with finding human form or attributes throughout the
test, even at the expense of what might be a more popular
or appropriate response. He exhibits a great deal of crea-
tivity and originality, which would support his high achieve-
for February, 1966
127
ment needs and indicates that he uses his intellectual abilities
to cope with impulses.
His HTP also indicates high achievement needs. His male
is not as fully developed as the female in terms of certainty
of characteristics and this supports that there is some dif-
ficulty in male identification.
His heart is a rather small valentine with arteries coming
out from it. He describes its function accurately and states
that it is healthy.
Group III (the "normal” group)
The normal group is made up of five children with
no known or suspected heart problems. These chil-
dren show initial anxiety, but this seems attributable
to the testing situation. There are no definite char-
acteristics that these children have in common, but
there is some tendency for them to display passive-
aggressive traits, insufficiently formed body aware-
ness, and an overstrict conscience.
Quantitatively, it was found that, with one excep-
tion, the intelligence level of all three groups, was
in the dull-normal range. Comparing the groups
using Rorschach scoring, we also found that the
"organic” group was more constricted in their ap-
proach to life situations, while the NOHD group was
more openly anxious and tended to use repression
(unconscious forgetting) devices. The normals
showed no consistent response patterns. The results
with the HIAP and the HTP tests tend to support
the above findings.
Conclusions
This pilot study demonstrates the facts that the
organic group is more constricted, makes more use
of denial, and has more marked somatic preoccupa-
tions than the other two groups. The NOHD group
displays a great deal of manifest (open) anxiety and
hypersensitiveness to people, which is not found in
the organics or normals. Hence, we conclude that
these data do differentiate between the three groups
and that these differences are due to or contribute to
the heart problems.
Practically, it is felt that both experimental groups
show a need for counselling and guidance. The
child with an organic heart lesion must learn to ac-
cept and live with his affliction. He must not only
learn to limit his activities but to accept and utilize
other potentials to compensate for those which must
be curbed. Ordinarily a child with a congenital
heart defect does not shine as a star athlete. He
does not get the usual life insurance coverage and
frequently is defined a poor risk as a job holder.
However, a child in the NOHD group must also
be given special consideration. He is in the peculiar
position of being a suspected heart case. This means
that although medical personnel disprove organic
pathology and accept the NOHD diagnosis, the
doubt has already been raised in the mind of the
child, his family, and other interested persons (e. g.,
the school). Whether it be in applying for a job or
going out for some athletic event, he will be faced
by people reluctant to use his talents because of their
fear that he will be unable to perform in the future
due to heart problems. To identify this group of
NOHD cases itself justifies any screening program
because the ratio is 10 NOHD to 1 organic heart
disease.
Both groups need intensive guidance and fol-
low-up from psychiatrically oriented cardiologists,
family physicians, psychiatric personnel, and others.
One of the specific problems to be dealt with in
any future research in this area is that of chronicity.
It has been suggested that one factor that was ignored
in our original control group was the question of the
effects of long-term illnesses on personality. To cor-
rect for this another control group would have to
be studied. This should be a group of children who
have the features of chronicity but who are not
subject to a life threatening illness (e. g., chronic
skin problems).
Suggested References
1. Beliak, L.: "The Third Psychiatric Revolution," in Beliak, L.
(ed.): Handbook of Community Psychiatry and Community Mental
Health. New York: Grune and Stratton, 1964.
2. Caplan, Gerald: "Pediatrics and Community Mental Health,"
in Beliak, L. (ed.): Handbook of Community Psychiatry and Com-
munity Mental Health, New York: Grune and Stratton, 1964.
PSYCHIATRIC COMPLICATIONS OF HEART SURGERY.— A psychosis
of the acute organic variety occurred in 38 per cent of 99 adult patients
subjected to open-heart surgery at the Columbia-Presbyterian Medical Center. A
major factor appeared to be the environment of the open-heart recovery room,
where intensive nursing and medical care produced an atmosphere of sleep and
sensory deprivation. The clinical picture closely resembled the syndrome reported
in experimental situations of sleep and sensory deprivation. Modifications in the
structure and procedures of intensive-care units are suggested to diminish this effect.
— Donald S. Kornfeld, M. D., Sheldon Zimberg, M. D., and James R. Malm,
M. D., New York City: The New England Journal of Medicine, 273:287-292,
August 5, 1965.
128
The Ohio State Medical Journal
Abstracts from Regional Meeting of
American College of Physicians
DITOR’S NOTE: Again this year The journal is pleased and proud to publish abstracts
H of the papers read at the Combined Regional Meeting of the American College of Physi-
' — ^ cians for Ohio, West Virginia, and Western Pennsylvania November 19 - 20, 1965, in
Pittsburgh, Pennsylvania. The abstracts present in concise form a wealth of information reflect-
ing the nature of current medical research in this part of the country. We are indebted to Dr.
Gerald P. Rodnan and his Program Committee for the selection of the papers and to them and
Drs. Richard W. Vilter, Edmund B. Flink, and William M. Cooper, Governors of the College for
Ohio, West Virginia, and Western Pennsylvania respectively, for permission to publish the abstracts.
*
Clinical Syndromes and Selective
Cine-Coronary Arteriography
William L. Proudfk, M. D., F.A.C.P., Earl K. Sh rey,
M. D., (Associate), and F. Mason Sones, M. D.,
(by invitation).
From the Division of Medicine, The Cleveland Clinic
F oundation, Cleveland, Ohio
On the basis of independent review of the clinical
records and selective cine-coronary arteriograms in
1000 patients, the following conclusions were
reached :
1. Symptomatic coronary disease is accompanied
by arteriographic evidence of significant obstruction
of major coronary arteries.
2. About 95 per cent of patients diagnosed as hav-
ing angina pectoris functional Class I-III had signifi-
cant objective disease.
3. Obstructive lesions were encountered in about
99 per cent of patients who showed QRS abnormal-
ities considered indicative of myocardial infarction.
4. The obstructions found were almost always
severe in patients who had angina pectoris functional
Class I-III and were always severe in patients who
had myocardial infarction.
5. A high correlation (87 per cent) existed in
patients who had angina functional Class IV.
6. Poorer correlation was noted in patients thought
to have anginal pain at rest only, coronary failure
(coronary insufficiency) and especially atypical angina
pectoris.
7. Most patients thought to have non-coronary
pain had normal arteriograms.
8. In congestive heart failure secondary to coro-
nary disease, arterial obstruction was extensive and
severe unless there was a complicating condition,
*
such as ventricular aneurysm, mitral insufficiency,
arrhythmia or arterial hypertension.
9. About 37 per cent of the 1000 patients had no
significant arteriographic abnormalities; most of these
had been thought to have coronary disease by at least
one physician.
* * *
Coronary Arteriovenous Fistula and
Aortic Sinus Aneurysm Rupture
John C. Holmes, M. D., (Associate), Noble O. Fowler,
M. D., F.A.C.P., and J. A Helmsworth, M. D.,
(by invitation).
From the Department of Medicine, Cincinnati General
Hospital, Cincinnati, Ohio
In local experience coronary arteriovenous fistula or
aortic sinus of Valsalva aneurysm rupture into the
right heart are the two common causes of acquired
continuous murmurs with systolic accentuation which
are maximum over the lower sternum. This report
describes three patients with coronary arteriovenous
fistula subjected to successful surgical repair and five
patients with anatomically verified aortic sinus rup-
ture, two of whom had successful repair.
Coronary arteriovenous fistula. Two patients were
20 year old women. The third was a 24 year old
man. Two had increased arterial pulse pressure and
heart failure, and each had cardiac enlargement. The
dilated right coronary artery was demonstrated by
aortography to communicate with the right ventricle
in each instance. Surgical correction was followed by
disappearance of the murmur and decrease in heart
size.
Aortic sinus aneurysm rupture into the right heart.
Each of the five patients demonstrated increased ar-
terial pulse pressure and cardiac enlargement. Three
had sudden onset of dyspnea. Three had congestive
for February, 1966
129
heart failure and one developed complete A-V block.
Right heart catheterization demonstrated entry of
oxygenated blood into the right atrium or ventricle.
Successful repair was carried out in two females, 14
and 22 years of age. In three men, age 40 to 66
years, the communication caused eventual death be-
cause of congestive heart failure, pulmonary hyper-
tension, or complete A-V block.
* * *
Electrocardiographic and Arteriographic
Features of Posterior (Infra- atrial),
Posterolateral and Posteroinferior
Myocardial Infarctions
R. C. Lewis, M. D., M.R.C.P., (by invitation), and
William L. Proudfit, M. D., F.A.C.P.
From the Division of Medicine, The Cleveland Clinic
Foundation, Cleveland, Ohio
When present, the ECG manifestations of myocar-
dial infarction are specific. Anterior and inferior in-
farctions are usually readily diagnosed as they are
accessible to conventional exploration. Posterior in-
farctions, with or without inferior or lateral exten-
sions, are frequently "missed” as the diagnostic
changes may not be apparent on the conventional
ECG. Pathologic Q waves are noted when posterior
leads are recorded, and in Vf and/or V6 if extension
is present.
Suggestive changes may be seen in right precordial
leads :
(a) S-T segment depression
(b) Peaked T waves
(c) Tall upward deflections with R/S ratio
greater than 1.
Changes a. and b. occur in the acute stage; c. is
usually persistent. The study included 96 indivi-
duals :
A. 40 patients — diagnostic Q waves in back leads,
no changes in right precordial leads.
B. 27 patients — diagnostic Q waves in back leads,
suggestive changes in right precordial leads.
C. 29 patients — diagnostic Q waves in Vf and/or
V6 and posterior leads. Additional changes noted in
right precordial leads. Coronary arteriography was
performed in 16 cases.
% H5
Experience with the Radio EKG
Gordon M. Mindrum, M. D., F.A.C.P.
From the Department of Medicine, University of Cincinnati College of
Medicine, and General Electric Company, Cincinnati, Ohio
The radio EKG was evaluated in 30 normal sub-
jects and 49 persons with heart disease, 37 of whom
had at least one myocardial infarction.
The radio EKG is slightly larger than a package
of cigarettes and may be carried in the pocket while
the person is walking, running, working, or sleeping.
This FM radio transmits a radio signal of the EKG
to a desk model receiver from which an EKG may be
written by a standard EKG machine. The EKG
could also be visualized on an oscilloscope or could be
recorded on tape for later playback or computer an-
alysis. All subjects were given detailed cardiac ex-
aminations, chest x-rays, standard 12 lead electrocar-
diograms and 4 lead phonocardiograms.
Radio EKG tracings were obtained in the resting
position and the subjects were permitted to do vary-
ing amounts of work. The heart was monitored for
minutes, hours or days. Normal and abnormal re-
sponses were established.
The radio EKG permits insight into the func-
tional capacity of the heart for work which the
standard EKG cannot give. It is a practical device
to help evaluate the cardiac reserve after myocardial
infarction.
* * *
Postcardioversion Ventricular Tachycardia
J. A. Shaver, M. D., F. W. Kroetz, M. D., J. F. Lancaster,
M. D., D. F. Leon, M. D., (all by invitation), and
James J. Leonard, M. D. (Associate).
From the Department of Medicine, University of Pittsburgh,
Pittsburgh , Pennsylvania
In our series of 84 synchronized countershocks in
67 patients, ventricular tachycardia (VT) occurred
in the immediate post-countershock period in three
patients having chronic atrial fibrillation (AF). Dur-
ing cardioversion, two patients, post-mitral commis-
surotomy, developed recurrent episodes of VT. One
patient had three successive bouts, each terminated by
countershock, ultimately stabilizing to the previous
AF. In a second patient six such arrhythmias were
terminated by six countershocks. Stable sinus rhythm
occurred only after the infusion of 750 mg. procaine
amide during the final three episodes. A third hy-
pertensive patient developed VT which reverted to
the previously present AF after single countershock.
Every patient received quinidine sulfate prior to car-
dioversion. All received cardiac glycosides, but in only
the third case could possible digitalis intoxication be
implicated. Light sodium Pentothal® anesthesia was
used. In each patient, following the initial counter-
shock, normal sinus beats were observed prior to
spontaneous development of VT, thereby ruling out
improper synchronization of the discharge. After
final reversion there was no subsequent instability of
cardiac mechanisms.
In summary, single or recurrent episodes of VT
have occurred in 4 per cent of 84 cardioversions.
Although the etiology is as yet undefined, digitalis
intoxication is not felt to be responsible.
* * *
Pneumococcal Endocarditis at the
Cincinnati General Hospital
In the Penicillin Era
Allen L. Straus, M. D., (by invitation), and
Morton Hamburger, M. D., F.A.C.P.
From the Department of Medicine, University of Cincinnati
College of Medicine
A significant reduction in the incidence of pneu-
mococcal endocarditis has occurred since the introduc-
130
The Ohio State Medical Journal
tion of penicillin. Though the prognosis of pneumo-
coccal endocarditis was hopeless before the discovery
of penicillin, evaluation of the impact of penicillin
therapy upon prognosis has been hampered by the
low incidence of the disease. The records of 15
cases of pneumococcal endocarditis treated at the
Cincinnati General Hospital from 1945 to 1965
were reviewed; all received penicillin. Twenty-nine
cases of penicillin-treated pneumococcal endocorditis
from the English language literature were also
reviewed.
Analysis of factors which may have influenced sur-
vival revealed:
1. There was no significant difference between the
quantities of penicillin received by survivors and non-
survivors of the acute illness. Cure was obtained with
as few as 0.12 x 106 units of penicillin daily. The
average duration of penicillin treatment in survivors
was 22 days.
2. The prognosis did not seem to be affected by
delay in diagnosis of endocarditis.
3. A uniformly higher mortality existed among
those with symptoms of shorter duration even though
endocarditis was recognized early and treated.
4. Eighty per cent of patients with aortic endo-
carditis and 70 per cent of patients with mitral endo-
carditis died. In contrast, only one of three pa-
tients with tricuspid endocarditis and no patient with
an infected congenital cardiac lesion died.
* * *
Cephaloridine Treatment of
Bacterial Infections
R. L. Perkins, M. D., M. A. Apicella, M. D., (both by
invitation), and Samuel Saslaw, M. D., F.A.C.P.
From the Department of Medicine, The Ohio State University
College of Medicine, Columbus, Ohio
Cephaloridine is an investigational semisynthetic
antibiotic derived from cephalosporin C. The chemi-
cal structure differs from cephalothin (Keflin) only in
substitution of pyridine for an acetoxy group at posi-
tion 3. Cephaloridine is reported to differ from
cephalothin in possessing measurably greater anti-
bacterial activity against Gram-positive bacteria, great-
er solubility, less protein binding, and results in
comparatively higher and more prolonged semm
levels after intramuscular injection.
Ninety-two patients were treated with cephalori-
dine. Therapy was successful in 65 (94 per cent)
and 17 (74 per cent) of Gram-positive coccal and
Gram-negative bacillary infections, respectively.
Twenty patients with histories of penicillin allergy
showed no reactions to cephaloridine. Serial semm
levels obtained from 10 volunteers after 1 Gm intra-
muscularly ranged from 5.5 to 28.8 mcg/ml at 15
minutes, 10.6 to 29.5 at 30 minutes and at six hours
concentrations of 4.1 to 7.9 mcg/ml were still present.
In vitro studies showed that the median minimum
inhibitory concentrations for penicillin resistant and
sensitive staphylococci were 0.235 mcg/ml and 0.120
mcg/ml, respectively, and median bactericidal con-
centration for both was 7.8 mcg/ml; 0.095 mcg/ml
or less was bactericidal for pneumococci and group
A streptococci. Enterococci, klebsiella, E. coli, P.
mirabilis and 11 salmonella strains were more resist-
ant, but cephaloridine showed bactericidal action on
50 per cent of these organisms at concentrations
readily achieved in vivo. These studies demonstrate
that cephaloridine is a safe effective antibiotic for
Gram-positive coccal and selected Gram-negative bac-
illary infections. It is particularly useful in penicil-
lin-allergic patients.
* * *
Evaluation of the HIM (Hepatitis-
Infectious Mononucleosis) Test
Donald R. Weaver, M. D., (by invitation), and
John W. King, M. D., F.A.C.P.
From The Cleveland Clinic Foundation, Cleveland, Ohio
The HIM test is a new test for agglutinins in the
serum of patients with hepatitis and infectious mono-
nucleosis, which was developed by Bolin in 1963.
Virus coated latex antigens are prepared using virus
isolated from patients with serum hepatitis. These
viruses as well as viruses from patients with serum
hepatitis and infectious mononucleosis were isolated
and propagated in human embryonic lung tissue
culture systems by Bolin. He demonstrated that
these viruses were serologically identical by neutral-
ization and complement fixation tests.
The present authors describe their experience with
this antigen. The agglutination test is simple, can
be performed rapidly, and appears to hold promise
as a screening test to detect carriers of serum hepatitis
among blood donors and as an aid in diagnosing
hepatic disease. Positive reactions were found in
five patients out of five studied with active infectious
hepatitis, five of five with serum hepatitis, five out
of five with a history of hepatitis, and 11 of 12
patients with infectious mononucleosis. An incidence
of 38 per cent positive reactions in 47 other patients
from the G. I. service approximates that of 42 per
cent found in a random sampling of 150 control
subjects. The group of 47 includes a wide spectrum
of hepatitis disease.
Liver biopsies were obtained in 22 patients and
correlated well with the HIM test. With further
experience, it appears that it will be useful in the
differentiation of the various types of cirrhosis.
* * *
Serologic Reactions and Serum Protein
Concentrations in the Aged
Roy J. Cammarata, M. D., (by invitation), Gerald P.
Rodnan, M. D., F.A.C.P., R. H. Fennell, Jr., M. D.,
and Alice S. Creighton, B. S., (both by invitation).
From the Department of Medicine, University of Pittsburgh,
Pittsburgh, Pennsylvania
The present report is based on study of the serum
protein concentrations and latex agglutination and
anti-nuclear factor reactions in a group of 325 in-
fer February, 1966
131
dividuals 70 years of age and over. Latex agglutina-
tion: there was a total of 52/325 positive reactions
(16 per cent), with titers 1:160 or greater in 20
cases. There was no significant difference in number
of positive reactions between men and women, but
the frequency was twice as high among patients at
the Jewish Home for the Aged compared to non-
Jewish patients. Anti-nuclear factors: there was a
total of 93/255 positive reactions (37 per cent), as
determined by indirect immunohistochemical method
utilizing human tissue. There appeared to be no
significant difference in the number of positive reac-
tions between men and women or between different
ethnic groups, except for a somewhat higher fre-
quency among Jewish women (27/58, 46 per cent).
Serum proteins: total serum protein concentration in
90 of the patients was slightly lower than that pre-
viously observed in a group of 50 healthy young
adults, this difference being accounted for by a les-
sened amount of albumin. In contrast, the concentra-
tion of gamma globulin was slightly greater in the
aged (average 1.15 Gm/100 ml) compared to the
younger group (average .96 ± 0.22 Gm/100 ml).
The concentration of gamma globulin was signifi-
cantly greater in those aged individuals who showed
positive latex agglutination reactions. Clinical find-
ings: 17 of the aged patients had possible, prob-
able, or definite rheumatoid arthritis, and 10 of
these had latex agglutination titers of 1:160 or
greater. The majority of individuals with positive
latex agglutination and anti-nuclear factor reactions
had no evidence of rheumatoid arthritis or other sys-
temic rheumatic disease.
jfc % Jfc
Azathioprine Therapy in
Rheumatoid Arthritis
Vol K. Philips, M. D., F.A.C.P., Norman O. Rothermich,
M. D„ F.A.C.P., and Howard W. Marker, M. D.,
(by invitation).
From The Columbus Medical Center Research Foundation,
Columbus , Ohio
The immunosuppressive effect of oral azathioprine
was tested in 25 patients with classical or definite
rheumatoid arthritis. All patients had active progres-
sive disease, worsening despite adequate therapeusis
including salicylates, gold, and steroids. Clinical
evaluations were obtained semimonthly and comprised
the Systemic Index, Articular Index, and adjunctive
medication requirement, hematologic, biochemical and
serologic data. Azathioprine dosage averaged 100
milligrams daily.
Serial bloods were tested for Bentonite and Flu-
orescent antibodies to DNA and RNA, for changes
in titre of rheumatoid factor, and for electrophoretic
patterns of hyperglobulinemia. Also performed were
corollary determinations of drug effect upon other
antibodies in most adults (i.e., protective antibodies
against typhoid antigen).
Results: Azathioprine is a well tolerated drug
and produces no dangerous toxicities at a dosage of
100 milligrams daily. Therapeutic effects are slow in
onset, but of prolonged duration. Discontinuance
of prednisone was accomplished in three patients
previously requiring an average of 6.4 mg. per day
for reasonable clinical control of rheumatoid arthritis.
Prednisone dose reduction by 24 per cent was ac-
complished without loss of prior clinical response in
9 of 20 patients previously requiring prednisone
control. Azathioprine supplanted gold therapy with-
out loss of clinical effect in eight. Anti-RNA and
anti-DNA antibodies, when present, were not sig-
nificantly altered by treatment with azathioprine in
the dosage given. Azathioprine may exert a sup-
pressive effect upon activity of rheumatoid arthritis
and upon certain other auto-immune rheumatic dis-
eases, as well as upon the demonstrated immune
processes involved at higher dosage levels than given
in this preliminary study.
* * *
The Effects of Food, Fast, and Alcohol on
Serum Uric Acid Levels and the Occur-
rence of Acute Attacks of the Gout
Margaret J. Maclachlan, M. D., (Associate), and
Gerald P. Rodnan, M. D., F.A.C.P.
From the Department of Medicine, University of Pittsburgh School
of Medicine, Pittsburgh, Pennsylvania
Despite the age-old belief that acute gouty arthritis
is often precipitated by over-indulgence in food and
drink, relatively little is known concerning the effects
of alcohol on uric acid metabolism in patients with
gout. The hyperuricemia which occurs during ther-
apeutic fasts and that which follows ingestion of
alcohol have recently been attributed to elevations,
respectively, in the blood levels of beta-hydroxy-
butyrate and lactate, both of which substances inhibit
urinary excretion of uric acid. Eight gouty patients
and one normouricemic person were admitted to a
metabolic ward and subjected to 1 - 2 day fasts with
and without administration of alcohol in the form of
beer or whiskey. Following these brief fasts, there was
a rise in serum urate concentration of approximately
1-2 mg/100 ml and in beta-hydroxybutyrate to levels
as high as 58 mg/ 100 ml. When alcohol was taken
with the low purine control diet there was a slight
elevation in blood lactate but no change in serum
urate level. However, when alcohol was consumed
during periods of fasting, there was an even greater
rise in serum uric acid and beta-hydroxybutyrate, than
in fasting alone, as well as a significant elevation in
blood lactate, which reached levels as high as 29
mg/ 100 ml. Seven patients experienced a total of
25 attacks of acute gouty arthritis during the course
of study. These attacks occurred most frequently
following a rapid change in serum urate concentra-
tion. When probenecid was given in a dose of 1.5
Gm. a day, similar changes in serum urate level
were induced by alcohol and fasting but these were
less striking in degree.
* * *
132
The Ohio Stale Medical Journal
Stenosing Small Bowel Ulcers
N. Akin, M. D., (by invitation), and
Charles H. Brown, M. D., F.A.C.P.
From the Department of Gastroenterology , The Cleveland Clinic
Foundation, Cleveland, Ohio
"Idiopathic,” nonspecific ulcers of the small in-
testine have been rare until the discovery that enteric
coated diuretics containing potassium (1964) could
cause such ulcers. Since then, and with the use of
such diuretics, there has been an increased incidence
of small intestinal ulceration, and greater interest in
this entity. Because of this interest, we have reviewed
our cases of small intestinal ulceration.
Since 1953, we have seen 11 cases with primary
ulcer of the small intestine. All of these patients
were contacted and shown samples of enteric coated
diuretics containing potassium, and only one had
taken such a drug. One other patient received hydro-
chlorothiazide without potassium during menstrual
periods, and another received enteric coated hydro-
chlorothiazide with potassium ten years After pre-
vious surgery for primary small bowel ulceration.
While it has been shown both clinically and experi-
mentally that such diuretics containing potassium
can cause small intestinal ulceration, nonetheless, the
incidence of such ulceration must be low. The num-
ber of enteric coated potassium pills dispensed in one
year by our Pharmacy:
(a) 48,000 Thiazide with K.
(b) 5,000 K enteric coated with Thiazide.
Small intestinal ulcers usually cause gastrointestinal
bleeding (two cases), or obstruction (six cases), or
a history of gastrointestinal bleeding followed by ob-
struction (three cases). So, a total of five patients
had gastrointestinal bleeding and nine developed
obstmction.
The possibility of a small intestinal ulcer must be
considered in any patient with a history of bleeding
in which it is difficult to determine whether they had
melena or bloody stools. This is the same type of
bleeding exhibited by some patients with a Meckel’s
diverticulum. Small intestinal ulcer must also be
considered in any patient with symptoms suggesting
obstruction - — - such as cramps, bloating, distention,
vomiting, etc. A definite diagnosis can be made only
by operation and pathological examination.
Primary ulcer of the small intestine must be dif-
ferentiated from a number of other conditions caus-
ing the same clinical syndrome. The etiology of
"Idiopathic, primary” small intestinal ulcer is un-
known. Since the majority of recent cases reported
had received enteric coated potassium, all patients
suspected of having small bowel ulcer should be
shown all the enteric coated potassium tablets to see
if they have taken them. Our own incidence of such
a drug reaction, however, is low, since we have seen
only one patient (of eleven with small bowel ulcer)
who had taken such a drug.
H: Hs
Effects of Norepinephrine on Gastrointestinal
And Pancreatic Blood Flow in
Hypotensive Dogs
Richard L. Wechsler, M. D., F.A.C.P., Andrew DeLuise,
B. S., and James Waldman, M. D., (both by invitation)
From the Department of Medicine, Monte fore Hospital and University
of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania
Although the use of vasoconstrictors in shock has
been established for many years, this concept has been
questioned because of the variable clinical response
and the possibility that this therapy increases vasocon-
striction and therefore tissue ischemia.
In an attempt to clarify this problem, blood flow
was measured through various parts of the gastro-
intestinal tract and pancreas of dogs in whom this
clinical situation was simulated. A previously estab-
lished method for measuring local circulation through
parts of the brain (Kety, SS., Methods in Medical
Research, 8:22, I960) was adapted to measure gut
and pancreatic circulation.
Results were obtained in 6 normotensive unanes-
thetized dogs, 5 blood loss induced hypotensive dogs
and in 4 dogs whose blood loss induced hypotension
was corrected with I. V. Norepinephrine.
BLOOD FLOW
(cc/100 Gm Gut Tissue/minute)
MABP (mm Hg)
Control
6 dogs
118
Hypotensive
5 dogs
52
Norepinephrine
4 dogs
109
Gastric
46±3-9
8.6±5
7.8±5.8
Small Intestine
55±6.8
23.0±3.1
12.1±2.4
Colon
60±10.2
22.8±4.1
8±2.8
Pancreas
51±3.3
Not Measured 5±2.0
The results reveal that blood loss induced hypo-
tension caused a statistically significant decreased
blood flow in all parts of the gut and pancreas.
Norepinephrine significantly decreased the blood
flow in colon and small bowel even more, regardless
of the return of the mean arterial blood pressure
(MABP) to normotensive levels. Gastric blood flow
did not change significantly with Norepinephrine
therapy.
Therefore, hypotension causes tissue ischemia of
all parts of the gut and Norepinephrine therapy ac-
centuates this ischemia of all parts of the gut except
the stomach. Gastric blood flow is not altered by
I. V. Norepinephrine. Norepinephrine may produce
this effect by increasing vasoconstriction in the gut
or by opening more intestinal shunts. These results
strengthen doubts concerning the efficacy of vasocon-
strictor therapy in shock.
* * *
Isotope Pancreatography
D. Bruce Sodee, M. D., (Associate)
From Doctors Hospital and Renner Clinic Foundation ,
Cleveland Heights, Ohio
Pancreatic scanning with Selenomethionine-se 75
is a successful investigational tool. In a series of 205
patients for which 645 scans were performed, this
procedure, in our hands, has had practical value in
for February, 1966
133
the screening of patients suspected of having pan-
creatic carcinoma.
In the past, the only usual screening modality for
pancreatic carcinoma was the upper gastrointestinal
series that became abnormal far too late in the course
of this disease. With scanning nine of our patients
with pancreatic carcinoma had abnormal pancreatic
scans without an abnormal upper gastrointestinal
series.
* * *
Virus Infection and Kidney Transplantation
B. K. Khastagir, M.R.C.P., Satoru Nakamoto, M. D., (both
by invitation), and W. J. Kolff, M. D., F.A.C.P.
From the Department of Artificial Organs, The Cleveland Clinic
Foundation, Cleveland , Ohio
Fulminant and deadly viral infections have been
observed in patients covered with immunosuppressive
drugs to make kidney transplantation possible.
Six patients developed herpes simplex. The vesicles
erupted on the lips, nostrils, and inside the mouth.
In two cases the vesicles spread rapidly. In others
the vesicles healed slowly in the course of three weeks.
In three cases cytomegalic inclusion bodies were found
at autopsy. In two cases the cytomegalic inclusions
were found in the lungs, and in the third case they
were located in the submucosa of the ureter. Similar
viral disease has heretofore been described in debil-
itated newborn children and patients with leukemia
or malignancy. The early recognition is of impor-
tance, since with reduction of immunosuppressive
drugs, recovery, at least from the herpes, has oc-
curred. These complications of kidney transplanta-
tion should be viewed against the background of
our clinical experience. From January 1963 to
August 1965, 84 kidneys were transplanted in 69
patients; 64 kidneys taken from cadavers were trans-
planted in 44 patients. There are now 31 function-
ing kidneys taken from cadavers, of which 17 are
functioning for more than six months.
* * *
Rapid Progression of Untreated Pernicious
Anemia in Postoperative Period
John B. Hill, M. D., (by invitation), and
William M. Cooper, M. D., F.A.C.P.
From the Department of Medicine, University of Pittsburgh School
of Medicine, Pittsburgh, Pennsylvania
During the last two years, four patients have been
seen in consultation because of rapid development of
unexplained anemia two to ten weeks following a
surgical procedure. Three patients had gastrointesti-
nal surgery and one a hysterectomy. In each instance
the anemia was megaloblastic. Two of these patients
also had concomitant rapid progression of neurologi-
cal changes typical of pernicious anemia. Schilling
tests in the other two confirmed the diagnosis of
pernicious anemia. In retrospect, all had mild anemia
and/or leukopenia preoperatively but peripheral blood
smears or bone marrow aspirates were not examined.
Megaloblastic changes undoubtedly existed in all
four prior to surgery. Tissue regeneration and thus
DNA production is increased in the postoperative
period as a result of tissue destruction during surgery.
Since vitamin B-12 is vital for DNA formation, fur-
ther depletion of already markedly reduced stores
of this vitamin would be expected in the postopera-
tive period. It is postulated that this sudden, addi-
tional depletion of vitamin B-12 was the etiology
of the rapid progression of the manifestations of
pernicious anemia in these four individuals. Although
such a course would not be expected in most other
hematological diseases, these cases again re-emphasi2e
the importance of evaluating even slight hematologic
abnormalities preoperatively.
* * *
Hemolytic Anemia Caused by Exposure to
Hyperbaric Oxygen (OHP) : Its Mechanism
And Significance
Herbert E. Kann, Jr., M. D., and Charles E. Mengel,
M. D., (both by invitation). (Introduced by
Henry E. Wilson, M.D., F.A.C.P.)
From the Department of Medicine, The Ohio State University
Medical Center, Columbus, Ohio
We observed hemolytic anemia (Hct. 48 per cent
to 35 per cent, reticulocytes 0.5 per cent to 4.6 per
cent, indirect bilirubin 0.5 mg/100 ml to 1.6 mg/100
ml) in a patient exposed to OHP (100 per cent 02
at 2 atmospheres for 30 minutes). His RBCs before
and after OHP contained no Heinz bodies, had nor-
mal methemoglobin and reduced glutathione con-
tent, and normal G6PD activity. However, during
incubation with hydrogen peroxide his RBC lipid
was peroxidized greater than normal and his RBCs
lysed excessively. We subsequently studied the in-
fluence of an inhibitor of lipid peroxidation, alpha
tocopherol, on the hematologic effects of OHP in
mice.
Tocopherol supplemented mice exposed to 100 per
cent 02 at 4 atmospheres for 90 minutes demon-
strated no RBC lipid peroxidation or lysis, whereas
tocopherol deficient mice showed marked RBC lipid
peroxidation followed by fall in Hct (45 per cent
to 28 per cent), hemoglobinemia, and reticulocytosis.
No decrease in reduced glutathione content or G6PD
activity, no increase in methemoglobin content, and
no Heinz body formation occurred.
These studies indicate that hyperoxic hemolysis is
associated with peroxidation of RBC lipid rather than
with overloading of usual oxidant protective mechan-
isms. Lipid peroxidation may be generalized bio-
chemical response primary in the pathogenesis of
oxygen toxicity and manifested overtly in our studies
by hemolytic anemia.
* * *
Clearance of Infused Fibrin
Jessica H. Lewis, M. D., and Isabel L. F. Szeto, M. D.,
(both by invitation).
From the Department of Medicine, University of Pittsburgh School
of Medicine, Pittsburgh, Pennsylvania
Intravascular formation of fibrin is associated with
such diseases as thromboembolism, amniotic fluid em-
134
The Ohio State Medical Journal
holism, and abruptio placentae. Less obvious fibrin
formation has been postulated following surgical
procedures, injuries, and even as a normal everyday
process involving constant fibrin formation and re-
moval. The mechanisms of fibrin removal are not
clearly understood, although much emphasis has been
placed upon the role of the plasma fibrinolytic enzyme
system.
To explore this process, finely particulate, iodinated
fibrin was infused into dogs either arterially or in-
travenously. The fibrin I131 disappeared from the
circulation within two minutes and shortly thereafter
soluble I131 appeared reaching a maximum level by
two to four hours after the infusion. In the first
few hours most of the I131 was attached to large
molecules (TCA insoluble). As time progressed more
TCA soluble I131 was found in the plasma and the
I131 content of the urine increased. Tissue studies
suggested that fibrin was being degraded at the site
of deposit. No changes in the plasma fibrinolytic
enzyme system were found. Coincident infusions
of heparin or a fibrinolytic activator enhanced the
solubilization rate but infusion of the fibrinolytic in-
hibitor, EACA, did not prevent or decrease fibrin
solubilization. It was concluded that fibrin could be
degraded by a mechanism independent of the plasma
fibrinolytic enzyme system and, perhaps, dependent
upon phagocytic activity of vascular endothelium or
leukocytes.
Autologous Bone Marrow Storage and
Infusion in Patients Receiving
Whole Body Irradiation
Ben I. Friedman, M. D., F.A.C.P.
From the Departments of Medicine and Radiology, University of
Cincinnati College of Medicine, and Radioisotope Laboratory,*
Cincinnati General Hospital, Cincinnati, Ohio
In an attempt to better understand clinical, hemato-
logical, psychological, physiological, metabolic, and
chromosomal changes after whole body irradiation,
patients with metastatic malignancies are being treated
with up to 200 rad (336r) whole body radiation.
Since severe hematologic manifestations of the acute
radiation syndrome are encountered in patients receiv-
ing 150 rad or more, storage of marrow for autolo-
gous infusion has been instituted.
All patients have marrow stored by the method of
Kurnick one to two weeks prior to irradiation. Aspi-
ration is from the posterior iliac crest under local
anesthesia. After the addition of Osgood-glycerol
solution, the temperature of the mixture is reduced
from ambient temperature by the Polge technique.
Storage is at -80° Centigrade. After the addition
of 33 1/3 per cent dextrose solution the bone mar-
row is infused intravenously without filtration at a
rate of 50 drops per minute.
Marrow from nine patients has been stored. It
has then been reinfused in three patients. Repopu-
lation of the marrow space may have been successful
in one case.
This procedure may be of clinical value in treating
the hematologic complications of cytotoxic drug and
radiation therapy.
* Supported in part by the Defense Atomic Support Agency, Con-
tract No. DA-49-146-XZ-315.
^
Utilization of Lymphangiograms in the
Evaluation of Patients with Lymphoma
Marie Manno, M. D., and John B. Hill, M. D.,
(both by invitation).
From Western Pennsylvania Hospital, Pittsburgh, Pennsylvania
During the last year, retroperitoneal lymphangi-
ograms have been performed in selected patients with
lymphoma. Twelve patients, seven with Hodgkin’s
disease and five with lymphosarcoma, have been stud-
ied. No complications have occurred. Seven had
positive lymphangiograms but in only one patient was
the intravenous pyelogram suggestive of retroperi-
toneal involvement. Confirmation and localization
of retroperitoneal disease in three patients with Stage
III Hodgkin’s disease was made by means of lym-
phangiograms and subsequent radiation therapy given
to this area. Three patients with lymphosarcoma
with suspected retroperitoneal disease, negative in-
travenous pyelograms, but positive lymphangiograms
received radiation therapy to the demonstrated in-
volved area. They would not have been treated in
the absence of a lymphangiogram. Three patients
with Stage II Hodgkin’s disease and one patient with
an epidural mass thought to be Hodgkin’s disease
had negative lymphagiograms and their therapy was
limited to radiation to proven involved areas.
This small series of patients confirms that lym-
phangiograms are a valuable procedure in the evalua-
tion of patients with lymphoma and superior to
intravenous pyelograms in the demonstration of
retroperitoneal disease. The procedure is relatively
simple to perform, can be utilized in any hospital
where patients with lymphoma are treated, and not
limited to a University Center or similar institution.
He sH sfc
Muscle Degeneration in Association with
Apparent Vitamin E Deficiency
In a Human
John W. Vester, M. D., and Leon R. Williams, M. D.,
(both by invitation). (Introduced by Gerald
P. Rodnan, M. D., F.A.C.P.).'
From Oakland Veterans Administration Hospital, and Departments of
Medicine and Biochemistry, School of Medicine, University of
Pittsburgh, Pittsburgh, Pennsylvania
A 48 year old man presented himself here six years
ago with muscle weakness. This involved first upper
and then lower extremities and was progressive in
a cyclic fashion to the point where the patient was
nearly bedfast. Muscle biopsy showed focal regener-
ation and sarcolemmal proliferation not consistent
with progressive muscular dystrophy. In January
1962, creatine phosphate phosphokinase was 20 units
per ml. compared to normal of 1 unit or less per
ml. Creatine/creatinine was 0.8. Electromyogram
data were felt to be compatible with muscular dys-
trophy. 100 mg. o:-tocopherol orally three times daily,
for February, 1966
135
given empirically, produced a slow but striking
subjective return of muscle strength. All objective
measurements except creatine/creatinine returned to
normal values and this latter reached 0.22. Therapy
was discontinued after 12 weeks and plasma tocopherol
levels gradually declined to 0.06 mg/100 ml coincident
with return of symptoms. All objective data were again
abnormal. An I131 triolein study showed 7 per cent
absorption and I131 oleic acid absorption was normal.
Restoration of o:-tocopherol therapy after 30 weeks
without it produced striking improvement again.
Strength has been maintained for two and a half
years and he is now gainfully employed. The muscle
biopsy, creatine excretion and serum creatine phos-
phokinase pattern during disease peaks was similar
to those shown by a-tocopherol deficient rabbits in
this laboratory.
These data suggest that this patient represents the
first clear-cut instance of vitamin E deficiency in a
human. The pancreatic lipase deficiency undoubtedly
played a major role in the development of this syn-
drome but does not fully explain it.
He
The Relationship of Thyroid Function
To Magnesium Metabolism
John E. Jones, M. D., (Associate), Paul C. Desper, M. D.,
Stanley R. Shane, M. D., (both by invitation), and
Edmund B. Flink, M. D., F.A.C.P.
From the Department of Medicine, West Virginia University
Aiedical Center, Aiorgantown, West Virginia
An evaluation of magnesium metabolism in eight
hypothyroid and six hyperthyroid patients has been
undertaken. Studies included determinations of
serum and erythrocyte magnesiums, exchangeable
magnesiums, and complete balance studies. Mean se-
rum magnesium levels were decreased in hyperthyroid-
ism and elevated in hypothyroidism. Urinary excretion
of Mg24 and Mg28 was reduced in hypothyroidism
and elevated in hyperthyroidism prior to therapy.
Total exchangeable and cellular exchangeable mag-
nesiums were low in hypothyroids and normal in
hyperthyroids both before and after therapy. Hypo-
thyroids were found to have negative sodium, potas-
sium, magnesium, calcium, phosphorus and nitrogen
balances with increasingly negative balance with in-
creasing doses of triiodothyronine, while balance
values were invariably positive in hyperthyroids dur-
ing propylthiouracil therapy. Magnesium balance
ranged from — 15 to — 221 mEq in hypothyroids
and from — |— 33 to -(-14 6 mEq in hyperthyroids.
Prompt increases in urinary magnesium were noted
in hypothyroids during triiodothyronine therapy.
The data demonstrate striking differences between
hypothyroidism and hyperthyroidism. The elevated
serum magnesium values and the lowered urinary
excretion of magnesium in hypothyroids contrast
sharply with their decreased exchangeable magnesium
values. The data suggest that magnesium transport
difficulties occur in thyroid hormone deficiency states.
STENOSIS OF RENAL ARTERY. — The frequency, severity, and location
of renal arterial stenosis, in both the extrarenal and intrarenal arteries, have
been determined in 154 patients comprising an unselected hospital necropsy sample,
using the techniques of injection, serial section, and clearing. Severe renal stenosis
was found to be bilateral in approximately half of the patients. Intrarenal stenosis
of a severe grade was much more common in women than in men, and in the
presence of severe extrarenal stenosis and girls aged 5-14 years have a slightly
decreasing death rate, averaging about 7 per million. The rate for persons aged
15-64 has increased from about 7 per million in 1955 to about 9 in 1962. In
persons 65 years old and over the overall rate has risen slightly to about 80 per
million, the increase being more pronounced among women than among men.
Deaths from scalds account for about one-tenth of the number due to burns, and
have tended to decrease in all age-groups. The main change in mortality has
therefore been an increase of deaths in persons aged 15-64. In spite of all efforts
at prevention, total deaths per annum have increased slightly, though this increase
is not marked when corrected for increase of population. — C. J. Schwartz, M. D.,
and T. A. White, M. B.: British Medical Journal, 2:1415-1421, December 5, 1964.
136
The Ohio State Medical Journal
Predicting Severity of Erythroblastosis
LUCIUS F. SINKS, M. D.,* COLIN R. MACPHERSON, M. D., J. PHILIP AMBUEL, M. D„
WARREN E. WHEELER, M. D„ WILLIAM E. COPELAND, M.D., and WILLIAM C. RIGSBY, M.D.
The Authors
• Dr. Sinks, Cambridge, England, former In-
structor in Pediatrics, Columbus (Ohio) Children’s
Hospital and Department of Pediatrics, The Ohio
State University, presently is a member of the staff.
Department of Medicine, University of Cambridge,
England.
• Dr. Macpherson, Columbus, is Director of
Clinical Laboratories, The Ohio State University.
• Dr. Ambuel, Columbus, is Professor of Pediat-
rics, The Ohio State University, and Columbus
Children’s Hospital.
• Dr. Wheeler, Lexington, Kentucky, is Chair-
man of the Department of Pediatrics, University of
Kentucky.
• Dr. Copeland, Columbus, is Associate Professor
of Obstetrics and Gynecology, The Ohio State
University.
• Dr. Rigsby, Columbus, is Instructor in Obstet-
rics and Gynecology, The Ohio State University.
THERE have been many attempts to analyze the
value of serial Rh antibody titers in predicting
the outcome of a particular gestation.1-7 Most
of these have been retrospective studies. Some have
combined retrospective with prospective studies, but
in these the prospective portion has been done with-
out a control series, hence serious doubt remains
about the value of titers when used to predict the need
for preterm induction. Such was the case at our
institution. It was impossible to establish a controlled
prospective study because of the widespread convic-
tion that preterm induction was valuable as a means
of reducing severity of disease and that the titers
could be used in predicting severity. One factor
complicating the use of titers in predicting the out-
come of a given pregnancy is the technical difficulty
of obtaining reproducible results. Titers in various
laboratories are seldom comparable, making extra-
polation from one institution to another difficult.
Moreover, Vaughan has pointed out that within each
laboratory there exists an error from one determina-
tion to another unless all specimens are frozen and
determined at one time using the same red cell
population.8
Because of these facts we felt that more factual
knowledge was essential before the value of serial
titers could be assessed.
We planned the following study. The maternal
history of a given pregnancy was presented to a
clinician who was asked to predict the outcome and
recommend whether preterm induction was necessary.
The serologist gave similar predictions based on the
serial titers. By this technique we hoped to simulate
a prospective study, thus obtaining a more objective
evaluation of the significance of titers versus a
control (history).
Materials and Method
We reviewed the charts of all Rh negative women
with detectable anti-Rh titers delivered at The Ohio
State University Hospital during the years 1958-
1962. The respective serial titers were also reviewed.
The information regarding the maternal history was
placed on one set of cards, the serial titers on a
separate set of cards. All cards were identified bv
code number only. The cards with the past maternal
* Clinical Cancer Trainee CST-071.
Submitted May 24, 1965.
and previous infant histories, henceforth termed his-
tory" cards, were circulated individually to two experi-
enced pediatricians and two obstetricians who had a
particular interest in this problem. These four clini-
cians were asked to predict, if possible, the outcome
of the current pregnancy and whether preterm induc-
tion was indicated. The serologist was given the
cards with titers only and was requested to make
similar predictions.
The second phase of the study was to determine
the prognostic ability of physicians given both his-
tories and titers. This information was supplied,
again on an individual basis, to the serologist and to
one of the pediatricians. These men did not have
their previous predictions available to them. There
was a total of 124 cases but four of these were not
evaluated by the serologist because of insufficient data.
For purposes of analysis (see results) the predic-
tions of all the physicians were divided into four
groups. The first group, referred to as the pedi-
atricians, consisted of the best predictions of both
pediatricians grouped together. The second, called
the obstetricians, represented the best recommenda-
tions of the two obstetricians. The third set rep-
resented the serologist’s predictions alone. The
for February, 1966
137
fourth and last group consisted of the best predictions
of the physicians who had both history and titer avail-
able. One must keep in mind, however, that all
predictions were done on an individual basis, even
though the results are in places pooled.
The actual predictions were compared to the out-
come of the pregnancy in question, and, depending on
the condition of the fetus at delivery and subsequent
behavior of the infant, an evaluation was made (see
tables). There were five possible choices that could
be differentiated:
(1) Cases that could not be objectively analyzed
because of inadequate data.
(2) Preterm induction recommended, which ap-
peared to be correct in view of the condition of the
fetus.
(3) Term delivery recommended, which ap-
peared to be correct in view of the fate of the
fetus.
(4) Preterm induction recommended, which ap-
peared to be incorrect.
(5) Term delivery recommended, which ap-
peared incorrect in view of the outcome. (In
other words, in this group the infant really re-
quired preterm induction, e. g., was a stillbirth
or severely affected infant.)
Any stillbirth or death due to hydrops or severe
erythroblastosis fetalis was considered as a case in
which preterm induction .was indicated. Any infant
born with a hemoglobin level of less than 11 Gm.
per 100 ml.10 was considered severely affected and
could have been helped in the judgment of some by
preterm induction.11
Serial titers were determined by four techniques
(1) saline, (2) albumin, (3) indirect antiglobulin,
and (4) enzyme.9 Determinations were obtained on
three or more occasions in most of the cases evaluated.
The interval between determinations varied; how-
ever, in the majority of cases they were drawn between
the 28th and 37th weeks of gestation.
Criteria Used by Serologist
( 1 ) It is not possible to identify an Rh-negative
fetus with certainty.
(2) Titer changes are most helpful in first sen-
sitized pregnancies.
(3) A dramatic rise in titers is most often seen
in a first affected infant.
(4) A "dissociated” rise (rising saline and/or
albumin titer with level enzyme and Coombs titers)
indicates an affected fetus.
(5) A "plateau” effect (no change in titer
throughout pregnancy) is usually seen in women
who have had two or more affected infants.
Results
In analyzing the data it was found that the dif-
ferent disciplines, i. e., pediatrics, obstetrics, and his-
tory plus titer group revealed remarkable consistency
within each group. With regard to the stillbirth
infants, there was only one disagreement in predic-
tion between the two pediatricians. The same was
true for the obstetricians. Therefore, we felt justi-
fied in pooling the correct predictions for each group.
The physicians with both history and titers agreed
with their predictions in the stillbirth group.
Therefore, all groups were treated in the same
fashion. The correct predictions within each group
were totaled, and it is these figures that are entered
in the tables.
The tables show that titers alone were of no help
in making a positive prediction whether or not to in-
duce the pregnant mother to prevent stillbirth. The
pediatric clinicians (Table I) using the past maternal
PEDIATRIC CLINICIANS' PREDICTIONS
124 CASES
(TABLE I)
total no
IN EACH
GROUP
QORF
INDUCTION
RECOMMENDED
?ECT
TERM DELIVERY
RECOMMENDEI
INCO
j INDUCTION
RECOMMENDED
RRECT
TERM DELIVERY
(SEVERE ERYTHRO-
8 LAS TOT 1C INFANT*
OR STILLBIRTHS)
STILLBIRTHS
to
6
4
Rh NEGATIVE
INFANT
5 \
5
MILO ERYTHRO-
BLASTOSIS
2
2
VARIABLE IN
SEVERITY
16
0
II
/
4
NO PREDICTIONS
OR EVALUATION
POSSIBLE
9/
TOTAL CASES
EVALUATED
33
18
/
WvA.f .1.1
—8
—
TERM CORRECT AND INCORRECT REFERS TO THE IDEAL MANAGEMENT OF THAT PARTICULAR
PREGNANCY IN VIEW OF THE ACTUAL FATE OF -THE FETUS.
history, namely the fact that there were one or more
previous stillbirths or severely affected erythroblas-
totic infants, as a guideline were able to recommend
preterm induction correctly in six out of ten cases
of stillbirths. The obstetrics clinicians (Table II)
OBSTETRIC CLINICIANS
124 CASES
(TABLE HJ
TOTAL NO
IN EACH
GROUP
CORI
INDUCTION
RECOMMENDED
w
TERM DELIVERY
RECOMMENDED
INCC
j INDUCTION
•recommended
)RRECT
TERM DELIVERY
(SEVERE ERYTHRO-
8 LAS TOT IC INBVNTS
OR STILLBIRTHS)
STILLBIRTHS
10
5
5
Rh NEGATIVE
INFANT
5
3
2
MILD ERYTHRO-
BLASTOSIS
2
2
VARIABLE IN
SEVERITY
16
7
5
4
NO PREDICTIONS
OR EVALUATION
POSSIBLE
9/
TOTAL CASES
EVALUATED
33
~*~5
10
\ 9
TERM CORRECT AND INCORRECT REFERS TC
PREGNANCY IN VIEW OF THE ACTUAL
THE IDEAL MAT.
=ATE OF THE FE
AGEMENT OF
TUS
that particular
were able to predict correctly in five of ten cases. The
clinicians had four additional stillbirths to evaluate
because there were insufficient titers in four which
voided any prediction by the serologist (Table III).
Of the five Rh negative infants, the obstetricians
138
The Ohio State Medical Journal
SERO LOG! ST'S PREDICTIONS
120 CASES
(TABLE IE)
TOTAL no
IN EACH
GROUP
CORRECT |
INDUCTION TERM DELIVERY
RECOMMENDED RECOMMENDEC
K INCORRECT |
1 TERM DELIVERY i
1 INDUCTION (SEVERE ERYTHRO-i
Irecommended blastotic infants;
1 OR STILLBIRTHS) i
STILLBIRTHS
6
6 \
Rh NEGATIVE
INFANT
5
5
MILD ERYTHRO-
BLASTOSIS
2
2
VARIABLE IN
SEVERITY
16
12
4 \
NO PREDICTIONS
OR EVALUATION
POSSIBLE
87
{
V
TOTAL CASES oq
EVALUATED
— 0
!9
-~to ;
TERM CORRECT AND INCORRECT REFERS TO THE IDEAL MANAGEMENT OF "HAT PARTICULAR
PREGNANCY IN VIEW OF THE ACTUAL FATE OF THE FETUS
recommended that two be delivered early. The two
pediatricians and serologist did not recommend pre-
term induction in any of these.
The one infant in the entire 124 cases, who was
actually bom at 38 weeks gestation after induction
and who died of respiratory distress but on autopsy
had signs of mild erythroblastosis, would have been
delivered early by the obstetricians and the two physi-
cians having both history and titer available (Table
IV). A second mildly affected infant would have
been delivered preterm by the obstetric group.
The last group contained 34 infants who were
affected but to a variable degree; however, 18 of
HISTORY AND TITER PREDICTIONS
120 CASES
( TABLE IS)
total NO
IN EACH
GROUP
CORRECT i
[ INCORRECT S
(INDUCTION
f*COMMEND6 O
TERM DELIVERY j
(SEVERE ERYTHRO-j
BLASTOTIC (WANTS
OR STILLBIRTHS) \
INDUCTION
RECOMMENDED
TERM DELIVER?
RECOMMENOED
STILLBIRTHS
6
2
4 \
Rh NEGATIVE
INFANT
5
5
1
j
i
MILD ERYTHRO-
BLASTOSIS
2
/
/
i
i
VARIABLE IN
SEVERITY
16
3
6
6
!
/ |
NO PREDICTIONS
OR EVALUATION
POSSIBLE
87
i
i
i
i
TOTAL CASES
EVALUATED
29
— 5
12
i 7
^ 5 !
TERM CORRECT ANO INCORRECT REFERS TO THE IDEAL MANAGEMENT OF THAT PARTICULAR
PREGNANCY IN VIEW OF THE ACTUAL FATE OF THE FETUS
these infants were delivered early making it impossible
to evaluate whether those who recommended induc-
tion were correct or those who advised term delivery.
The suggestive evidence of Kelsall and Vos11 led
some people to believe that early induction not only
prevented stillbirth but would also decrease the re-
quirement for exchange transfusions and the possi-
bility of anemia. This meant that we could not
evaluate that group of infants with objectivity. There-
fore, we were left with 16 infants who were actually
fullterm but were controversial as far as predictions
were concerned. In this group, there were four in-
fants who had hemoglobins below 11 Gm. per 100
ml. and required two or more exchanges. The only
physicians to select three of these four severely af-
fected infants out of 120 cases were the ones who had
both history and titers available. The pediatricians,
obstetricians, and serologist were unable to detect
these three severe erythroblastotic infants. Two of
these three infants were first affected, the third was
the second affected infant. (Total of four severely
affected) (Table V).
SUMMARY OF PREDICTIONS
/TABLES)
TOTAL HQ
N EACH
GROUP
CORRECT
NDUCTI0NS
INCORRECT
INDUCTIONS
INCORRECT TERM !
DELIVERY (SEVERELY j
AFFECTED INFANTS |
OR STILLBIRTHS j
PEDIATRICIANS
29
4
I /
!
* !
OBSTETRICIANS
29
3
j 9
7 i
J
SEROLOGIST
29
O
o
to 1
HISTORY a TITER
29
7
5 |
SUMMARY OF PREDICTIONS OF ALL GROUPS BASEO ON
THE 29 CASES THAT ALL GROUPS COULD ADEQUATELY
EVALUATE (FOUR STILLBIRTHS HAO INSUFFICIENT
PRENATAL TITERS PERFORMED)
Comment
It is readily apparent that the serologist’ s opinion
that titers in subsequently affected infants are less
reliable, is borne out by this objective study. The
titers were of no help in the group of stillbirths, 50
per cent of which had a preceding history, and cer-
tainly cannot distinguish Rh negative or mildly af-
fected infants with any prognostic certainty.
However, the titers and history together enabled
the physicians to predict that three would be rela-
tively severe erythroblastotic infants and two of these
three were first affected infants. It is also tme that
the titers and history led to one recommendation of
preterm induction in a baby with mild erythroblastosis
who died of respiratory distress. The results also
bear out Chown’s1 opinion that titers are of help
only infrequently, but on occasion they enable one to
ascertain that a certain infant may be severely eryth-
roblastotic.
It is important to point out at this time the rela-
tive accuracy of predictions for each group. If one
takes into account that there were four additional
severely affected infants which were missed by all
groups because of insufficient information and adds
this to the number of wrong predictions for each
group, one can obtain an idea of the percentage ac-
curacy expected by the different methods.
The pediatricians were accurate in 90 per cent of
the cases, the obstetricians 83 per cent, the serologist
90 per cent and the history and titer group 87 per
cent. Immediately, one is struck by the high degree
of accuracy using history alone. However, one also
must note the accuracy obtained by the serologist alone
(Table III).
This occurred in this series because there were very
for February, 1966
139
few stillbirths and severely affected infants; therefore,
if one does not attempt to recommend preterm induc-
tion in any of the cases one will still be quite accurate
in terms of percentage of total number of infants.
The serologist using titers alone did not make any
positive recommendations.
The implication is that there is a large number of
erythroblastotic infants who are not severely affected
or stillborn and, therefore, most of the infants will
do well. However, in those few cases in our series in
which accurate predictions were necessary the titers
were of no help. In fact, in terms of accuracy, the
combination of history and titers was less so than
the control group (pediatricians). This difference is
probably not significant; however, the point is that
the combination of history and titers was not of any
greater value than history alone except in regard to
the three severely affected infants already discussed.
It becomes readily apparent that we should not
express accuracy of predictions, when dealing with
erythroblastosis, on the basis of the total number of
infants at risk but rather in terms of stillborn and
severely affected infants. It wrould be much more
meaningful if one would relate one’s stillbirth rate
and one’s error in prediction. By the latter we mean
the number of times that one recommends preterm
induction improperly and obtains an Rh negative or
mildly affected infant.
Walker’s* 1 2 3 4 5 6 7 8 * 10 11 12 figures indicate that about 3 6 per cent
of all stillbirths are preceded by a pregnancy which
itself led to a stillbirth or a very severely affected
infant. He also states that 70 to 80 per cent of all
subsequently affected infants will be stillbirths12 if
preceded by a stillbirth. This means that any method
introduced to aid in prediction of stillbirths would
have its greatest value in the stillbirths whose mothers
have not had any prior stillborns. Therefore, one
should preferably express the value of any predictive
method in terms of the number of stillbirths in those
mothers who have never had a previous severely af-
fected infant or stillbirth. This is similar to the way
that Tovey and Valaes4 express their results.
In addition, one should indicate the number of
recommendations for preterm induction in which the
infant was Rh negative or mildly affected. This
would immediately give the reader an idea of the
specificity of the technique.
If one assumes that the pediatricians in the first
part of our study represent the control group that is
recommending preterm induction only when the his-
tory so indicates, i. e., previous stillbirth or severely
affected infant; then since their accuracy was over
90 per cent it is readily apparent that any method
with an initially impressive accuracy of approximately
90 per cent does not in fact enhance one’s prognostic
ability. In order to appreciate a technique one must
relate it to the stillbirth rate as well as the stillbirth
rate in those mothers with first affected infants. One
must also indicate the specificity by reporting the
number of recommendations for early induction which
led to mildly affected or Rh negative infants.
Summary
A retrospective controlled study of the relative
prognostic value of anti-Rh titers and history was
performed. The charts from the years 1958-1962
(124 cases) were reviewed, the histories placed on
coded cards and the respective titers on separate
coded cards. The coded histories were given indi-
vidually to two pediatricians and two obstetricians.
The titers were given to the serologist. The history
and titers were later given to the serologist and one
pediatrician separately with no information on their
previous predictions. All participants were asked to
predict the outcome of the fetus and recommend
preterm induction. The predictions were then com-
pared to the actual outcome of the fetus.
The results show that the pediatricians predicted
accurately in 90 per cent of the cases, the obstetricians
in 83 per cent, the serologist in 90 per cent, and the
history and titer group in 87 per cent. These re-
sults indicate that the prognostic value of a technique
should realistically be related to the stillbirth rate
and to the number of times the recommendation for
preterm induction was incorrect, i. e., the frequency
of recommending preterm induction in a baby who
is Rh negative or very mildly affected. The widely
accepted method of expressing accuracy of predic-
tion in terms of percentage of total number of eryth-
roblastotic infants at risk is shown to be mislead-
ing and actually uninformative.
Acknowledgment: The serologic study was supported in
part by a grant by the Copeland Russelot Foundation.
We gratefully acknowledge the aid and time given this
project by T. K. Oliver, M. D.
References
1. Chown, B.: The Place of Early Induction in the Management
of Erythroblastosis Fetalis. Canad. Med. Assoc. J., 78:252-256,15
Feb., 1958.
2. Allen, F. H., Jr., and Diamond, L. K.: Erythroblastosis
Fetalis. New Eng. J. Med., 257:659-668, Oct. 3, 1957; ibid, 705-
712, Oct. 10, 1957; ibid, 761-772, Oct. 17, 1957.
3. Sundal, A.: Erythroblastosis Foetalis. A Survey of 491 Con-
secutive Cases of Rh-Immunization in Pregnancy. II. Liveborn
Affected by Erythroblastosis Foetalis. Acta. Paediat. (Stockholm ) ,
52:65-81 (Jan.) 1965.
4. Tovey, G. H., and Valaes, T. : Prevention of Stillbirth in
Rh Haemolytic Disease. Lancet, 2:521-524 (Oct.) 1959.
5. Walker, W.; Murray, S., and Russell, J. K.: Induction of
Labour to Prevent Recurrent Stillbirth Due to Haemolytic Disease.
Lancet, 1:348-350, Feb. 16, 1957.
6. Bowman, J. M.: Personal Communication.
7. Gordon, R. R.: Rh Antibody Titres and Foetal Wastage.
Proc. Roy. Soc. Med., 54:1015 (Nov.) 1961.
8. Vaughan, V. C., Ill: Management of Hemolytic Disease ol
the Newborn. /. Pediat., 54:586-601 (May) 1959-
9- Macpherson, C. P.: To be published.
10. Walker, W. : "Early” Exchange Transfusions. Brit. Med. J.
2:1513-151 6 (Dec.) 1961. '
11. Kelsall, G. A.; Vos, G. H., and Kirk. R. L.: Case for
Induction of Labour in Treatment of Haemolytic Disease in the
Newborn. Brit. Med. J., 2:468-473, Aug. 23, 1958.
12. Walker, W., and Murray, S.: Haemolytic Disease of the
Newborn as a Family Problem. Brit. Med. J., 1:187-193 (Jan.)
1956.
140
The Ohio State Medical Journal
What About Nose Drops in Kids?
Controlled Study of Xylometazoline* * — A New Nasal Decongestant
H. P. SENGELMANN, M. D.
The Author
• Dr. Sengelmann, Columbus, is a member of the
Attending Staffs (Pediatrics) at University, Chil-
dren’s, and Riverside Hospitals; Instructor in
Pediatrics, Ohio State University College of
Medicine.
AMONG the most frequent complaints any physi-
cian dealing with children hears is that of a
^ "stuffy nose.” There have been moments
when we have wondered whether the nose drops wre
were recommending in children were worth the effort
or even accomplishing their purpose. The difficulty
in objectively evaluating nose drops is obvious. There-
fore we tried to determine if nose drops help little
people; and if so, which kind are best.
Consequently an actual "double blind” procedure
was set up comparing one of the most widely used
decongestants, phenylephrine** with a newer prep-
aration, xylometazoline. The plan, we felt, would
serve a dual purpose. It would give us a comparison
of this newer agent and an older preparation and
would serve to elaborate whether or not the prep-
arations actually helped the patient.
Phenylephrine, because of its wide use, requires
no further description; there is no more "standard”
medication used today. The newer xylometazoline
belongs to a group of highly effective aromatic imid-
azoline derivatives of which Privine® is the most
widely known. Xylometazoline is purported to be
a pharmacologically structured improvement over this
best known of vasoconstrictors.
Clinical reports1'4 have indicated the compound
closely approaches the concept of the ideal topical
vasoconstrictor — effective, longer duration of action,
fewer radical side effects, and with little or none
of the usual rebound phenomena.
Plan of Study
Our plan of study, therefore, served a dual purpose.
One was to determine whether nose drops were worth
the effort and the other was to evaluate which of the
preparations was the best for the purpose.
We chose phenylephrine 14 Per cent as our standard
of control, because it is a preparation in wide use whose
qualities, advantages, and limitations are well known.
The other compound, xylometazoline 0.05 per cent,
was chosen because it had seemed to be very efficacious
Research supported in part by Funds from CIBA Pharmaceutical
Company.
Submitted April 12, 1965.
* xylometazoline hydrochlorothiazide (Otrivin®) CIBA.
** phenylephrine (Neo-Synephrine® ) .
in practice and was well accepted. The initial clinical
reports were also impressive.
Patients were randomly selected. Since we con-
sidered the nose and upper respiratory passages as
our major concern, our only criterion for selection
was a "stuffy nose,” regardless of whether it was
related to a "cold” or pneumonia; simple "URI” or
complicated otitis media. We felt that such related
conditions might well be left for some future more
detailed tangential analysis or study.
Both preparations were prepared for our study by
the manufacturer of the newer compound. The drugs
were then placed in identical, unmarked, plain, coded
bottles. After selection, patients were given the plain
bottle of medication with a printed instruction sheet
and report form. They were requested to follow in-
structions carefully, record their observations, and
return within 48 to 72 hours. Upon their return,
parents were queried as to whether: (1) the drops
helped, (2) the child objected and how much, (3)
the effects were evident and how soon, (4) the ef-
fect lasted and how long, and (5) there were any
untoward reactions. The code was not broken until
the first group had been completed and had returned
their reports.
Results
By chance, of the first group of 44 patients, 22
received xylometazoline and 22 received phenyl-
ephrine.
Tables 1 and 2 depict age distribution, action, etc.
Conclusions
In our study, and as can be noted from Tables 1
and 2, both preparations were equally effective, help-
ful, and acceptable with but one major interesting
for February, 1966
141
Table 1. Xylometazoline (22 patients) 0.05%
Age 0-1 2-3 4 5
No. of Patients 10 8 3 1
Help No Yes
No. of Patients 2 20
Acceptance Good Fair Poor
No. of Patients 14 3 3
Onset of Action 0-5 5-10 10-15 15-30
(minutes )
No. of Patients 12 2 5 3
Duration (Hours) 0-1 1-3 3-4 4-6 6-8 8
No. of Patients 2 2 6 5 6 1
Table 2. Phenylephrine (22 patients) 0.25%
Age 0-1 2-3 4 5
No. of Patients 9 7 3 3
Help No Yes
No. of Patients 4 18
Acceptance Good Fair Poor
No. of Patients 11 8 3
Onset of Action 0-5 5-10 10-15 13 * 30
(minutes)
No. of Patients „ 11 4 3 4
Onset of Action 0-5 5-10 10-15 13 * 30
(minutes)
No. of Patients „ 11 4 3 4
Duration (Hours)
0 - 1
1 - 3
3 - 4
4 - 6
6 - 8
8
No. of Patients
5
9
5
2
1
0
difference. Although onset of action was fairly
similar, xylometazoline presented a far more favor-
able duration of effect. Duration of action lasted
three to eight hours in over 82 per cent of the pa-
tients who received xylometazoline, whereas 64 per
cent of the patients receiving phenylephrine had a
duration of effect of three hours or less. Further,
phenylephrine was ineffective in 23 per cent, and
41 per cent showed only one to three hours duration.
The two patients who found xylometazoline in-
effective were children who did not like nose drops
and did not accept the situation with any degree
of cooperation. There were no side effects of con-
sequence noted with either preparation.
It was interesting in that one particular instance,
a physician’s set of infant twins (3 months) suffering
from nasal stuffiness were treated for three days with
one coded bottle and then switched to the other
bottle. One bottle was recorded as having given
"better, more complete relief of stuffiness and longer
duration of action.’’ When the code was broken
the bottle giving greater, more prolonged relief
proved to be xylometazoline.
It is our opinion that the newer nasal vasoconstric-
tor, xylometazoline, is apparently as effective as one
of the most widely used preparations, phenylephrine,
in children with nasal congestion. This new com-
pound, which has an added important factor of offer-
ing a very significantly longer duration of action,
deserves further study. In the interim, it can be used
safely and effectively as a nasal decongestant in in-
fants and children.
Summary
A double blind comparative study of two nasal
decongestant preparations was made in 44 randomly
selected children with nasal stuffiness. The study re-
vealed that the newer preparation (xylometazoline)
was as effective as an older, widely used compound
with one important difference. The more recent
compound presented a much longer duration of effect
in the vast majority of cases. Further use, study
and evaluation is recommended.
References
1. Peluse, S.: An Improved Topical Vasoconstrictor for the
"Stuffy Nose": a Preliminary Evaluation of the Use of Otrivin.
Eye Ear Nose Throat Monthly, 38:936-939 (Nov.) 1959.
2. Jacques, A. A., and Fuchs, V. H.: A New Topical Nasal
Decongestant. /. Louisiana Med. Soc., 111:384-386 (Oct.) 1959.
3. Hagen, W. J., and Trelles, M. G.: A New Local Decongest-
ant of Unusually Low Toxicity. Eye Ear Nose Throat Monthly,
39:56-58 (Jan.) I960.
4. Kolodny, A. L.: Ba-11391 (Otrivin), a New Imidazole Vaso-
constrictor with Lessened Side Effects: a Preliminary Clinical Report.
Antibiotic Med., 6:452-456 (Aug.) 1959.
142
The Ohio State Medical Journal
A Clinicopathological Conference
From The Ohio State University Hospital, Columbus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
COLIN R. MACPHERSON, M. D„ President
Presented by
• William H. Carter, M. D., Columbus, and
• Dante G. Scarpelli, M. D., Ph. D., Columbus.
Edited by Dr. Scarpelli.
PRESENTATION OF CASE
A NEGRO WOMAN, aged 40, was admitted to
University Hospital with the chief complaint
“ of vaginal bleeding and fatigue. She had
been well until three months prior to admission when
a spontaneous abortion occurred at three months.
She was hospitalized and a dilatation and curettage
was performed. She was told at this time that her
blood pressure was elevated but not high enough to
require medication. Following surgery she bled for
approximately six weeks, using six to eight pads per
day, then stopped bleeding without treatment.
Throughout this period she felt some malaise and
weakness. Her fatigue persisted and she went to her
family physician. He told her that her blood pres-
sure was still elevated but prescribed no medication.
She did not improve and became somewhat dyspneic
on exertion.
About three weeks prior to admission she again
had vaginal bleeding as before. Two weeks prior to
admission a throbbing, generalized headache began
that usually started in the occipital area, was more
severe when she arose in the morning, and would
gradually subside during the day. She experienced
some nausea but vomited very little. One week prior
to admission she developed sudden back pain, wdiich
persisted. She had dysuria and urinated less fre-
quently and in small amounts. She began to vomit
more frequently and ate less well. She complained
of blurring of vision and of diplopia. Her symp-
toms increased and a few days prior to admission she
vomited each time she attempted to eat. The patient
sought hospitalization and at her local hospital her
blood pressure was elevated and her blood urea
nitrogen was 175 mg., her creatinine 22 mg./lOO ml.
Her hemoglobin was 6.5 Gm. Transfusion with U/2
units of whole blood was performed and she was
transferred to University Hospital.
At the time of her first pregnancy (twins) 12
years before this, she was told that her blood pres-
sure was high and that she should not become preg-
nant again. She apparently did well without treat-
Submitted November 22, 1965.
ment and subsequently had four more children and
the only complication was puffiness of her face with
her second pregnancy. At no time with her subse-
quent pregnancies was she told that her blood pres-
sure was out of the range of normal. She denied
any symptoms of urinary tract infection, kidney ail-
ments, cardiorespiratory difficulties or significant gas-
trointestinal complaints in the past. Her father died
of hypertension and a kidney disease of unknown
etiology, and a sister and brother had hypertension.
Physical Examination
The patient was well developed, slightly obese,
rather lethargic and answered questions with some
difficulty. She appeared acutely ill and showed some
puffiness of her hands and about her eyes. Her
blood pressure was 230/120, her pulse rate 104 per
minute and regular, respiratory rate 24/min., the tem-
perature normal. The pupils reacted normally. Both
fundi showed fresh hemorrhages and exudates and
approximately 2 diopters of papilledema; the arteri-
oles were narrowed and Grade I-II arteriosclerotic
changes were reported. The neck veins were some-
what distended and filled from below when the pa-
tient was tilted up about 10°. There were moist
rales at both lung bases but no dullness was noted.
The heart had a sinus tachycardia with the point
of maximum impulse located 2 cm. to the left of the
midclavicular line in the fifth intercostal space. A
loud presystolic gallop was heard and no murmur.
The abdomen was slightly distended. The liver was
palpable 8 cm. below the right costal margin and
was not irregular or tender. There was no spleno-
megaly. The bowel sounds were normal. There was
1 plus pretibial and pedal edema. The pedal pulses
were present. The neurological examination was nor-
for February, 1966
143
mal except for papilledema and lethargy. A pelvic
examination revealed uterine bleeding and an other-
wise normal pelvis.
Laboratory Data
On admission the hemoglobin was 6.7 Gm., the
hematocrit 23 per cent; leukocyte count 11,400 with a
normal differential count; there was moderate hypo-
chromia of the red blood cells with occasional macro-
cytes. The 5 ml. of urine that was obtained for
initial examination was cloudy, had a specific gravity
of 1.018, contained 1,920 mg. of protein per 100
ml., no sugar or acetone, 3 to 4 white blood cells,
20 to 30 red blood cells, and a few epithelial cells
per high power field. The C02 combining power
was 17, sodium 133, potassium 5.9, and chloride 100
mEq./L. The blood urea nitrogen was 191, the
uric acid 12.4, and the creatinine 30 mg./ 100 ml.
The total protein was 5.4 Gm./lOO ml. with 4 Gm.
of albumin and 1.4 Gm. of globulin. The fasting
blood sugar, serology, and vaginal Papanicolaou smear
were within normal limits.
X-ray of the chest showed evidence of passive
pulmonary congestion. Supine and right decubitus
films of the abdomen gave the appearance of ascites
fluid. There were also areas of radiolucency along
the left upper side of the abdomen that suggested
free air.
Hospital Course
Shortly after admission paracentesis was performed
but no fluid was obtained. On cystoscopy, both ure-
ters were easily catheterized and a few drops of urine
were obtained from the left kidney but none from
the right. A retrograde pyelogram suggested atrophy
of the right kidney; the left pyelogram appeared nor-
mal. There was no evidence of obstruction. A
Foley catheter was then left in place. The patient
had a urine output of only 40 cc. on the first hospital
day. She was given digoxin, fluids were restricted,
and she was given reserpine intramuscularly. A peri-
toneal dialysis was started on her second hospital day.
She tolerated this well, and the following day her
blood urea nitrogen fell to 91 mg. and her creatinine
to 17.2 mg. She was given packed red cells. She
became more alert and responded more readily to
questions.
Throughout the hospital course the patient had
guaiac-positive stools. Her urinary output remained
less than 100 cc. each day. With intravenous fluids
and intravenous Apresoline® her diastolic pressure
was maintained at about 100 mm. Hg. Her blood
urea nitrogen and creatinine again rose slowly after
the dialysis, her urea nitrogen reaching 214 mg. on
the fifteenth hospital day. A steadily rising potas-
sium was controlled to some extent with a potassium
exchange resin. The patient’s lungs remained rela-
tively clear. She was on a 20 Gm. protein diet with
20 mEq. potassium. She later developed slight swell-
ing and tenderness in the area of the cut-down on
her foot. She became progressively comatose, and
her potassium rose to 8.9 mEq. She had 2 units of
packed red cells during the hospitalization. The
hemoglobin remained at about 7.5 Gm. until the last
three hospital days, when it fell to 4.4 Gm.
On her sixteenth hospital day the patient developed
hypotension and an arrhythmia and died shortly
thereafter.
CLINICAL DISCUSSION
Dr. Carter: I am going to approach what I
think really happened to this woman from two as-
pects. This has to do with relating this to her
pregnancies and to the last pregnancy, which termi-
nated with a spontaneous abortion. We are told that
at the time of her first pregnancy, when she was
about age 28, she was noted to have elevation of
blood pressure. We know nothing else - — - whether
she manifested other symptoms of toxemia or not —
but we know that we are dealing with a 28 year old
woman who had elevation of blood pressure in preg-
nancy. We can only speculate as to whether hyper-
tension existed prior to that time or not. There is
nothing, I think, that answers the question for us
at that point. She was neither a young nor an old
primpara and thus was in the middle ground as far
as being the type of patient in whom we would ex-
pect to see toxemia of pregnancy occur. We do know
that she apparently tolerated four subsequent preg-
nancies without significant difficulty. At age 40 she
became pregnant again and this seemed to set off her
terminal illness leading to death in renal failure with
severe hypertension.
Pregnancy and Renal Function
What kinds of things happen during pregnancy
that might present this picture? One of the inter-
esting things that happens initially upon gestation
is the elaboration of humoral or hormonal-like sub-
stances apparently from the placenta that have a
tremendous stimulatory effect on renal function.
Long before anything has happened that you can
detect as pregnancy by the usual manifestations, by
the fourth to eighth week, the glomerular filtration
rate has risen to 150 per cent or higher of what it is in
the normal nonpregnant state. This gradually dimin-
ishes towards term and somewhere from two to six
weeks postpartum it will return to normal. In the
presence of preexisting renal disease, which I suspect
this patient may have had, instantaneously with con-
ception renal function begins to deteriorate. We
can relate this with what happens to renal plasma
flow.
We see the same type of percentage increase in
renal plasma flow associated with the very early stages
of pregnancy, and we see a deterioration of renal
plasma flow in the face of preexisting renal disease
in pregnancy. This is analogous, after a fashion,
to what one can do experimentally. If for any
reason we compromise the kidney by interfering with
144
The Ohio State Medical Journal
the vascular supply or by wrapping it in cellophane,
we can produce an ischemic situation if we give
exogenous growth hormone. This is quite similar
to what we see in pregnancy and in kidney disease
— the elaboration of some substance that stimulates
the kidney to hypertrophy and increases its function,
and if these are impaired the result is a severe degree
of hypertension. Whether eclampsia in itself leads
to chronic kidney disease and hypertension some-
time in the future remains unanswered.
There are two schools of thought on this. The late
Dr. Dieckmann believed that eclampsia itself never
led to permanent kidney disease or to permanent
hypertension. On the other hand, another obstetri-
cian, Dr. Elliott Page, feels quite strongly that hy-
pertension and chronic kidney disease may be a
sequel to eclampsia — the idiopathic eclampsia of
pregnancy. Another possibility comes to mind at
the very mention that this woman at the age of 40
became pregnant again: If she had some form of
underlying chronic kidney disease prior to this time,
she could demonstrate this accelerated form, which
in a sense is a toxemia of pregnancy superimposed
upon preexisting renal disease, leading to renal failure
and severe hypertension.
Some things we are told about the x-rays are
somewhat bothersome. I cannot explain the presence
of the free air in the abdomen that is described in the
decubitus film unless the film might have been taken
after the patient had had an abdominal tap. There is
nothing in the information we are given that would
lead me to think that she had a perforated viscus
or anything that would be associated with free air
within the abdominal cavity.
Atrophic Kidney
The other thing with regard to her x-rays that I
would like to bring up before we look at them is
this apparent discrepancy in renal size that we are
told existed on the retrograde pyelogram. This be-
comes extremely interesting to think about. We
are told that she had a small or even atrophic right
kidney but a left kidney that appeared to be normal,
and one of the things we don’t like to see is somebody
dying of kidney disease who has one normal size
kidney. This always bothers us to understand why
this exists. One of the things we have come to
recognize is that preexisting renal vascular disease
— that is, some form of stenotic disease involving one
or both renal arteries — in the presence of pregnancy
can mimic the toxemia of pregnancy, can mimic the
full-blown picture of eclampsia. May we look at
the x-rays and get this clear?
Dr. Dunbar: The abdominal x-ray shows a col-
lection of gas that suggests mild intestinal ileus sec-
donary to abdominal ascities. The chest film shows
the presence of subdiaphragmatic air bilaterally. I
feel fairly certain that this film was taken after the
paracentesis. The heart is at the upper limits of nor-
mal size, and there is a slight passive pulmonary hy-
peremia. There is a slightly large left ventricle and
a slightly elongated aorta consistent with hyperten-
sion. The retrograde pyelogram shows an atrophic
right kidney and a normal size left kidney.
Dr. Carter: We have learned in the last few
years that we should be extremely concerned about
the presence of renal vascular stenosis in any pa-
tient with hypertension who has discrepancy in kidney
size. I think this becomes even more important when
any history to suggest another cause for this discre-
pancy in size is absent. We are told that this woman
never had had any problems of urinary tract symp-
tomatology or infection. One of the things that we
would certainly think about is the possibility of an
atrophic pyelonephritis. I think that we might con-
sider that this woman had a renal artery stenosis on
the right side of a fibromuscular type and that the
left kidney, having been subjected to persistent eleva-
tion of blood pressure, had undergone arteriolo-
sclerosis secondary to the hypertension and had some
atrophy on this basis.
Renal Artery Stenosis
One other thing that comes up appears early in
her course: One week prior to her admission she ex-
perienced an episode of severe back pain which ap-
parently persisted, and it was also noted at that time
that there was a change in the volume of urine that
she was making, and she remained in this state essen-
tially throughout the rest of her course. What might
have happened in this situation to account for her
back pain and this rapid decrease in function? It is
conceivable that with the nausea and vomiting and
all that was present, perhaps some degree of dehydra-
tion, this woman may actually have thrombosed either
all or part of the left renal artery and literally in-
farcted her kidney.
Another possibility that one has to consider in
such a situation is this: We know that renal artery
aneurysms can be associated with hypertension and
we also know that these are predisposed to rupture.
Conceivably, and I bring it up just to mention that
such a thing does exist, a renal artery aneurysm as a
cause of hypertension could be present in a situation
like this and its rupture could account in part for
the back pain that was present. The possibility
that she may have infarcted the left kidney, which
was perhaps carrying a large percentage if not all
of her renal function at that time, is suggested
in some way by the urinalysis that was obtained,
which showed a large percentage of protein, al-
though the volume was small, and the presence of
red cells. This could all go along with infarction.
To summarize, two possibilities exist: (1) We are
dealing with a woman who had toxemia of preg-
nancy at or around the age of 28. This was asso-
ciated either with some preexisting hypertension or
in itself led to a hypertensive state with some degree
for February, 1966
145
of kidney damage. This was progressive, untreated,
and then with the additional insult of a pregnancy
late in life that was complicated early in its course
by toxemia, it went on to progressive renal failure.
(2) The second consideration we would have is that
this woman from the beginning had renal artery
stenosis on the right side, with subsequent atrophy
in the left kidney secondary to the hypertensive dis-
ease itself, and then finally perhaps had an infarc-
tion of all or part of the left kidney, went rapidly
into renal failure and died.
Dr. Schieve: What is this disease that happens
to the other kidney?
Dr. Carter: I think it is arteriolosclerosis. I
am sure Dr. Scarpelli can explain this much better
than I, but if you develop muscular hypertrophy and
hyperplasia of the arterioles secondary to the hyper-
tension, this leads to further renal ischemia that may
eventuate in renal failure.
Dr. Schieve: I would like to ask you about the
problem of pancreatitis in these patients. Is it present
in the uremic syndrome alone or particularly in those
patients who have had peritoneal dialysis ?
Dr. Carter: I think if you had to pick a way to
diagnose uremia in a patient it would be to look at
the pancreas. I think that you almost invariably are
going to see some pancreatic disease existing in the
presence of uremia.
Dr. Saslaw: Is the pancreas reachable with a
needle or a trocar?
Dr. Carter: It would be reachable certainly,
but heaven forbid that we get there with a trocar. I
think it is possible that in peritoneal dialysis the tonic-
ity of the fluids that we use may be sufficient to
precipitate pancreatitis.
Dr. Smith: I would say that on the one occasion
when we thought it was conceivable that peritoneal
dialysis had created pancreatitis, straight 7 per cent
dialysis solution had been used. We don’t use that
any more. We always dilute the 7 per cent dialysis
fluid at least half by using 1.5 per cent dialysis fluid.
Dr. Schieve: Bill, in the diagnosis of fibro-
muscular hyperplasia of the renal arteries, I have been
under the impression that it can only be made ac-
curately on renal arteriography where you see the
beaded appearance of the renal artery. Is this true?
Or if you don’t have this appearance, can you still
implicate this diagnosis ?
Dr. Carter: I think fibromuscular hyperplasia
now really constitutes a group of five entities, one
of which will give you the beaded appearance that
you see radiologically. There are things that we can
use to diagnose this — going on the basis of the loca-
tion of the lesion. Almost invariably we look for
fibromuscular hyperplasia in the distal third of the
main renal artery or at the bifurcation involving
the segmental arteries as opposed to atheromatous
plaques, which are invariably at the orifice or within
the proximal one third of the artery. I think that
in general we do very well in picking out fibro-
muscular hyperplasia from renal artery atherosclerosis.
CLINICAL DIAGNOSIS
1. Hypertensive heart disease.
2. Right renal artery stenosis.
3. Renal hypertension.
4. Uremia.
PATHOLOGICAL DIAGNOSIS
1. Thrombosis of right renal artery.
2. Atrophy of right kidney.
3. Arteriolar and arterial nephrosclerosis.
4. Acute and chronic pyelonephritis.
5. Uremia.
6. Acute necrotizing pancreatitis.
7. Hypertensive heart disease.
DISCUSSION OF PATHOLOGY
Dr. Scarpelli: This is an extremely interesting
case, which at autopsy showed ascites, pericardial ef-
fusion, and evidence of hypertensive heart disease.
Her heart weighed 450 Gm. and the left ventricle
measured 1.8 cm. in thickness. The lungs were
slightly heavier than normal and microscopically
showed an early uremic pneumonitis with its char-
acteristic hemorrhage with fibrin. The pancreas was
edematous and hemorrhagic. Microscopically, there
was evidence of acinar cell injury and fat necrosis.
This woman also had thickened arterioles in her pan-
creas and the hallmark of uremic pancreatitis, so-
called, described first by Baggenstosse at the Mayo
Clinic. What this amounts to is an inspissation of
secretions within the acini and the ductular system of
the pancreas. This characteristically does not lead to
a hemorrhagic pancreatitis; however, in view of the
several days of severe hypotension described in her
clinical course, in the presence of severe arteriolar
sclerosis, hemorrhagic necrosis may well have ensued.
The right kidney weighed 25 Gm. and was de-
scribed as being atrophic. This was predicated on the
normal size pelvis and calyceal system in the face
of a truly diminutive kidney. The two renal arteries
supplying this organ were probed and appeared to
be completely occluded; however, microscopically
there was evidence of recanalization of what was
probably old thrombosis. The next problem, of
course, was the contralateral kidney. It weighed 175
Gm., was edematous and showed the "flea-bitten”
appearance that we not uncommonly see in malig-
nant nephrosclerosis, or accelerated hypertension. The
cortico-medullary junction was indistinct, and there
were multiple petechial hemorrhages throughout the
renal substance. The left renal artery was patent
although it and its intraparenchymal branches were
sclerotic.
The microscopic appearance of the two kidneys
146
The Ohio State Medical Journal
was vastly different. The right kidney showed ex-
tensive atrophy as characterized by loss of interstitial
tissue and marked crowding of glomeruli. The in-
terstitium w^as infiltrated with both acute and chronic
inflammatory cells, and although morphologically it
appeared to be capable of little or no function, there
was no evidence of necrosis. The arterioles were only
moderately sclerotic. The tubules appeared atrophic
and were filled with inspissated material. The renal
artery was sclerotic and there was evidence of old
thrombosis with organization and recanalization.
In the left kidney we again encountered extensive
acute and chronic interstitial inflammation with sev-
eral areas of abscess formation. Again, large numbers
of tubules were probably not functioning very well.
The glomeruli did not show the proliferative and
membranous vascular lesions found in toxemia of
pregnancy. So, although there was a strong pos-
sibility of this in this woman, it was not present.
The parenchymal arterioles showed extensive sclerosis
with intimal proliferation to a far more severe degree
than that present in the right kidney.
The extensive interstitial infection present in this
case is of interest inasmuch as there was no history
whatever suggesting kidney infection. This em-
phasizes the point Dr. Kass is always making that
kidney infection can exist in the asymptomatic patient.
This case has several noteworthy features which
merit amplification and may well fit into a pattern
of pathogenesis which eventuated in this woman’s
death. Twelve years ago, at the time of her first
pregnancy, she already had an elevated blood pres-
sure, which may have been of non-renal origin. Her
history shows a strong family background of high
blood pressure. Repeated pregnancies with their pro-
found effects on renal function, especially the de-
creased excretion of sodium, may well have aided in
intensifying her hypertension. The coup de grace
was delivered when the right renal artery became
thrombosed. The resulting cortical ischemia re-
sulted in the elaboration of vasopressor substances
which further elevated the blood pressure. The dim-
inution of blood flow secondary to the thrombosis in
effect protected the arterioles of the right kidney from
the ravages of hypertension, while those of the left
kidney responded by extensive sclerosis. Thus the
culprit organ is spared, precisely what was found
here. The right renal atrophy not only removed ef-
fective functional renal mass but predisposed the
organ to infection.
Dr. Gwinup: Let me ask you whether you think
that at one time in her life she had two normal
kidneys.
Dr. Scarpelli: Yes, I think so; the size of the
pelves and ureters would support this. In this hypo-
plastic kidney the size of the pelvis and ureter is
in proportion to the rest of the kidney. In an ac-
quired atrophy the ureter and pelvis are of normal
size, while the kidney mass is small. Since these
were the findings in this case, the right kidney was
most probably atrophic.
Dr. Carter, what do you as a clinician think is the
important factor or factors that determine whether or
not a hypertensive patient is going to have a good
result from removal of a kidney that is affected by
unilateral vascular disease?
Dr. Carter: He is going to have a good effect
if he does not have arteriolar disease in his opposite
kidney. If he does have it there, then he should have
a nephrectomy on that side and vascular repair of
the contralateral kidney. If this is due to stenosis
and there is a pressure gradient that is greater than 35
mm. of pressure, and if he has an increase in the
number of granules in the juxtaglomerular ap-
paratus on the side with stenosis, then I think you
can probably predict a good result.
Dr. Saslaw: Bill, doesn’t duration of the hyper-
tension play a part here too?
Dr. Carter: I don’t think so.
Dr. Saslaw: In time doesn’t it become irrever-
sible ?
Dr. Carter: It does become irreversible if you
have reached the stage in which you have arteriolar
changes in the contralateral kidney. But one person
may get this in one month and the next one may not
have it 15 years later.
Dilemmas in the practice of surgery. — The sum total of the
experience of a mature surgeon, one who has systematically made a critical
analysis of his acts, makes up a precious legacy that can be transmitted only partially
to his successors. This experience gives him a moral dimension and shapes his
individuality both personal and professional. It enables him to make a wise choice,
in advance, of his operative technique and guides his hand in the process of the
actual operation. Every year should find him an abler surgeon than the year before.
— Achille Mario Dogliotti, Turin, Italy: Bulletin of The Neiv York Academy of
Medicine, 41:1107-1116, November, 1965.
for February, 1966
147
Which Is Pyloroplasty with Vagotomy?
Which Is Pro-Banthine?
Photographs— Harry Barowsky, M.D., Lawrence Greene, M.D., and Robert'
Bennett, M.D., from a Scientific Exhibit presented at the Annual Meeting
of the American College of Gastroenterology, Bar Harbour, Florida, Oct.
24-27, 1965.
148
The Ohio State Medical Journal
Another example of
Pro -Banthme
(propantheline bromide)
a true anticholinergic in action
Normal relaxed pyloric antrum; con-
tracted pylorus (pyloric fleurette)
The true anticholinergic values of
Pro-Banthlne have never been so
graphically realized as they are
with the recent development of
fiber gastroscopy and the intr agas-
tric camera.
Pro-Banthine consistently pro-
duces complete relaxation and im-
mobility of the stomach with a dose
of only 6 to 8 mg. intravenously.
This is less than half the usual dose
orally.
Atropine, on the other hand,
required 0.8 mg. intravenously, or
twice the normal dose, to achieve
a similar effect. This high dose of
atropine resulted in expectedly
adverse side effects.
Pro-Banthine, in minimal dosage,
produces effects similar to pyloro-
plasty and vagotomy without the
disadvantages of permanent post-
vagotomy sequelae.
The intragastric photograph A
is of a patient who has had pyloro-
plasty with vagotomy. Photograph
B is of a patient given 6 mg. of Pro-
Banthine.
Indications: Peptic ulcer, functional hy-
permotility, irritable colon, pyloro-
spasm and biliary dyskinesia.
Oral Dosage: The maximal tolerated
dosage is usually the most effective.
For most adult patients this will be four
to six 15-mg. tablets daily m divided
doses In severe conditions as many as
two tablets four to six times daily may
be required. Pro-Banthine (brand of
propantheline bromide) is supplied as
tablets of 15 mg., as prolonged-acting
tablets of 30 mg. and, for parenteral use,
as serum-type ampuls of 30 mg.
Side Effects and Contraindications:
Urinary hesitancy, xerostomia, mydri-
asis and, theoretically, a curare-like
action may occur. Pro-Banthine is con-
traindicated in patients with glaucoma,
severe cardiac disease and prostatic
hypertrophy.
SEARLE
Research in the Service of Medicine
for February, 1966
149
Proceedings of The Council . . .
Minutes of December 11-12 Meeting; Approved 1966 Budget;
Also Report of Other Matters Considered and Actions Taken
A REGULAR MEETING of The Council of the
Ohio State Medical Association was held on
- December 11-12, 1965 at the Home Office
Building of Ohio Medical Indemnity, Inc., 3770
North High Street, Columbus. All members of
The Council were present except Dr. P. John Robe-
chek, Cleveland, Councilor of the Fifth District.
Others attending were: Mr. Wayne Stichter, Toledo,
legal counsel; Dr. Perry R. Ayres, Columbus, Editor,
The Ohio State Medical Journal; Dr. Charles L. Hud-
son, Cleveland, President-Elect of the AMA; Mr.
David B. Weihaupt, Chicago, AMA Field Represen-
tative; Dr. George W. Petznick, Cleveland, AMA
delegate; Dr. John H. Budd, Cleveland, Chairman of
the Ohio delegation to the AMA; Dr. Edmond K.
Yantes, Wilmington, delegate to the American Medi-
cal Association and President, Ohio Medical In-
demnity, Inc., Board of Directors; Mr. Charles H.
Coghlan, Columbus, Executive Vice-President, Ohio
Medical Indemnity, Inc.; Mr. Herman Tice, Tice &
Company, Inc., Columbus; Messrs. Page, Edgar, Gil-
len, Traphagan and Moore, members of the OSMA
staff.
Minutes Approved
The minutes of the meeting of The Council held
on November 21, 1965 were approved by official
action.
Membership Statistics
The following membership statistics were announced
by Mr. Page: OSMA membership as of December 10,
1965, 10,040, compared to a total membership at the
end of 1964 of 9,933. The report stated that of
the 10,040 OSMA members, 9,010 were affiliated
with the AMA.
Reports by Councilors
The Councilors reported on activities in their re-
spective districts.
1966 Annual Meeting
Mr. Traphagan presented a progress report on the
1966 Annual Meeting. The Council decided to ask
AMA President-Elect Charles L. Hudson to discuss
the Medicare Act at a general session program on
Thursday, May 26.
Reports on AMA Meetings
Dr. Budd reported on the special session of the
American Medical Association House of Delegates in
Chicago, October 2-3, and the clinical session held
November 28 - December 1 in Philadelphia. By
official action, The Council commended Dr. Budd
for his leadership of the Ohio AMA Delegation at
these meetings and approved the report.
Summaries of the special meeting in October ap-
peared on pages 1019 through 1021 of the Novem-
ber, 1965, issue of The Ohio State Medical Journal,
and the clinical session in Philadelphia on pages 58
through 60 of the January, 1966, issue of The Journal.
Mr. Page reported on plans for the presidential
reception to be held by the Ohio delegation in con-
nection with the inauguration of Dr. Charles L. Hud-
son, Cleveland, as President of the American Medical
150
The Ohio State Medical Journal
Association, Tuesday, June 28, 1966, at the AMA
Annual Meeting, Chicago.
Financial Report
The Council then went into executive session and
a report of the Committee on Auditing and Appro-
priations was presented by the chairman, Dr. Robert
E. Howard, Cincinnati. The report of the commit-
tee, including a budget for 1966, was approved by
official action.
BUDGET FOR 1966
The Ohio State Medical Journal $ 47,000.00
Organizational Staff Salaries and Expenses 62,500.00
Stenographic and Clerical Salaries 61,195.00
President: Expense $4,500;
Honorarium $2,000 6,500.00
President-Elect: Expense $2,500;
Honorarium $1,000 3,500.00
Council, Expense 7,500.00
American Medical Association Delegates
and Alternates 20,000.00
Department of Public Relations ($34,325.00)
Salaries and Expenses 19,825.00
Exhibits and Newspaper Publicity 500.00
Literature 500.00
Postage 3,000.00
Supplies 500.00
Miscellaneous Activities 10,000.00
Committees:
Education 500.00
Judicial and Professional Relations 600.00
Public Relations and Economics 400.00
Scientific Work 1,000.00
Auditing and Appropriations; Bookkeeping 1,270.00
Cancer 150.00
Care of the Aging 600.00
Disaster Medical Care 600.00
Eye Care 300.00
Hospital Relations 2,000.00
Laboratory Medicine 500.00
Maternal Health 1,650.00
Medicine and Religion 300.00
Mental Health 1,200.00
Rural Health 1,800.00
School Health 1,500.00
Workmen’s Compensation 500.00
Environmental and Public Health 1,150.00
(Occupational Health, Poison Control,
Radiation, Traffic Safety Committees com-
bined into one committee. )
Annual Meeting 30,000.00
Conference of County Society Officers 2,500.00
Councilor District Conferences 4,500.00
Emergency and Equipment Fund 6,475.00
Employees’ Retirement Fund 13,500.00
Insurance, Bonding, and Social Security 11,220.00
Lectures for Senior Medical Students 2,800.00
Legal Expense 12,000.00
Library 300.00
OSMAgram 7,500.00
Postage 2,800.00
Professional Relations Activities 6,500.00
Rent and Utilities 21,465.00
Rural Medical Scholarships 3,500.00
Stationery and Supplies 6,000.00
Telephone and Telegraph 6,100.00
Woman’s Auxiliary Contribution 1,500.00
New Office in Huntington Building: Equip-
ment and Moving Expense 15,000.00
Total $412,200.00
OSMA Employees’ Pension Plan
Following the executive session, The Council dis-
cussed with Mr. Herman Tice of Tice & Company,
Inc., changes in the Ohio State Medical Association
employees’ pension plan as proposed by the Auditing
and Appropriations Committee.
On motion duly made, seconded and carried, The
Council voted:
That the present pension plan be amended as
follows:
1. That there be adopted a formula of benefits
to provide a retirement income equal to 45 per cent
of monthly salary, including the primary social
security benefit in effect as of December 17, 1965,
based upon a straight life annuity income option
with a minimum income provision of $100 per
month from the OSMA pension plan.
2. We recommend that this increase in benefit
be limited to those participants who as of Decem-
ber 17, 1965, are not over age 61, and to those
who after December 17, 1965, are not over age 60.
3. That the Plan be changed in the method of
funding from a fully insured basis to what is
known as the combination method of funding and
that the amount by which the contracts are over-
funded at this date of conversion be applied against
the deposits required over the next five years.
Ohio Medical Indemnity and Medicare
Dr. Yantes appeared before The Council to report
that the Ohio Medical Indemnity Board of Directors
had recommended on December 8, 1965 that OMI
apply as a fiscal intermediary under Part B of the
Medicare Act.
Mr. Coghlan reported that Blue Shield contracts
for subscribers age 65 and over billed at home
would continue.
An executive session of The Council was then held
and the following was adopted on motion by Dr.
Smith, seconded by Dr. Fulton:
"That the Board of Ohio Medical Indemnity be
informed that The Council of the Ohio State Medi-
cal Association does not object to Ohio Medical
Indemnity making application for appointment as
a fiscal intermediary under Part B of the Medicare
Act, provided, however, that if the application is
granted and the government designates Ohio Medi-
cal Indemnity as such, Ohio Medical Indemnity
will submit the proposed contract to the Ohio State
Medical Association Council before entering into
such contract.”
OMI Board of Directors
By official action, The Council authorized Presi-
dent Crawford to appoint a nominating committee
to select nominees for the Ohio Medical Indemnity,
Inc., Board of Directors, such nominees to be voted
(Continued on page 154)
I or February, 1966
151
This tablet has
earned “...the
greatest clinical
acceptance,nof
any long-acting
coronary
vasodilator
But if you prescribe
PETN...
your patient could
get any one of these
66 generics.
Which one?
And what do you
know about it?
In quality control tests... many generic penta-
erythritol tetranitrate products would be
rejected if evaluated by the standards specified
and recommended for Peritrate (pentaerythri-
tol tetranitrate).2
Nearly one hundred separate tests — including
total PETN content, disintegration time,
individual tablet analysis, and others — assure
the therapeutic consistency of Peritrate
(pentaerythritol tetranitrate) today,
tomorrow, next year.2
That the therapeutic effect you desire from a
drug can be compromised by disparities among
such parameters as solubility, purity, potency
and particle size is underscored in a recent
review3 of the comparative effects of brand
name and “generic equivalent” drugs.
All available evidence indicates Peritrate
(pentaerythritol tetranitrate) is the most
thoroughly assayed agent of its kind. And,
clinically, Peritrate (pentaerythritol tetra-
nitrate) is the most thoroughly documented
pentaerythritol tetranitrate product.
in pentaerythritol tetranitrate therapy...
your patients deserve no less than
Peritrate’
pentaerythritol tetranitrate
. ..brings more blood and oxygen
to the myocardium safely
...stimulates development of
collateral circulation4
Side effects: Negligible— but, occasionally,
transient headache may occur.
Precautions: Exercise caution in glaucoma,
and with dosage forms containing phenobar-
bital, which may be habit forming. Full infor-
mation available on request.
References: 1. Johnson, P. C., and Sevelius, G.: J.A.M.A.
173: 1231, 1960. 2. Data on file in the Medical Depart-
ment, Warner-Chilcott Laboratories. Available on
request. 3. Sadove, M. S.; Rosenberg, R.; Heller, F., and
Shulman, M.: Am. Prof. Pharm. 31:23, 1965. 4. Lumb,
G. D., and Hardy, L. B.: Circulation (Pt. II, Cardiovas-
cular Surgery) 27:717, 1963.
WARNER-CHILCOTT
Warner-Chilcott, Morris Plains, N. J.
Makers of Coly-Mycin Gelusil Mandelamlne Proloid Tedral
PC.GP-S26-JC
on at the annual OMI stockholders’ meeting in April,
1966.
Fall District Conferences
Mr. Edgar reported on the Fall District Conferences
and noted increased attendance and enthusiasm at
these meetings which had representatives from 78 of
88 counties in attendance.
1966 County Society Officers Conference
It was announced by Mr. Edgar that the annual
County Society Officers’ Conference is scheduled for
Sunday, February 27, at the Pick-Fort Flayes Hotel,
Columbus. An outline of the program, presented by
Mr. Edgar, was accepted by The Council.
Committee Reports
Military Advisory — Mr. Edgar reported on in-
creased activities of the OSMA Medical Advisory
Committee due to the build-up of military activities in
Viet Nam. It was suggested by Dr. Tschantz that a
communication be addressed to Selective Service
Headquarters, suggesting that requests for medical
information be postponed until after the Selective
Service medical examination of the registrants.
Insurance — The Executive Secretary presented a
report of the Committee on Insurance, based on the
minutes of a meeting of that committee held on No-
vember 14, 1965. The report was approved as pre-
sented. This included approval of authorization to
raise the ceiling on the OSMA group term life insur-
ance from $20,000 to $40,000; travel accident insur-
ance coverage for officers, councilors, committeemen,
delegates, alternates and employees engaged in Asso-
ciation activities; income continuation insurance in
event of disability occurring to State Association em-
ployees; and the exploration of a suggestion that a
consultant or consultants be retained to assist the
Association with insurance problems.
Several communications regarding the OSMA Ma-
jor Medical Insurance Plan were referred to the
Committee on Insurance.
Ad Hoc Committee on Education of the Com-
mittee on Mental Hygiene — Minutes of the meet-
ing of this committee held on August 30, 1965 were
discussed. The Council accepted the report for infor-
mation and referred suggestions concerning psychiat-
ric material for presentation in The Ohio State Medi-
cal Journal to the Editor of The Journal for his con-
sideration. Item 2 regarding a pamphlet on commit-
ment procedures to be prepared by the committee and
distributed to all members with an OSMAgram and,
subsequently, with the "new member packet” was
approved.
Laboratory Medicine — The minutes of the meet-
ing of the Committee on Laboratory Medicine held
on September 22, 1965, were presented by Mr. Trap-
hagan and were accepted.
A statement of policy with regard to county medi-
cal society bulletin advertising of laboratory services
was amended to read as follows:
"Based on the established policy of the Ohio
State Medical Association, the practice of pathology
is a part of the practice of medicine and in the
judgment of The Council of the OSMA, it is im-
proper for a county medical society publication to
accept advertising proposing to perform clinical,
pathological services.”
Disaster Medical Care — Minutes of the meeting
of the Committee on Disaster Medical Care held on
November 21, 1965, were approved. The minutes
dealt with the appointment of members of the OSMA
committee as spokesmen for each of eight "emergency
medical care districts” and four meetings in 1966 to
train personnel to operate the stored packaged disaster
hospitals. A communication to the Ohio Depart-
ment of Education, stating that the OSMA has ap-
proved the Medical Self-Help Training Program for
students in public and parochial schools, was endorsed.
| Rural Health — Minutes of the meeting of the
Committee on Rural Health held on October 6, 1965,
were approved. With regard to a letter from the
Western Reserve Medical Alumni Association, the
committee voted to send a letter to the dean of the
Western Reserve University Medical School, stating
that if the medical school wants the student lectures
for junior medical students and will cooperate in
conducting the program, the committee will put forth
its efforts at Western Reserve University as it has at
Ohio State University and the University of Cincin-
nati. If the dean of the Western Reserve University
Medical School does not answer the letter, The
Council asked that the Western Reserve University
Alumni Association be notified.
Subcommittee on Measles Education Campaign
- — A progress report on the measles education cam-
paign presented by Mr. Gillen was accepted.
Hospital Relations — Mr. Gillen reported on the
meeting of the Committee on Hospital Relations,
held on November 24, 1965. A policy statement
regarding nursing procedures was amended and ap-
proved as follows:
Emergency Nursing Procedures
"The best interests of a patient requiring emer-
gency treatment or emergency procedures will be
served by permitting a competently trained reg-
istered nurse to render such needed emergency
treatment or procedures not previously defined as
accepted nursing care as may be authorized by the
medical staff of the hospital or the medical ad-
visory committee of the employing agency and
and approved by the individual physician.
"The ultimate decision as to the exact role and
responsibility of the nurse in carrying out such
emergency treatment and procedures must rest with
154
The Ohio State Medical journal
such medical staff or medical advisory committee
and the individual physician.”
Hospital-Based Services
A statement on hospital-based physician sendees
was amended and approved as follows:
"The committee endorsed and fully supports the
position taken by the American College of Radi-
ology and the College of American Pathologists on
relations between their specialties and the hospitals
in which they practice.
"The committee recommended that the Ohio
delegates to the AMA Clinical Meeting in Phila-
delphia be instructed to support any resolution
which insists that hospital-based specialists bill sep-
arately for their sendees. The committee further
requested that Ohio Medical Indemnity immedi-
ately develop policies that would pay hospital-based
specialists’ fees.
"It was announced that the Ohio Hospital As-
sociation has deferred action on the subject of
having a joint meeting of the Ohio State Medical
Association, Ohio Hospital Association, Blue Shield
and Blue Cross to discuss the transferal of hospital-
based physicians’ fees from Blue Cross to Blue
Shield plans. The committee instructed the secre-
tary to arrange a meeting, as soon as possible, with
representatives of the Ohio State Medical Associa-
tion, Blue Shield and Blue Cross.”
The Council requested that a letter be directed by
Dr. Crawford to the Ohio State Radiological Society,
the Ohio Society of Pathologists and the Ohio Hos-
pital Association advising of the action of the Ohio
State Medical Association with regard to separate
billing for physicians’ services.
Dr. Fulton reviewed correspondence from Dr. Wil-
liam B. Schwartz, Columbus, and a communication
from Dr. Schwartz to the administrator of Riverside
Hospital, Columbus, concerning a separate billing for
radiological services. The Council requested that a
letter be sent to Dr. Schwartz, advising him that his
communication had been discussed by members of
The Council and encouraging him to proceed with
his action to establish separate billing for radiological
services at Riverside Hospital. In addition, it was
requested that Dr. Schwartz receive a copy of the
minutes of the meeting of the Committee on Hospital
Relations held on November 2-4 and a copy of the
American Medical Association Principles of Medical
Ethics, Section 6.
Hospital Directors of Medical Education
A report on replies of hospital directors of medical
education concerning a survey on forming an Ohio
section of hospital directors of medical education was
referred to the Committee on Hospital Relations for
study, with instructions for the committee to report
to the next meeting of The Council.
Conference of Chairmen of County
Hospital Relations Committees
A conference of chairmen of county committees on
hospital relations was approved as a part of the
report.
Adherence to AMA Policies — "Model Agreement”
and Utilization Committees
Also approved as a part of the minutes were two
resolutions introduced by the Ohio Delegation at the
November 28 - December 1 session of the AMA
House of Delegates in Philadelphia. One resolution
requested adherence to AMA House of Delegates
policies with regard to an AMA-issued "model agree-
ment” between physicians and hospitals and another
insisting that utilization committees shall be com-
posed of practicing physicians.
OHA Coordinating Committee
The matter of appointments to represent the Ohio
State Medical Asosciation on the Ohio Hospital As-
sociation Coordinating Committee for Health Facility
Planning was discussed. The following appoint-
ments were announced by the President: Dr. William
R. Schultz, Wooster; Dr. Oscar Clarke, Gallipolis;
Dr. Homer A. Anderson, Columbus; Mr. Herbert E.
Gillen, Columbus; Dr. David A. Chambers, Cleve-
land; Dr. Jonathan G. Busby, Columbus; Dr. Rob-
ert M. Craig, Dayton; Dr. Lloyd Larrick, Cincinnati;
Dr. J. Lester Kobacker, Toledo.
Medicare
A letter from the Health Insurance Council regard-
ing insurance companies and Medicare was reviewed.
The Council authorized the staff to confer with rep-
resentatives of the Health Insurance Council regard-
ing problems arising as a result of the passing of the
Medicare Act.
A letter from the Summit County Medical Society
regarding a request that the Summit and Portage
County Medical Societies have a voice in the selection
of the Medicare carrier chosen for their area was
duly noted and referred to Ohio Medical Indemnity,
Inc.
The Ohio State Medical Journal
Reports from Dr. Perry R. Ayres, Editor of The
Ohio State Medical Journal and from Mr. Moore on
the progress of The Journal were accepted.
Charters and Bylaws
The Council granted a request for the reissuance
of a charter to the Jackson County Medical Society.
With regard to proposed amendments to the
Lorain County Constitution and Bylaws, the OSMA
legal counsel was authorized to write to the Lorain
County Medical Society with suggestions as to what
changes in the language would be indicated in order
to meet the purpose of the amendments.
It was announced that amendments which had
for February, 1966
155
been submitted by the Wayne County Medical Society
were defeated in a recent meeting of the society.
Dependents’ Medical Care
A communication 'from the Office for Dependents’
Medical Care, granting certain fee increases for ton-
sillectomy anesthesia and for a variety of otolaryn-
gological procedures, was reported to The Council.
Small Claims Courts in Ohio
Correspondence proposing small claims courts in
Ohio was accepted for information.
Welfare Advisory Committee
The President was authorized to appoint a represen-
tative of the Ohio State Medical Association to the
Department of Public Welfare Advisory Committee
on the matter of the development of the department’s
medical assistance program.
Belmont County
Belmont County developments were discussed.
Community Service Award
A request from the A. H. Robbins Company to
participate in its Community Service Award Project
was declined with thanks.
Woman’s Auxiliary
The following amendment to Article VII, Section
7 of the Constitution and Bylaws of the Woman’s
Auxiliary was approved:
Amend by changing 30 days to 90 days and insert
after the first sentence the following: "Not less than
60 days before the annual meeting all resolutions ap-
proved by the Advisory Committee and the Resolu-
tions Committee shall be sent to each component
auxiliary.”
A second amendment to Article VIII, Section 5,
C-2, C-l, also approved by Council, is a deletion of
”2) be Membership Chairman.” This would pro-
vide for a membership chairman instead of having
that duty one of the duties of the President-Elect.
Also approved was the following resolution on
joining a number of counties into one auxiliary:
"Whereas, The Woman’s Auxiliary to the Ohio
State Medical Association has been working to
organize every county auxiliary in the State of
Ohio for the past 25 years,
"Whereas, We have organized every possible
county and have reached a stalemate,
"We, the Woman’s Auxiliary to the Ohio State
Medical Association, request permission to unite
two or more of the counties to form one organiza-
tion as it is done in other states.”
The Council disapproved the following resolution
regarding team membership:
"Whereas, The Woman’s Auxiliary to the Ohio
State Medical Association has worked on member-
ship for 25 years and has a membership of ap-
proximately 5,600 members from a potential of
about 9,000,
"Whereas, The Woman’s Auxiliary to the Ohio
State Medical Association could improve the quality
and quantity of the work they are doing with the
additional dues and members,
"Whereas, The Woman’s Auxiliary to the Ohio
State Medical Association could spend the time
devoted to obtaining new members to doing other
important work,
"Whereas, The American Medical Association
has endorsed the 100 per cent team membership,
"Whereas, The money for the dues comes from
the same source,
"We, the Woman’s Auxiliary to the Ohio State
Medical Association, request the permission and
cooperation of the Ohio State Medical Association
to promote 100 per cent team membership of the
Woman’s Auxiliary - Ohio State Medical Associa-
tion and the Ohio State Medical Association. That
is, at the time the doctor pays his county, state and
national dues to his medical association, he will
also pay those of his wife.”
Workmen’s Compensation
Mr. Edgar reported on the progress of the usual
and customary fee program of the Bureau of Work-
men’s Compensation and announced that a conference
of OSMA officers and staff would be held with the
officials of the Bureau on December 16, 1965.
Reports on Meetings
Dr. Crawford reported on meetings of the Michi-
gan and West Virginia State Medical Associations
which he had attended. Dr. Meredith discussed the
Kentucky and Indiana State Medical Society meetings
at which he represented the President.
Reports to The Council on other meetings attended
were as follows:
AMA National Conference on Physicians and
Schools, Chicago, September 24-25, 1965 — Mr.
Gillen.
Emergency Hospital Training Program, October
17, 1965 — Mr. Traphagan.
First Ohio Congress on Psychological Medicine,
October 24 — Mr. Traphagan.
American Medical Political Action Committee Con-
ference, Chicago, November 5 — Mr. Page and Mr.
Stichter.
Institute on Areawide Planning of Health Facil-
ities, November 7, 1965 — Mr. Gillen.
Ohio Hospital Association Institute on Long Term
Care, November 19 — Mr. Gillen.
Legislation
Correspondence with Dr. Arthur D. Collins, Cleve-
land, chairman of the OSMA Committee on Eye Care,
156
The Ohio State Medical Journal
An antibiotic
of choice
is one that works
TAO works
Susceptibility Results
Staphylococci 2,3,1
# OF CULTURES
YEAR
% EFFECTIVE
6,725
1962
88.6%|
5,440
. 1963
88.0% |
10,384 1964 88.5%
y^-Hemolytic Streptococci 2,3,1
The Product
In a world study of antibiotics in vitro1, TAO had an over-
all effectiveness of 87.3%, higher than chloramphenicol
and erythromycin, and significantly higher than tetracy-
cline and penicillin.
The Plus... Consistent Performance
Yet antibiotics must not only work. They must work con-
sistently. Here are the results from the largest study of
microbial susceptibility ever undertaken. In 29,048 cul-
tures of overt staphylococcal and ^-hemolytic streptococ-
cal infections, note the consistency of results with TAO.
TAO
[triacetyloleandomycin]
J. B. Roerig and Company, New York, New York 10017
Division, Chas. Pfizer & Co., Inc., Science for the World's Well-Being '
TAO Rx information
Indications: The bacterial spectrum includes: streptococci, staphy-
locci, pneumococci and gonococci. Recommended for acute,
severe infections where adequate sensitivity testing has demon-
strated susceptibility to this antibiotic and resistance to less toxic
agents. Contraindications and Precautions: TAO (triacetyloleandomycin) is not recommended for prophylaxis or in the treatment of infectious processes
which may require more than ten days continuous therapy. In view of the possible hepatotoxicity of this drug when therapy beyond ten days proves
necessary, other less toxic agents, of course, should be used. If clinical judgement dictates continuation of therapy for longer periods, serial monitor-
ing of liver profile is recommended, and the drug should be discontinued at the first evidence of any form of liver abnormality. It is contraindicated in
pre-existing liver disease or dysfunction, and in individuals who have shown hypersensitivity to the drug. Although reactions of an allergic nature are
infrequent and seldom severe, those of the anaphylactoid type have occurred on rare occasions. References: 1. Isenberg, Henry D.: Health Laboratory
Science 2:1 63-173 (July) 1965. 2. Fowler, J. Ralph et al: Clinical Medicine 70:547 (Mar.) 1963. 3. Isenberg, Henry D.: Health Laboratory Science
T185-256 (July-Aug.) 1964.
for February, 1966
157
regarding S. B. 2568, the Hart Bill, was discussed.
The President was authorized by The Council to dis-
cuss the matter with Dr. Collins.
Ohio Health Commissioners
With regard to a request from the Ohio Health
Commissioners’ Association, the staff was authorized
to communicate with that Association regarding meet-
ings of the Committee on Environmental and Public
Health, inviting the representatives of that Associa-
tion to attend when matters on the agenda indicate
that such is advisable.
ATTEST: Hart F. Page,
Executive Secretary.
Western Reserve Project Applies
Smear Test to Dental Patients
A grant from the U. S. Public Health Service is
supporting a case-finding project at the Western Re-
serve University School of Dentistry based on detec-
tion of mouth cancer through an exfoliative cytology
technique applied to the oral cavity.
Western Reserve has one of 20 such laboratories in
major centers across the country. The case finding
program is being conducted primarily among service
patients of the dental clinic, but private patients may
be referred at nominal fees.
One in Ten Ohio Automobiles
Found Unsafe for Driving
More than ten per cent of the vehicles checked
in the 1965 Ohio Safety-Check Program were in un-
safe driving condition, the Ohio Department of
Highway Safety reported. Rear lights, tires and
brakes were the items found most frequently to be
in unsafe condition.
Safety-check programs sponsored in Ohio were
part of the national program. A total of 379,924
vehicles were checked in Ohio. Of these, 38,577
were rejected because of one or more defects. Forty-
eight per cent of the rejected vehicles were re-
checked.
Twenty-six per cent of the vehicles checked had
seat belts installed. A seat belt use survey showed
that 55 per cent of the drivers questioned always
use seat belts for local travel while 68.6 per cent
always use them for long trips.
A new Ohio law requires all automobiles manu-
factured on or after January 1, 1966 to have the
front seats equipped with safety belts.
The Catholic Medical Mission Board, Inc., last
year shipped over 2,592,000 pounds of medical sup-
plies to mission hospitals throughout the world. Per-
sons interested in more information about this effort
are invited to contact the board at 10 West 17th
Street, New York, N. Y. 10011.
Deadline for Submission of Resolutions to Columbus
, , , Office of the Association Is March 25
/. . L U'tri!
DELEGATES to the Ohio State Medical Association and County Medical Societies
planning to have resolutions submitted for consideration by the House of Dele-
gates at the 1966 Annual Meeting should be guided by the following Constitutional
requirements:
1. Resolutions, regardless of whether they have been submitted in advance and pub-
lished in The journal, must be introduced at the first session of the House of Delegates,
Tuesday evening, May 24, at the Sheraton-Cleveland Hotel, Cleveland.
2. When the resolution is introduced, copies in triplicate should be presented.
3. To be eligible for presentation, a resolution must have been filed with the Executive
Secretary of the Ohio State Medical Association, Columbus, at least 60 days prior to the
first session of the House of Delegates, namely, not later than March 25. This requirement
may be waived by a two-thirds majority of the House of Delegates.
4. Resolutions received will be published in The journal prior to the meeting. Also
copies of resolutions will be distributed to members of the House of Delegates to give them
an opportunity to discuss issues with their constituents and possibly receive voting intruc-
tions from their County Medical Societies.
158
The Ohio State Medical journal
APPLICATION FOR SPACE, SCIENTIFIC AND HEALTH EDUCATION
EXHIBITS, OHIO STATE MEDICAL ASSOCIATION, 1966 ANNUAL MEETING,
SHERATON-CLEVELAND HOTEL, CLEVELAND, OHIO, MAY 24 - 28
1. Title of Exhibit:
2. Name(s) of Exhibitor (s) :
Institution (if desired):
City
3. Do you have a built-in exhibit?
4. Description of Exhibit: (Attach 200 word description to this blank)
5. Exhibit will consist of the following: (Check which)
Charts and posters Photographs Drawings X-rays
Specimens Moulages Other material
(Describe)
6. Booth Requirements:
Amount of wall space needed? I
Back wall Side walls
Square feet needed? :
Shelf desired? (yes or no) ,
7. Transparency Cases:
Needed? (yes or no)
If answer “yes,” give following information:
Number of transparencies to be shown and size of each
Booths will have a back wall and two side
walls. The side walls of all booths will be
six feet wide. Back wall and side walls
are eight feet high. If standard shelf is
used, only 5% ft. will be available for ex-
hibit material. For most exhibits, a back
wall, eight feet long will be sufficient. With
the two 6 ft. long side walls, this gives a
total of 110 square feet of wall space.
(It is suggested that transparencies should be no larger than 10 by 12 inches in order to conserve space. For size
of view boxes which will be supplied by the Ohio State Medical Association if requested by you and how films
should be mounted, see pages 3 and 4 of folder “Regulations and Information, Scientific and Health Education
Exhibits, Ohio State Medical Association” which will be supplied to all applicants.
Date
Signature of Applicant
Mailing Address, Street
City, State, Zip Code
SEND APPLICATION TO: COMMITTEE ON SCIENTIFIC AND HEALTH EDUCATION EXHIBITS,
OHIO STATE MEDICAL ASSOCIATION, 79 EAST STATE STREET, COLUMBUS, OHIO 43215
DEADLINE FOR FILING APPLICATIONS FEBRUARY 28, 1966
1966 Annual Meeting
HIGHLIGHTS A NEW LOOK
THURSDAY, MAY 26
GENERAL SESSION
(Gold Room, Mezzanine Floor)
1:30 P. M.
"Medicare’s Rules and Regulations and their Effect
on the Practice of Medicine.”
Charles L. Hudson, M. D.
Cleveland, Ohio
President-Elect, American Medical Association
Dr. Hudson will present detailed information re-
garding the rules and regulations of Public Law 89-97,
which becomes effective July 1, 1966. He has partici-
pated in the activities of the AMA’s Task Force in its
consultations with the Federal Government on the
development of these rules and regulations. Dr.
Hudson will answer questions from the audience fol-
lowing his formal presentation.
FRIDAY, MAY 27
GENERAL SESSION
(Gold Room, Mezzanine Floor)
1:30 P. M.
"Care of the Patient: 19 66”
Edward R. Annis, M. D.
Miami, Florida
Past President, American Medical Association
Dr. Annis will make his presentation on the theme
of the 1966 OSMA Annual Meeting. He will look
at the future of patient care and the effect of the
various pieces of Federal legislation upon the tradi-
tional physician-patient relationship. A question and
answer period will follow Dr. Annis’ formal presen-
tation.
The New Look of the 1966 Annual Meeting is planned with emphasis on a fast paced
schedule to accommodate the busy physician. New features include "name” guest
speakers preceding scientific section meetings; a larger and better scientific exhibit;
medical booth seminars presenting practical demonstrations of procedures of interest;
and emphasis throughout the meeting on brief, snappy papers on current medical topics.
160
The Ohio State Medical journal
MEDICAL BOOTH SEMINARS
These one-half hour booth seminar presentations will feature practicel demonstrations of
equipment and procedures that may be used in everyday practice. As you will note, three of
the presentations will be running simultaneously beginning at 9:00, 10:00 and 11:00. The
other three beginning at 9:30, 10:30 and 11:30. It is hoped that physicians will have an oppor-
tunity to view all of the presentations on Friday morning.
FRIDAY, MAY 27
(Exhibit Hall Area)
Starting Time: 9:00, 10:00 and 11:00 A. M.
Booth No. 1 "Conditioning, Prevention and First
Aid for Athletic Injuries"
Mr. Ernest R. Biggs
Columbus, Ohio
Head Athletic Trainer, Ohio State Uni-
versity
Chairman of Committee on Injuries,
NationalAthleticTrainers Association
Member, Committees on Competitive
Safeguards and Medical Aspects of
Sports, National Collegiate Athletic
Association
Booth No. 3 "Bedside Pulmonary Function
Testing”
Joseph F. Tomashefski, M. D.
Columbus, Ohio
Assistant Professor of Medicine and
Associate Professor of Preventive
Medicine and Physiology, O. S. U.
College of Medicine and Chief of
Research and Director of Cardio-
pulmonary Laboratories, Ohio Tu-
berculosis Hospitals
Booth No. 5 "Physical Medicine in the Home”
Ernest W. Johnson, M. D.
Columbus, Ohio
Professor and Chairman of the Depart-
ment of Physical Medicine, The Ohio
State University College of Medicine
Starting Time: 9:30, 10:30 and 11:30 A. M.
Booth No. 2 "Resuscitation”
John H. Kennedy, M. D.
Cleveland, Ohio
Surgeon-in-charge of thoracic surgical
sendees, Cleveland - Metropolitan
General Hospital and Assistant Pro-
fessor of Thoracic Surgery, Western
Reserve University
John Homi, M. D.
Cleveland, Ohio
Department of Anesthesiology, Cleve-
land Clinic Foundation
Henry E. Kretchmer, M. D.
Cleveland. Ohio
Associate Professor of Anesthesiology,
Western Resent University School
of Medicine
Director, Department of Anesthesiology
at Cleveland Metropolitan General
Hospital
Booth No. 4 "Lacerations”
H. W. Porterfield, M. D.
Columbus, Ohio
Instructor, Department of Surgery, Ohio
State University College of Medicine
Private Practice of Plastic Surgery
S. W. Hartwell, Jr., M. D.
Cleveland, Ohio
Department of Plastic Surgery, Cleve-
land Clinic Foundation
Donald M. Glover, M. D.
Cleveland, Ohio
Clinical Professor of Surgery, Emeritus,
Western Reserve University School
of Medicine
Booth No. 6 "Fractures”
Charles M. Evarts, M. D.
Cleveland, Ohio
Staff, Department of Orthopedic Sur-
gery, Cleveland Clinic Foundation
Kent L. Brown, M. D.
Cleveland, Ohio
Assistant Surgeon, St. Luke’s Hospital
for February, 1966
161
SCHEDULE of EVENTS in BRIEF
TUESDAY, MAY 24
5:00 P. M.
(Mezzanine Floor)
OSMA House of Delegates
REGISTRATION
6:00 P. M.
(Whitehall Room, Mezzanine Floor)
OSMA House of Delegates
COMPLIMENTARY DINNER
7:30 P. M.
House of Delegates
FIRST BUSINESS SESSION
(Gold Room, Mezzanine Floor)
Herbert Morris Platter, M. D., Secretary of the
Ohio State Medical Board for 48 years, to whom the
entire 1966 Annual Meeting is dedicated will be
honored.
WEDNESDAY, MAY 25
9:00 A. M.
Resolution Committee No. 1
(Whitehall Room, Mezzanine Floor)
Resolution Committee No. 2
(Empire Room, Parlor Floor)
Resolution Committee No. 3
(Terminal Room, Parlor Floor)
REGISTRATION FOR EXHIBITORS OPEN
(Grand Ballroom Foyer, Mezzanine Floor)
10:00 A. M.
OSMA REGISTRATION OPENS
(Grand Ballroom Foyer, Mezzanine Floor)
Scientific, Health-Education and Technical
Exhibits Open
(Grand Ballroom and Ballroom Balcony)
11:30 A. M.
Ohio Medical Political Action Committee
American Medical Political Action Committee
LUNCHEON
(Gold Room, Mezzanine Floor)
Speaker: Hoyt D. Gardner, M. D.
Louisville, Kentucky
Member, Board of Directors, AMPAC
WEDNESDAY (Contd.)
1:00 P. M.
Ohio Health Commissioners’ Meeting with Director
(Grand Ballroom — Terrace, Parlor Floor)
1:30 P. M.
GENERAL SESSION
(Cleveland Room, Lobby Lloor)
"Problems in Marriage”
Sponsored by: Section on Psychiatry and Neurology;
Ohio Psychiatric Association and cosponsored by all
other sections and OSMA Committee on Medicine
and Religion.
2:00 P. M.
Ohio Health Commissioners’ Institute
FIRST SESSION
(Grand Ballroom — Terrace, Parlor Floor)
2:00 P. M.
Section on Ophthalmology
and
Ohio Ophthalmological Society
(Lewis Room, Lobby Floor)
3:00 P. M.
INTERMISSION FOR TOUR OF EXHIBITS
3:30 P. M.
GENERAL SESSION
(Gold Room, Mezzanine Floor)
"What I Do About It”
Sponsored by: The Faculty of Western Reserve
University College of Medicine.
3:30 P. M.
Continuation of Scientific Section Meetings
THURSDAY, MAY 26
8:30 A. M.
(Gold Room, Mezzanine Floor)
"A New Look at Tetanus Prophylaxis”
Film sponsored by the Ohio Committee on
Trauma, American College of Surgeons
9:00 A. M.
OSMA REGISTRATION OPENS
(Grand Ballroom Foyer, Mezzanine Floor)
Scientific, Health-Education and Technical
Exhibits Open
(Grand Ballroom and Ballroom Balcony)
162
The Ohio State Medical Journal
THURSDAY (Contd.)
9:00 A. M.
GENERAL SESSION
(Gold Room, Mezzanine Floor)
"Athletic Injuries”
Cosponsored by Ohio Committee on Trauma, Amer-
ican College of Surgeons; Joint Advisory Committee
on Athletic Injuries of the OSMA; and the Ohio High
School Athletic Association.
9:30 A. M.
Executive Session of Resolution Committee No. 1
(Wigwam Room, First Floor)
Executive Session of Resolution Committee No. 2
(Mohawk Room, First Floor)
Executive Session of Resolution Committee No. 3
(Chieftain Room, First Floor)
9:30 A. M.
Ohio Health Commissioners’ Institute
SECOND SESSION
(Lewis Room, Lobby Floor)
9:30 A. M.
Annual Meeting of Ohio Psychiatric Association
and
OSMA Section on Psychiatry and Neurology
(Grand Ballroom — Terrace, Parlor Floor)
10:30 A. M.
INTERMISSION FOR TOUR OF EXHIBITS
11:00 A. M.
Continuation of General Session and
Scientific Section Meetings
1:30 P. M.
GENERAL SESSION
(Gold Room, Mezzanine Floor)
Charles L. Hudson, M. D.
President-Elect, American Medical Association
2:30 P. M.
INTERMISSION FOR TOUR OF EXHIBITS
3:00 P. M.
OSMA Section on Anesthesiology
(Terminal Room, Parlor Floor)
Section on Internal Medicine
and
Ohio Society of Internal Medicine
(Gold Room, Mezzanine Floor)
Section on Psychiatry and Neurolog)'
and
Ohio Psychiatric Association
(Grand Ballroom — Terrace, Parlor Floor)
THURSDAY (Contd.)
Ohio Health Commissioners’ Institute
THIRD SESSION
(Lewis Room, Lobby Floor)
Ohio Academy of Medical History
(Erie Room, Parlor Floor)
Ohio State Surgical Association
(Whitehall Room, Mezzanine Floor)
FRIDAY, MAY 27
7:30 A. M.
WOMAN’S AUXILIARY BREAKFAST
for
Physicians and Auxiliary Members
(Cleveland Room, Lobby Floor)
9:00 A. M.
OSMA House of Delegates
FINAL BUSINESS SESSION
(Gold Room, Mezzanine Floor)
9:00 A. M.
OSMA REGISTRATION OPENS
(Grand Ballroom Foyer, Mezzanine Floor)
Scientific, Health-Education and Technical
Exhibits Open
(Grand Ballroom and Ballroom Balcony)
Medical Booth Seminars
(Exhibit Hall Area)
9:30 A. M.
Ohio Health Commissioners’ Institute
FOURTH SESSION
(Lewis Room, Lobby Floor)
10:30 A. M.
Ohio State Surgical Association
(Business meeting to be followed by luncheon)
(Continued on Next Page)
for February, 1966
163
FRIDAY (contd.)
1:30 P. M.
GENERAL SESSION
(Gold Room, Mezzanine Floor)
"Care of the Patient: 1966”
Edward R. Annis, M. D.
Past President, American Medical Association
2:30 P. M.
INTERMISSION FOR TOUR OF EXHIBITS
3:00 P. M.
Section on General Practice
Section on Obstetrics and Gynecology
Section on Pediatrics
Ohio Chapter, American Academy of Pediatrics
(Gold Room, Mezzanine Floor)
Section on Ear, Nose and Throat
and
Ohio Ear, Nose and Throat Society
(Terminal Room, Parlor Floor)
Section on Occupational Medicine
(Erie Room, Parlor Floor)
Section on Physical Medicine and Rehabilitation
Ohio Society of Physical Medicine and Rehabilitation
(Navajo Room, First Floor)
Section on Orthopaedic Surgery
and
Ohio Orthopaedic Society
(Lewis Room, Lobby Floor)
Section on Radiology
Ohio Chapter, American College of Chest Physicians
(Whitehall Room, Mezzanine Floor)
Section on Pathology
The Ohio Society of Pathologists
(Cleveland Room, Lobby Floor)
Section on Neurological Surgery
Ohio Neuro-Surgical Society
(Empire Room, Parlor Floor)
3:00 P. M.
ALL EXHIBITS CLOSED
6:30 P. M.
OSMA PRESIDENT’S RECEPTION
(Whitehall and Gold Rooms, Mezzanine Floor)
SATURDAY, MAY 28
9:00 A. M.
REGISTRATION
(Grand Ballroom Foyer)
Conference on Laboratory Medicine
(Gold Room, Mezzanine Floor)
Cosponsored by OSMA Committee on Laboratory
Medicine and Ohio Association of Blood Banks.
New Provisions in OSMA Bylaws
Pertaining to Nomination
Of President-Elect
Attention is called to new provisions in the
Bylaws of the Ohio State Medical Association
pertaining to the nomination and election of the
President-Elect at the OSMA Annual Meeting.
The President-Elect and other officers are elected
by the House of Delegates, meetings of which
will be held during the Annual Meeting in
Cleveland, May 24- 28.
Nominations of the President-Elect are to be
made 60 days in advance of the meeting at
which election takes place and information on
nominations published in The Journal, unless
these provisions are waived by a two-thirds vote
of the House of Delegates. The 60-day dead-
line is March 28.
The revised section in the OSMA Bylaws
pertaining to the procedure reads as follows :
Section 1 (a). Nomination of President-
Elect. Nominations for the office of Presi-
dent-Elect shall be made from the floor of the
House of Delegates, provided however that only
those candidates may be nominated whose names
have been filed with the Executive Secretary at
the time and in the manner hereinafter provid-
ed, unless compliance with such requirements
shall be waived as hereinafter provided. The
name of a candidate for the office of President-
Elect shall be filed with the Executive Secretary
of the Association at least sixty (60) days prior
to the meeting of the House of Delegates at
which the election is to take place. Promptly
upon filing of such candidate’s name, the Execu-
tive Secretary, if such candidate is eligible for
election, shall prepare and transmit this infor-
mation to each member of the House of Dele-
gates. No candidate may be presented at any
meeting of the House unless the foregoing re-
quirements of filing and transmittal have been
complied with or unless such compliance shall
have been waived or dispensed with by a vote
of at least two-thirds (^3) of the Delegates
present at the opening session of such meeting.
The Executive Secretary shall cause to be pub-
lished in The Journal in advance of such meet-
ing of the House of Delegates biographical
information on all eligible candidates meeting
the requirements of filing and transmittal.
164
12:00 Noon
ANNUAL MEETING CLOSES
The Ohio State Medical Journal
she’s pleased she's on
a significantly
different
oral
contraceptive
(medroxyprogesterone acetate with ethinyl estradiol)
New Drug Abuse Law . . .
Physicians Not Required to Keep Records Unless
They Dispense Certain Drugs and Charge for Them
ON February 1, Public Law 89-74, the Drug
Abuse Control Amendments of 1965, aimed
at curbing drug abuse through curtailment
of illicit drug traffic, became effective. The law estab-
lishes special controls over the manufacture and dis-
tribution of depressant and stimulant drugs.
Among the controls is the requirement for the
keeping of records of the manufacture, sale, delivery,
and receipt of such drugs. This matter of record-
keeping is of particular importance to physicians,
particularly because there has been some confusion as
to what records a physician must keep under the
provisions of P. L. 89-74, 89th Congress.
Mr. C. Joseph Stetler, president of the Pharmaceu-
tical Manufacturers Association and former director
of the American Medical Association’s Law Depart-
ment, points out that "Physicians are not required
to keep records as a consequence of this law un-
less, in the corns**, of their practice, they dispense
the drugs referred to in the law and charge for
them.”
Record-Keeping
To illustrate his point, Mr. Stetler cites a part of
the law relating to record-keeping, which reads:
"The provisions of paragraphs (1, Records) and
(2, Inspection) of this subsection shall not apply
to a licensed practitioner . . . with respect to any
depressant or stimulant drug received, prepared,
processed, administered, or dispensed by him in
the course of his professional practice, unless such
practitioner regularly engages in dispensing any
such dmg or drugs to his patients for which they
are charged, either separately or together with
charges for other professional services.”
Mr. Stetler explains that the significant phrases in
this paragraph are the words "regularly engages”
and "for which they are charged.” He continues,
"Further in this regard is a quote from the report
of the U. S. House of Representatives Committee on
Interstate and Foreign Commerce . . .”
"The committee intends ... to require record-
keeping and to permit inspection in the case of
those physicians who maintain a supply of phar-
maceuticals or medicinals in their offices from
which they compound prescriptions for their pa-
tients for a fee.”
"The language of the Senate Committee report
is identical,” reports Mr. Stetler, "and both commit-
tee reports stated that those required to keep records
'involve only a very small percentage of physicians.’ ”
The proposed regulations underscore this point, in-
dicating that . . maintaining of small supplies of
these drugs for dispensing or administering in the
course of professional practice in emergency or
special situations will not be considered as reg-
ularly engaged in dispensing for a fee.” (Emphasis
added.)
Dispensing of Drugs
For those physicians who, in the course of their
practice, regularly dispense drugs and charge for
them, certain records are required to be kept for three
years, effective February 1. Included are:
(1) A complete, accurate record of all depres-
sant and stimulant drugs on hand February 1, 1966;
(2) A complete, accurate record of the kind and
quantity of each drug received, sold, delivered or
otherwise disposed of;
(3) The name, address (and registration num-
ber under Section 510(e) of the Federal Dmg and
Cosmetic Act) of the person from whom the drugs
were received, and to whom they were sold, deli-
vered, dispensed or otherwise disposed of; and
(4) The date of the transaction.
No separate, special form for these records will
be required as long as the information is readily
available, officials report.
The system of record-keeping was designed to per-
mit government agents to follow the movement of
all of these prescription drugs from producer to
consumer.
The U. S. Commissioner of Food and Drugs is au-
thorized to determine that a stimulant or depressant
168
The Ohio State Medical Journal
drug has a potential for abuse, and therefore should
be covered under the law, if there is evidence of :
1. Individuals taking the drug in amounts suffi-
cient to create a hazard to their health or to the
safety of other individuals or the community.
2. Significant diversion of the drug from legiti-
mate drug channels.
3. Individuals taking the drug on their own ini-
tiative rather than on advice of a physician li-
censed by law to administer such drugs.
However, to reiterate, under P. L., 89-74, physi-
cians do not have to keep records unless they regularly
dispense and charge for the drugs covered by the
Act.
To further understand the details of this law,
physicians may obtain a copy of the pamphlet "H. R.
2 and You” from the American Pharmaceutical As-
sociation, 2215 Constitution Avenue, N. W., Wash-
ington, D. C., 20037. Single copies of this refer-
ence guide to the Drug Abuse Control Amendments
of 1965 are available free of charge.
Ohio Licensed Practical Nurses
Announce New Organization
Following a statewide meeting on November 18
in Columbus, an announcement was issued of forma-
tion of the Ohio Federation of Licensed Practical
Nurses. Bylaws were adopted and temporary officers
were elected.
Temporary officers are: Mrs. Irene Monkowski, L.
P. N., 1643 Bunts Road, Lakewood, president; Mrs.
Isabelle Mulchany, L. P. N., 2450 Northview Road,
Rocky River, secretary; and Mrs. Jean Rice, L. P. N.,
521 Zeller Court, Berea, treasurer.
The November meeting followed a previous meet-
ing on April 26 in Cleveland. The earlier meeting
was arranged by a steering committee consisting of
delegates from Alumnae Associations of Schools of
Practical Nursing.
The Ohio Federation of Licensed Practical Nurses
will be a constituent of the National Federation of
Licensed Practical Nurses (NFLPN).
It was voted at the November meeting to hold an-
other statewide meeting in April in Columbus, date
and place of which is to be announced.
All licensed practical nurses are eligible for mem-
bership. Dues are $12.00 annually. Nine dollars
will be held by the state organization to develop state
programs. Three dollars will be forwarded to the
national headquarters. Payment of dues entitles the
member to a subscription to the NFLPN bi-monthly
publication, The American Journal of Practical Nurs-
ing. All qualified applicants whose dues have been
received by the April meeting will be charter members
of the state organization.
Provisions have been made to include student af-
filiates from students enrolled in schools of practical
nursing.
Venerable Medical Board Secretary
Retires After 48- Year Record
Herbert Morris Platter, M. D., secretary of the
State Medical Board of Ohio since 1917, retired from
that post at the end of the year and climaxed a
career that has done much to promote the highest
standards of practice in this State.
Dr. Platter’s achievements and the honors bes-
towed upon him are numerous and impressive. He
is a Past-President of the Ohio State Medical Asso-
ciation, Past-President of the Academy of Medicine
of Columbus and Franklin County, Past-President of
the Federation of Licensing Boards, a practicing
physician of long standing in Columbus where he
specialized in dermatology, and a former member of
the faculty at Ohio State University College of Medi-
cine where he lectured on dermatology and medical
law.
In 1964, the Executive Committee of the Federa-
tion of State Medical Boards of the United States
put on record a resolution entitled "The Impact of
Herbert Morris Platter, M. D., on American Medi-
cine.” Here is an excerpt: "He possesses the rare
ability of always rendering sendee in all of his many
activities. He is well known for his unyielding faith
in his fellow man and a firm belief in American
Medicine and is one of the nation’s outstanding physi-
cians of all times.”
At the 1964 Annual Convention of the American
Medical Association in San Francisco, Dr. Platter was
honored before the House of Delegates when he re-
ceived the AMA Certificate of Merit. Dr. Platter
was secretary of the AMA Committee on Arrange-
ments for the AMA meeting in Columbus in 1899,
the meeting at which the Scientific Exhibit was
established.
Dr. Platter again will be honored by the Ohio State
Association at the 1966 OSMA Annual Meeting in
Cleveland, May 24-28, for his years of service to the
medical profession and to the public. The entire
meeting has been dedicated in his honor.
Dr. Platter, who will celebrate his 97th birthday
on June 18, is making his residence at the Lutheran
Senior City, Inc., 977 Parkview Avenue, Columbus
43219. His many friends may wish to correspond
with him at that address.
Dr. Robert A. Hingson, Cleveland, was special
speaker for the December 14 dinner meeting of the
Fort Steuben Academy of Medicine in the Fort
Steuben Hotel, Steubenville. His subject was "Spe-
cialty of Anesthesia Prepares for the Last Quarter of
the 20th Century to Serve All Branches of Medicine.”
A presentation of slides illustrated worldwide ap-
plication of anesthesia.
for February, 1966
1 69
• • •
OMPAC Memberships Rolling In
Physicians Totaling 1,227, From 56 Counties Have Joined Up To
January 20; Board of Directors Enlarged; Officers Are Elected
LTHOUGH collection of 1966 Ohio Medical
Political Action membership dues has been
in process only since January 1, as of Janu-
ary 20, a total of 1,227 physicians have affiliated
with OMPAC, according to Dr. Carl A. Lincke, Car-
rollton, secretary-treasurer of OMPAC.
The 1966 OMPAC dues are being collected by the
secretary-treasurers of County Medical Societies along
with medical society dues. Payment is optional on
the part of each individual physician. The County
Medical Societies will be reimbursed by OMPAC for
expenses incurred by them in collecting OMPAC
dues.
AMPAC Gets Part of Dues
If there is any county where the County Medical
Society is not collecting OMPAC dues, physicians
may join OMPAC by paying the $25.00 annual dues
to OMPAC direct - — P. O. Box 5617, Columbus, Ohio
43221.
A portion of each member’s annual dues — an
amount of $10.00 — is contributed to the American
Medical Political Action Committee, Chicago, for
its activities on a national basis. This amount quali-
fies each Ohio member for membership in the Ameri-
can Medical Political Action Committee. OMPAC
membership cards will be sent to members by the
Ohio committee; AMPAC membership cards by the
national committee.
Affiliates from 49 Counties To Date
OMPAC 1966 dues have been received from
physicians in 56 counties up to January 20. Many
of these counties are still in the process of collecting
dues as are those counties which have not as yet re-
ported to OMPAC. Following is a list of counties
from which 1966 OMPAC dues have been certified,
with the number of OMPAC members certified as
of January 20, shown in parenthesis:
Adams (1), Allen (66), Ashland (6), Ashta-
bula (14), Athens (12), Auglaize (2), Belmont
(18), Brown (6), Butler (49), Carroll (6), Clark
(51), Clermont (4), Crawford (35), Cuyahoga
(72), Defiance (1), Fairfield (1), Fayette (12),
Franklin (2), Geauga (10), Greene (19)’ Guern-
sey (3), Hancock (3), Harrison (6), Jeffer-
son (2), Lake (42), Lawrence (14), Licking (1),
Lorain (48), Lucas (3), Mahoning (74), Marion
(6), Medina (14), Miami (35), Montgomery (191),
Morrow (2), Muskingum (23), Noble (1), Ottawa
(6) , Perry (3), Pickaway (5), Ross (18), Sandusky
(8), Scioto (33), Stark (148), Trumbull (44),
Tuscarawas (17), Wayne (27) Wood (2), Wyan-
dot (3).
Other counties which have certified are : Darke
(7) , Henry (7), Hocking (1), Knox (25), Pauld-
ing (1), and Shelby (15).
OMPAC Board Enlarged
At a recent meeting of the Board of Directors of
the Ohio Medical Political Action Committee in
Columbus, the members of the board who have been
administering the activities of OMPAC since its
founding in the Fall of 1963 were re-elected and
six new members elected in order to give the board
more geographical representation.
Current members of the Board of Directors are:
Frank H. Mayfield, M. D., Cincinnati; George M.
Petznick, M. D., Cleveland; Carl A. Lincke, M. D.,
Carrollton; Edwin H. Artman, M. D., Chillicothe;
Robert S. Martin, M. D., Zanesville; anl Mrs. Edward
E. Bauman, Warren, all of whom have been serving
on the Board, and the following new members :
Thomas D. Allison, M. D., Lima; Edward L. Doer-
mann, M. D., Toledo; Jack L. Kraker, M. D., Lan-
caster; William J. Lewis, M. D., Dayton; James C.
McLarnan, M. D., Mt. Vernon; and H. William
Porterfield, M. D., Columbus. One original member
of the board — Dr. C. C. Sherburne, Columbus —
died on November 13, leaving a vacancy which was
filled at the board meeting.
Officers Elected
Officers for 1966 were elected as follows: Chair-
man, Dr. Mayfield; vice-chairman, Dr. Petznick; and
secretary-treasurer, Dr. Lincke, filling the vacancy
in that office which had been held by Dr. Sherburne.
The Board, by a standing vote, adopted a resolu-
tion in memory of Dr. Sherburne, in which his effici-
ent and loyal services on behalf of the objectives of
OMPAC were emphasized.
Luncheon in Cleveland Planned
Proposal for an OMPAC luncheon on May 25 at
the Cleveland Sheraton Hotel during the 1966 An-
nual Meeting of the Ohio State Medical Association
was approved by the board. An offer from the
Woman’s Auxiliary of the Ohio State Medical As-
170
The Ohio State Medical Journal
sociation to co-sponsor the luncheon and help in the
sale of luncheon tickets was accepted by the board
with an expression of appreciation. Tickets will be
sold before, and during, the Annual Meeting. The
luncheon will be open to physicians and their wives,
and their guests. A program designed to describe
the activities and objectives of AMPAC and OMPAC
and to summarize some of the vital political and legis-
lative problems confronting the medical profession
during 1966 is being arranged.
OMPAC will have a booth at the Annual Meeting
in Cleveland at which members may obtain literature
and submit questions about OMPAC’s organization
and activities. Those who may desire information
immediately concerning OMPAC’s program should
direct their inquiry to OMPAC, P. O. Box 5617,
Columbus, Ohio 43221, and literature will be sent
to them.
\ A Policy Announced Regarding
Treatment of Certain GIs
Veterans recently discharged from the Armed
Forces, who require immediate care for disabilities
apparently incurred in sendee, may now be entitled
to both outpatient treatment and hospitalization from
the Veterans Administration, according to an of-
ficial announcement from VA headquarters.
VA has liberalized its rules to allow medical and
dental treatment at any of its clinics as well as care
in any of its hospitals, as needed, during the period
required for a veteran to establish that his disability
was sendee incurred.
In an emergency7, a recently discharged veteran
awaiting adjudication of his claim to connect his
injuries to his sendee, may obtain care at non-VA
facilities at VA expense, when VA facilities are not
available. However, the veteran should remember
that prior approval of the VA is necessary in such
cases.
Only veterans discharged or released with an hon-
orable or general discharge after six or more months
of active duty are eligible for hospitalization or out-
patient treatment while awaiting VA recognition of
their claimed disabilities.
In addition, application for VA medical care must
be made within six months of the veteran’s discharge
or release from sendee.
The outpatient medical, dental and hospitalization
privileges cease immediately when the VA adjudica-
tion board denies a veteran’s claim that his disability
was related to his military sendee, the VA said.
The American College of Physicians has issued
information on a number of postgraduate courses in
cooperation with medical educational institutions
throughout the country. Several courses are scheduled
in areas convenient for Ohio physicians. Details may
be obtained from the American College of Physicians,
4200 Pine Street, Philadelphia, Pa. 19104.
Canton Physician Named to
State Medical Board
Dr. Ralph K. Ramsayer, of Canton, has been ap-
pointed to the State Medical Board by Governor
James A. Rhodes, to complete the unexpired term of
Dr. William Hoyt, of Hillsboro, who resigned re-
cently after long and faithful sendee with the board.
The term expires March 18, 1967.
A practicing physician, specializing in obstetrics
and gynecology, Dr. Ramsayer is an active participant
in medical and civic affairs. He was reappointed
last June to a new seven-
year term on the Public
Health Council, advisory
group to the Ohio Depart-
ment of Health. He is a
past-president of the Stark
County Medical Society and
a delegate of his county to
the OSMA House of Dele-
gates. He has sensed the
State Association in numer-
ous ways and is at present
a member of the OSMA
Committee on Maternal
Health. Among other local honors, he is president of
the Stark County Historical Society and head of the
local YMCA board. A few years ago he was named
Canton’s Man of the Year by the Chamber of
Commerce.
Other members of the State Medical Board are
Dr. John N. McCann, Youngstown; Dr. John D.
Brumbaugh, Akron; Dr. Donald F. Bowers, Colum-
bus; Dr. Domenic A. Macedonia, Steubenville; Dr.
J. O. Watson, Columbus, the osteopathic member;
Dr. Melvin F. Steves, Cincinnati; and Dr. Frederick
T. Merchant, Marion.
Upon the resignation of Dr. Hoyt, the Board
adopted the following resolution:
"WHEREAS, W. M. HOYT, M. D., has faith-
fully and well performed his duties as a member of
the State Medical Board for the past 26 years and
"WHEREAS, The State Medical Board of Ohio
is aware of the long and faithful sendee, devotion,
dedication and interest to the Board and to the State
of Ohio as well as to the medical profession and
patients, and
"WHEREAS, The State Medical Board of Ohio
desires to express its gratitude to W. M. Hoyt, M. D.,
for his sendees,
"NOW BE IT RESOLVED by the State Medical
Board of Ohio that the Board on behalf of itself
and the State of Ohio extends its thanks and best
wishes to W. M. Hoyt, M. D., for his 26 years of
faithful sendee to the Board and to the State of Ohio.’’
for February, 1966
171
Obituaries
Ad Astra
Everette P. Coppedge, Sr., M. D., Cleveland;
Western Reserve University School of Medicine,
1908; aged 82; died December 29; member of the
Ohio State Medical Association, the American Medi-
cal Association and the American Academy of Gen-
eral Practice. A practicing physician and surgeon in
Cleveland for all of his professional career, Dr. Cop-
pedge was long associated with Woman’s Hospital.
Among affiliations, he was a member of the Meth-
odist Church. Dr. Everette Peter Coppedge, Jr., his
son, also is a practicing physician in Cleveland. Other
survivors include his widow, two daughters and two
other sons.
Ewing Herman Crawfis, M. D., Cleveland; Ohio
State University College of Medicine, 1935; aged 55;
died December 18 as the result of an airplane ac-
cident; member of the Ohio State Medical Associa-
tion and member of the OSMA Committee on
Mental Health; member of American Medical Asso-
ciation, the American Psychiatric Association, a
member and past-president of the Ohio Psychiatric
Association, member of the Central Neuropsychiatric
Association. A career psychiatrist, who also held a
law degree, Dr. Crawfis formerly was assistant super-
intendent of the Lima State Hospital and later super-
intendent of the Cleveland State Hospital. In 1951
he left the State to accept appointments in California
and later in Arkansas. He returned to Ohio in 1956
to become head of the Fairhill Psychiatric Hospital.
A 32nd Degree Mason, he is survived by his widow,
two daughters, a son, a brother and a sister.
George Morris Curtis, M. D., Columbus; Rush
Medical College, 1921; aged 75; died December 23;
member of the Ohio State Medical Association, the
American Medical Association, International College
of Surgeons, American Association for the Surgery
of Trauma, American College of Surgeons, American
Association for Thoracic Surgery and American Col-
lege of Chest Physicians. A practicing surgeon for
many years in Columbus, Dr. Curtis was a prominent
member of the faculty at Ohio State University Col-
lege of Medicine and former chairman of the Depart-
ment of Research Surgery at the University. Upon his
retirement, the George M. Curtis Lecture was estab-
lished at OSU in his honor. Other honors included
an honorary degree of Doctor of Science bestowed
by the University of Michigan, and the Govern-
ment of Chile Award for his research on iodine.
Among numerous contributions to medical literature,
Dr. Curtis contributed several of his scientific articles
to The Journal. Survivors include his widow, two
daughters and a brother, Dr. Arthur C. Curtis, Uni-
versity of Michigan.
Casimir Joseph Czarnecki, M. D., Toledo; St.
Louis University School of Medicine, 1922; aged 67;
died December 19; member of the Ohio State Medical
Association, the American Medical Association, Amer-
ican College of Physicians and the American Diabetes
Association. A lifelong resident of Toledo, Dr.
Czarnecki practiced there for some 40 years, and dur-
ing World War II served overseas in the Medical
Corps. A member of the Catholic Church, he is
survived by his widow, four daughters, and a sister.
Harvey A. Finefrock, M. D., Barberton; Univer-
sity of Cincinnati College of Medicine, 1911; aged
80; died January 4; member of the Ohio State Medi-
cal Association and the American Medical Associa-
tion. A native of northeast Ohio, Dr. Finefrock
was in the practice of medicine for more than 50
years in the Barberton area. He was city health com-
missioner for 35 years and was on the board of edu-
cation for 24 years. Among survivors are his widow
and a son.
Samuel T. Forsythe, M. D., Cleveland; Ohio State
University College of Medicine, 1913; aged 83; died
January 2; member of the Ohio State Medical Asso-
ciation, American Medical Association and the Ameri-
can Academy of Ophthalmology and Otolaryngology.
A practicing physician and surgeon in Cleveland for
more than a half century, Dr. Forsythe specialized in
ophthalmology. A veteran of World War I, he was
a member of the American Legion. Other affiliations
included membership in several Masonic bodies and
the Rotary Club. A daughter and a brother survive.
James P. Foy, M. D., Cleveland; Indiana Univer-
sity School of Medicine; aged 25; died November 4
in an airplane accident. Dr. Foy was in training at
the Cleveland Clinic. He and his wife were both
killed while returning from the East Coast in a
private plane.
Oscar Joseph Fatum, M. D., Van Wert; Univer-
sity of Toronto Faculty of Medicine, 192 4; aged 66;
died December 1; member of the Ohio State Medical
Association, the American Medical Association,
American Academy of General Practice and the
American Society of Anesthesiologists. A practic-
ing physician in the Van Wert area for a num-
ber of years, Dr. Fatum was a past-president of
the Van Wert County Medical Society. Among
other affiliations he was a member of several Ma-
sonic bodies, the Elks Lodge and the Rotary Club;
172
The Ohio State Medical Journal
also he was a veteran of World War II. Survivors
include his widow, a daughter, two sons and two
brothers.
Andrew Meek Gulliford, M. D., Newark; Uni-
versity of Pittsburgh School of Medicine, 1928; aged
60; died September 9, 1965; member of the Ohio
State Medical Association and the American Medical
Association. A physician in Newark, Dr. Gulliford
was medical examiner for the B. & O. Railroad. Un-
til 1957 his practice was in the area of Apollo, Pa.
Paul Ramsey Hawley, M. D., Shady Side, Md.;
University of Cincinnati College of Medicine, 1914;
aged 74; died December 1. Dr. Hawley’s distin-
guished career is well known to Ohio physicians.
After receiving his training at the University of
Cincinnati College of Medicine, he practiced for a
brief period with his father, the late Dr. William
Harry Hawley, in College Corner, the Butler County
community on the Ohio-Indiana border. Decorated
by governments of six nations, and honored with
numerous degrees, Dr. Hawley retired from the
Army Medical Corps in 1946 with the rank of Major
General. He subsequently held appointments with
the Veterans Administration, the Blue Cross and Blue
Shield Commission and the American College of
Surgeons. Affiliations included memberships in
numerous professional and nonprofessional organiza-
tions. His widow, a daughter and a son survive.
Edward Frederick Heffner, M. D., Wapakoneta;
Medical College of Ohio, Cincinnati, 1904; aged 84;
died December 19; former member of the Ohio
State Medical Association and the American Medical
Association; past-president of the Auglaize County
Medical Society. A practicing physician for more
than 60 years, Dr. Heffner served virtually all of his
professional career in the Wapakoneta area, and for a
time was Auglaize County coroner. Among affilia-
tions he was a member of several Masonic bodies and
the Lutheran Church. Survivors include his widow,
three sons and two daughters.
Thomas Hulick, M. D., Cincinnati; Miami Medi-
cal College, Cincinnati, 1901; aged 87; died Decem-
ber 2; former member of the Ohio State Medical
Association. A practitioner of long standing in the
Evanston area of Greater Cincinnati, Dr. Hulick was
retired and customarily spent the winters in Florida.
He was a veteran of World War I. A daughter
survives.
Harlin G. Knierim, M. D., Mansfield; Ohio State
University College of Medicine, 1938; aged 52; died
December 24; member of the Ohio State Medical
Association, the American Medical Association, Amer-
ican Academy of Dermatology and Syphilology,
American Academy of Facial, Plastic and Reconstruc-
tion Surgery, American Academy of Allergy, Ameri-
can College of Allergists and American Academy of
General Practice. Dr. Knierim began his practice
in Mansfield in 1941, then went into the Navy during
World War II, and returned to Mansfield. He was
a past-president of the Richland County Medical
Society and served on numerous committees of the
local organization. A member of the Seventh Day
Adventist Church, he is survived by his widow, two
sons and a brother.
Saul Isaac Krasne, M. D., Wickliffe; Eclectic
Medical College, Cincinnati, 1936; aged 55; died
November 29 in a hunting accident; member of the
Ohio State Medical Association and the American
Medical Association. A practicing physician in the
Wickliffe area, Dr. Krasne had only recently moved
his residence to Cleveland. His widow and a child
survive.
Bruno Leichtentritt, M. D., Cincinnati; medical
degree from the medical faculty of Friedrich-Wil-
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for February, 1966
173
helms University; aged 77; died October 14; mem-
ber of the Ohio State Medical Association, the
American Medical Association and the American
Rheumatism Association. Born and educated in
Germany, Dr. Leichtentritt practiced in that country
before coming to the United States in the 1930’s. A
resident of Cincinnati since 1944, he held an appoint-
ment with the City Health Department and engaged
in private practice, specializing in pediatrics. His
widow survives.
James William Long, M. D., Bryan; Bellevue Hos-
pital Medical College, New York, 1897; aged 94;
died December 1; former member of the Ohio State
Medical Association. A native of Bryan, Dr. Long
served all of his professional career in that vicinity.
He is survived by his widow and two daughters.
(See the following obituary on his son.)
Perrin Hamilton Long, M. D., Edgartown, Mass.;
University of Michigan Medical School, 1924; aged
66; died on or about December 20. A native of
Bryan, where his father practiced (see above obit-
uary) Dr. Perrin Long moved to the East Coast
and specialized in research. He is credited with im-
portant contributions in the fields of the sulfa drugs.
William Hugh Miller, M. D., New Carlisle; Ohio
State University College of Medicine, 1929; aged
62; died December 19; member of the Ohio State
Medical Association and the American Academy of
General Practice. A practicing physician in the New
Carlisle area for some 30 years, Dr. Miller was
physician also for the Clark County Home and during
World War II directed the civilian medical program
at Wright-Patterson Air Force Base. Among affilia-
tions he was a member of the Sertoma Club and the
Episcopal Church. Among survivors are his widow
and three daughters.
Albert John Mdchels, M. D., East Liverpool; Uni-
versity of Pittsburgh School of Medicine, 1919; aged
71; died December 10; member of the Ohio State
Medical Association, the American Medical Associa-
tion and the American Academy of General Practice.
A resident of long standing in the East Liverpool
area, Dr. Michels practiced there more than 46 years.
Among affiliations he was a member of the Catholic
Church and the Knights of Columbus. Surviving
are his widow, a daughter and a son, Dr. Albert J.
Michels, Jr., of the Cleveland area.
James Weaver Rae, M. D., Sylvania; Toledo Medi-
cal College, 1910; aged 85; died December 4; mem-
ber of the Ohio State Medical Association and the
American Medical Association. Dr. Rae’s early prac-
tice was in Bowling Green. About 1932 he helped
establish the Department of Physical Medicine and
Rehabilitation at Flower Hospital in Toledo and
headed that service until his retirement in 1962. He
was a veteran of both the Spanish-American War
and World War I. Surviving are his widow, two
daughters, a son, Dr. James W. Rae, Jr., of Ann
Arbor, Mich.; also a brother and a sister.
David F. Schaefer, M. D., Defiance; University of
Cincinnati College of Medicine, 1957; aged 33; died
November 26; member of the Ohio State Medical As-
sociation and the American Medical Association. Born
and reared in northwest Ohio, Dr. Schaefer returned
to the vicinity in 1964 to practice. He completed an
internship and residency training in Naval hospitals
in the East and completed a tour with the Navy be-
fore beginning practice. A member of the Catholic
Church, he is survived by his widow, four children
and two sisters.
Edward H. Schoenling, M. D., Harrison; Medical
College of Ohio, Cincinnati, 1900; aged 90; died
August 1 7 ; former member of the Ohio State Medical
Association. A general practitioner from 1900 to
1930, Dr. Schoenling became health commissioner
for the Hamilton County General Health District
and held that position until 1948.
Elizabeth Cisney Smith, M. D., Arlington, Mass.;
Women’s Medical College of Pennsylvania, 1911;
aged 83; died November 13; former member of the
Ohio State Medical Association. Dr. Elizabeth Smith
with her husband, Dr. Augustus Edwin Smith, moved
from Pennsylvania to Ohio in 1919- Both practiced
in Warren until the death of the husband in 1934.
She later did extensive public health work after
taking advance courses in that field. Among her in-
terests, Dr. Smith was a pioneer woman suffrage
worker. Two daughters and two sons survive.
Oscar Harley Stuhlman, M. D., West Milton;
Medical College of Ohio, Cincinnati, 1909; aged 82;
died December 10; member of the Ohio State Medi-
cal Association and the American Medical Associa-
tion. A native of Darke County, Dr. Stuhlman
served all of his professional career in the west-cen-
tral area of Ohio, beginning his practice at Laura,
he later moved his office to East Dayton. Active
in civic affairs, he was a member of several Masonic
bodies and the Friends Church. Survivors include
his widow, a daughter and a son, Dr. Byron C.
Stuhlman, of Dayton.
Willis H. Willis, M. D, Mashaba, Southern
Rhodesia; Western Reserve University School of
Medicine, 1927; aged 65; died January 1; former
member of the Ohio State Medical Association and
the American Medical Association. A former medi-
cal missionary in Southern Rhodesia for the Con-
gregational Church, Dr. Willis resigned his position
as Lake County Health commissioner in 1959 to
return to Africa. During World War II he served
in the Army Medical Corps and attained the rank of
lieutenant colonel. After the war he practiced medi-
cine in Painesville before becoming full-time health
commissioner. His widow, two daughters and three
sons survive.
174
The Ohio State Medical Journal
Activities of County Societies . . .
j
First District
(COUNCILOR: ROBERT E. HOWARD, M. D„ CINCINNATI)
BUTLER
Dr. Nathan R. Abrams, director of the Arthritis
Clinic in Cincinnati, was principal speaker for the
November meeting of the Butler County Medical So-
ciety, where he discussed "Arthritis in Children.’’ Dr.
Abrams also is associate clinical professor of medicine
at the University of Cincinnati College of Medicine.
The program was jointly sponsored by the Ohio
Valley Chapter of the Arthritis Foundation.
HAMILTON
"Treatment of Shock’’ was the topic of discussion
for the January 18 meeting of the Academy of Medi-
cine of Cincinnati in the academy building.
Participating in the panel, as indicated on the ad-
vance program, were the following physicians :
Dr. Thomas Gaffney, assistant professor of medicine
and director of the Division of Clinical Pharmacology,
University of Cincinnati College of Medicine.
Dr. F. A. Simeone, professor of surgery, Western
Reserve University School of Medicine, Cleveland,
and
Dr. Richard C. Lillehei, associate professor of sur-
gery, University of Minnesota School of Medicine.
Second District
(COUNCILOR: THEODORE L. LIGHT, M. D., DAYTON)
MONTGOMERY
The Montgomery County Medical Society’s 117th
Annual Presidential Inaugural program was held on
January 14 at the Sheraton Dayton Hotel. A recep-
tion and dinner was held for members, their wives
and guests.
Installed as 1966 president, Dr. Charles E. O’Brien
delivered the president’s address. Other officers are
Dr. William J. Lewis, president-elect; Dr. Peter A.
Granson, vice-president; Dr. Albert B. Huffer, secre-
tary; and Dr. Don E. Sando, treasurer. Dr. Mason
S. Jones is the immediate past-president.
Fourth District
(COUNCILOR: ROBERT N. SMITH, M. D., TOLEDO)
LUCAS
The January program of the Academy of Medicine
of Toledo and Lucas County included the following
features :
January 12 — 64th Annual Academy Meeting;
guest speaker, Dr. Nicholas P. Dallis, "The Mode
of American Medicine.”
January 19 — Dr. Peter P. Bosomworth, profes-
sor of medicine, University of Kentucky, "Prevention
and Management of Pulmonary Complications Asso-
ciated with Long-term Mechanical Ventilation.” The
program was sponsored by the Toledo Society of
Anesthesiology.
SANDUSKY
The Sandusky County Medical Society and Auxi-
liary held the regular Christmas party in the Hotel
Fremont, Fremont, on December 14. Donations were
accepted for the work of the King’s Daughters.
Fifth District
(COUNCILOR: P. JOHN ROBECHEK, M. D., CLEVELAND)
CUYAHOGA
The Academy of Medicine of Cleveland and the
Heart Association of Northeastern Ohio sponsored
a seminar on "Rheumatic Fever in Cleveland — 19 66,”
at the Academy auditorium on January 5.
Among guest speakers were Dr. Richard Krause,
St. Louis, and Dr. Allan C. Siegal, Chicago. Local
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for February, 1966
175
speakers included Dr. E. A. Mortimer, Jr., and Dr.
Charles H. Rammelkamp, Jr.
The Cleveland Academy is sponsoring the Acad-
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evening broadcasts over Station WGAR entitled,
"The Doctor Speaks."
Sixth District
(COUNCILOR: EDWIN R. WESTBROOK, M. D., WARREN)
STARK
Dr. A. R. Furnas, Jr. of Massillon was installed
as president of the Stark County Medical Society at
the annual meeting held Thursday evening (Dec. 16)
in Mergus Garden Room. He succeeds Dr. Harold
J. Bowman. Designated as president-elect for 1967
is Dr. Murray W. Scott, Jr. of Canton. The secre-
tary-treasurer for the coming year is Dr. Mark F.
Moots. Dr. Mark G. Herbst was named delegate and
Dr. Richard Skibbens alternate delegate to the State
Association.
Serving on the Board of Censors for the next year
are Dr. Gerry I. Newman, Dr. C. V. Smith, Dr. Wil-
liam D. Baker, Dr. Bowman, Dr. Furnas, Dr. Scott
and Dr. Moots.
Special honors were bestowed on three physicians
who have been in the practice of medicine for more
than 50 years: Dr. H. S. Myers of Massillon, Dr. C.
J. Schirack of Canton and Dr. Loren L. Frick of
North Canton.
Dr. Myers is a graduate of Western Reserve Uni-
versity Medical School and following two years of
service in World War I, began his practice in Navarre.
Six years later he moved to Massillon and has served
that community since.
Dr. Schirack received his training at Eclectic Medi-
cal College in Cincinnati and except for wartime
military service has practiced his entire 50 years in
Canton.
Dr. Frick is a graduate of Ohio State Medical
School and has spent his entire career in practice
in North Canton and Canton, except for military
service in France during World War I.
TUSCARAWAS
The Tuscarawas County Medical Society with the
Auxiliary held its annual Christmas party at the
Union Country Club. A feature of the program
was an auction of articles made mostly by members
of the Auxiliary, with Dr. James Houglan as auc-
tioneer. Proceeds of the auction go to the AMA-ERF.
TRUMBULL
The Trumbull County Medical Society with the
Auxiliary held its annual holiday season dinner dance
on December 15 at the Trumbull County Country
Club.
Eleventh District
(COUNCILOR: WILLIAM R. SCHULTZ, M. D„ WOOSTER)
LORAIN
New officers for 1966 were installed on Decem-
ber 14, when 101 members of Lorain County Medical
Society, including their wives, met at Oberlin Inn for
the annual meeting. They took office as of January 1.
Joseph A. Cicerrella, M. D., of Lorain, succeeded
John W. Wherry, M. D., of Elyria, as president. The
role of secretary-treasurer was assumed by John B.
McCoy, M. D., Elyria, for a two-year term, and the
president-elect for 1967 is Robert S. VanDervort,
M. D., Elyria. Installed as vice-president was Bristow
C. Myers, M. D., of Lorain, and Charles C. Butrey,
M. D., Lorain, serves as a censor for a three-year term,
replacing H. C. Marsico, M. D., Lorain, whose term
expired.
Delegates to Ohio State Medical Association for
a two-year term are Ben V. Myers, M. D., Elyria,
and James T. Stephens, M. D., Oberlin, who continue
for another term in office. Named Alternate Dele-
gates are William H. Miller, M. D., Elyria, and Max
L. Durfee, M. D., Oberlin.
The new President, Dr. Cicerrella, received his
M. D. Degree from St. Louis University, Mo., and
has been a member of Lorain County Medical So-
ciety, Ohio State Medical Association and American
Medical Association since 1946. His specialty is
pediatrics.
A standing vote of thanks for their successful
term of office was accorded to outgoing officers Presi-
dent John W. Wherry, M. D., and William H. Mil-
ler, M. D., who has served in the capacity of secre-
tary-treasurer for the last three years. Continuing
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The Ohio State Medical Journal
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in office as censors are Drs. Harold E. McDonald,
Elyria, and William E. Kishman of Lorain.
Preceding the Installation of officers was a social
hour and dinner at the Inn. Lawrence C. Meredith,
M. D., Elyria, President-Elect of the State Organiza-
tion, addressed the audience and outlined the role of
the individual physician and the medical profession
as a whole, in their future endeavors to eliminate
deterioration of medical care. The Women’s Auxi-
liary retired to the Red Rooms to conduct its business
affairs as the annual meeting of Lorain County Medi-
cal Society continued. Corespondence was read from
11th District Councilor William R. Schultz, M. D.,
who was unable to attend. Kenneth O’Connor,
M. D., Elyria, was unanimously elected to Active
Membership in the Society, and a first reading was
given to the application of Ibrahim Eren, M. D., of
Lorain.
Two Resolutions were read and passed unani-
mously for transmittal to Council of OSMA.
Committee reports were heard from Chairmen of
the committees as follows: Public Relations, R. S. Van-
Dervort; Education and Medical Symposium, Max L.
Durfee; Mediations, Bristow C. Myers; School Health,
Andrew M. Mattey; Cancer, A. Clair Siddall; Blood
Bank, Stanley J. Birkbeck; Insurance, George W.
Bennett; Resident Training, Roy E. Hayes; Medical
Foundation, Roy E. Hayes; Liaison with Health Pro-
fessions, Maynard J. Brucker; Legislative and "Oper-
ation Hometown,’’ R. L. Shilling.
Following announcement of future programs and
seminars, President John W. Wherry, M. D., re-
ported on the activities and interests of the Society
throughout 1965 and thanked all the members who
had assisted him during his term of office. Secretary-
Treasurer William H. Miller, M. D., presented the
financial report and the budget for 1966, together
with data on the membership and various meetings
held throughout the year. The Nominating Com-
mittee’s report was unanimously accepted and instal-
lation of officers for 1966 proceeded.
Dr. Cicerrella’s response as newly installed Presi-
dent outlined the further aims and endeavors of the
Society in 1966.
Hs s{s H5
President Joseph A. Cicerrella, M. D., welcomed a
total audience of 50 at the regular meeting of Lorain
County Medical Society at Oberlin Inn on January 11.
Business included the election of Ibrahim N. Eren,
M. D., of Lorain, to Associate Membership in the
Society, and the reading of a Resolution which was
unanimously approved for submission to Ohio State
Medical Association for presentation at the Annual
Meeting in May of 1966.
Featured speaker of the evening was George G.
Goler, M. D., of Cleveland. An OB-Gyn Specialist,
Dr. Goler recently served a tour of duty aboard the
S. S. HOPE in Conakry, Guinea, West Africa. With
slide presentations, he outlined Project HOPE’S ef-
forts toward world good will and international
friendship and emphasized the diplomatic accom-
plishments of this ship, together with the training
of local personnel in efforts to alleviate the crippling
ill health in underdeveloped countries.
An informative question and answer period fol-
lowing the program stressed the value of individual
and personal commitment to such a project as HOPE.
The color film "HOPE in Peru” was also shown to
the audience.
MEDINA
The Medina County Medical Society held its an-
nual Christmas dinner dance at the Rustic Hills
Country Club in mid-December.
Dr. Louis Rakita, associate professor of medicine
at Western Reserve University School of Medicine,
will be a member of the guest faculty when the
American College of Physicians holds Postgraduate
Course No. 13 in Houston, Texas. Subject for the
course at Baylor University College of Medicine,
March 7-11, is "The Big Heart.”
Dr. Francis W. Logan, Delaware, and his wife
are serving tours with the Peace Corps in Iran.
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For Information, Call Or Write
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178
The Ohio State Medical Journal
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for February, 1966
179
• •
Woman’s Auxiliary Highlights
By MRS. S. L. MELTZER, Publicity Committee
Chairman, 2442 Dorman Dr., Portsmouth
CHAIRMANWISE, there is no more important
job on the State Board in these days of the
Great Society than that of the Legislation
chairman. She has to keep up with the raft of bills
passed, proposed and being dreamed up. She has
to keep in direct touch with the Legislation Commit-
tee of the Ohio State Medical Association and with
the American Medical Association to become knowl-
edgeable on the parent organization’s attitudes toward
these bills. If anyone can do this and do it success-
fully, it is Mrs. Harry L. Fry of Cincinnati, the
incumbent chairman, who takes her job seriously and
gives it all she’s got. She has spent, and is spending,
innumerable hours, days and weeks compiling essen-
tial data and she wants to share her information
with the county auxiliaries.
To that end, she made a courageous announcement
at the recent mid-winter State Board meeting: she is
willing to go anywhere, any time, to any county
auxiliary, to bring local groups the vital information
they should have. There is a most significant election
coming up this November and the time to begin
laying the groundwork is NOW — not in the last
frantic weeks before Election Day. There is so much
we need to know — what we can do — what we can-
not do. We even need to know about such things
as the cmel hoax being played by con men on elderly
people: despicable characters who go from door to
door collecting the three dollar voluntary insurance
payments. Have you heard about PREVENTACARE
which is said to be the next possible piece of medical
legislation that will be introduced ? Most impor-
tant, do you understand fully the import of OMPAC
— the medical association’s Political Action Com-
mittee ?
If Frankie Fry is willing to give of her time and
energies to bring each of you her message directly,
it would seem to go without saying that every local
group should be deeply grateful and anxious to
avail itself of this unusual opportunity. Mrs. Fry
hopes she can come up with a well-trained Speak-
ers’ Bureau one of these days, but in the meantime,
she is at your service. There is no more vital
project on which doctors’ wives can work than this
matter of legislation. Prove your interest and dedica-
tion by contacting Mrs. Harry Fry, Apartment 1804,
at 1071 Celestial Street, Cincinnati 45202, telephone
421-3595. Not so incidentally, if you haven’t had
the privilege of hearing Mrs. Fry, take it from this
reporter that there is no more dynamic, forceful or
interesting a speaker than this charming woman who
heads our State Legislation Committee.
Two More Chairmen Speak
Mrs. Max T. Schnitker, International Health chair-
man, wants to call attention to the new address of
the World Medical Relief Organization in Detroit,
Michigan: 11745 - 12th Street. The telephone num-
ber is 866-5333 and the zip code for Detroit is 48201.
She hopes everyone is remembering about those drug
samples, etc., and she further urges continued finan-
cial (and badly needed!) support of Project Hope.
From our AMA-ERF chairman, Mrs. R. K. Ram-
sayer, comes the word that as of January 8, contribu-
tions were in the amount of $20,665.13. While
these figures show an increase over the same period
last year, we still have a long way to go (if we hope
to stand a chance of winning a national award) . Not
that that is the incentive, of course. Maximum sup-
port of the outstanding work of AMA-ERF is what
counts. But it would be nice (a fringe benefit, sort
of ! ) to nose out California for a change ! Remember
to make your checks out to the AMA-ERF Auxiliary
THE WOMAN’S AUXILIARY TO THE OHIO STATE MEDICAL ASSOCIATION
President : Mrs. Herbert F. Van Epps
425 E. 15th St., Dover 44622
Vice-Presidents : 1. Mrs. A. L. Kefauver
4421 Aldrich PI., Columbus 43214
2. Mrs. M. W. Sloan, II
415 Towerview Rd., Dayton 45429
3. Mrs. Edward L. Doerman
3605 Laskey Rd., Toledo 43623
Past-President and Nominating Chairman :
Mrs. John D. Dickie
2146 Shenandoah Rd., Toledo 43607
President-Elect: Mrs. James Wychgel
3320 Dorchester Rd., Cleveland 44120
Recording Secretary : Mrs. J. W. Loney
15450 Hemlock Point Rd., Chagrin Falls
Corresponding Secretary : Mrs. C. Raymond Crawley
1507 Seven Mile Dr.,
New Philadelphia 44663
Treasurer : Mrs. R. L. Wiessinger
2280 W. Wayne St., Lima 45805
180
The Ohio State Medical Journal
Improvement of a Formula used by
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ANNUAL CLINICAL CONFERENCE
CHICAGO MEDICAL SOCIETY
FEBRUARY 27, 28 - MARCH 1, 2, 1966
Palmer House, Chicago
THIS CONFERENCE WILL BE OF INTEREST TO ALL PHYSICIANS. It
will be presented in a manner designed to interest the generalist and special-
ist alike. The program is presented by types of disease entities , not sectional-
ized by medical specialties. All physicians, regardless of their field of interest,
will find this program to be informative and useful.
For program or registration information address:
Clinical Conference Committee
Chicago Medical Society
310 So. Michigan Ave.
Chicago, Illinois 60604
for February, 1966
1 81
Fund and send them to its treasurer, Mrs. F. P. Cuth-
bert, 218 East Cherry Street, Canal Fulton, 44614.
Now — The Counties
Discussing new educational trends for the Allen
County group at Hampshire House recently was Dr.
Lloyd Ramseyer, emeritus president of Bluffton Col-
lege. Guests of the auxiliary were pharmacists’
wives. Dr. Ramseyer spoke of the population ex-
plosion, ever-increasing automation and competitive
pressures. Current emphasis, the speaker added, is
concentration on fewer subjects, better utilization of
facilities, audio-visual aids and more diversified cur-
ricula to accommodate all student types. Hosting the
luncheon for the 60 members and guests were Mrs.
B. W. Travis, Mrs. W. C. Berry, Mrs. Theophile
Andjus, Mrs. J. D. Albertson, Mrs. T. D. Allison,
Mrs. J. F. Tillotson, Mrs. H. C. Weisenbarger, Mrs.
W. T. Wright and Mrs. R. S. Sobocinski.
Something new for the Hamilton Auxiliary was on
the calendar in January. Instead of the usual lunch-
eon meeting that brings the membership together at a
central spot, 13 "coffees” were held simultaneously
in the homes of members in various sections of the
city. The idea was conceived by the group’s presi-
dent, Mrs. John B. Toepfer, as a means of promot-
ing fellowship among the organization’s 600 members
in a smaller, more informal setting and the gather-
ings this time were entirely social to permit members
to get to know each other better.
Mrs. Don Aicholz and Mrs. Richard Wendel were
general chairmen for the day and issued the invita-
tions to the specific homes. A representative of the
executive board was present at each get-together. The
homes at which this unusual, event took place included
those of: Mrs. William A. Altemeier, Mrs. James
Gray, Jr., Mrs. Robert L. Coith, Mrs. John M. Glenn,
Mrs. Robert S. Heidt, Mrs. Ken W. Rahe, Mrs. Neal
M. Earley, Mrs. Daniel E. Earley, Mrs. James D.
Phinney, Mrs. Robert H. Preston, Mrs. Howard
Pfister, Mrs. Ogden H. Baumes and Mrs. William
P. Jennings.
A recent outstanding display and feature story in
the Cincinnati 'Enquirer deserves recognition. "Apple
Tree Bears Fruit for Hospitals” was the headline
and it was doubly significant because of a front page
story in that very edition telling of the nurse short-
age at Cincinnati General Hospital and the subsequent
forced cutting of certain hospital service. Those of
you who read the story on the Apple Tree in this
column will recall the purpose of it all was to do
something about the shortage of registered nurses
and other essential personnel in Cincinnati hospitals.
The auxiliary project is a day-care center where such
personnel can leave their children while they work.
The Help of Music
January was "Music Month” for the Lucas County
auxiliary "Morning Coffee Concerts,” annual events,
benefit the Citizens’ Day Care project in its out-
standing program for Toledo school children. Each
morning concert took place on a different day of
the week. (Lucas and Hamilton certainly put coffee
to work for them, wouldn’t you say?) Mary Nelson
and Shirley Roe performed as duo-pianists at the
home of Mrs. John Erler; at the home of Mrs. L.
D. Fruchtman, singers from the Toledo Opera As-
sociation featured the program; Mrs. Kermit Meinert’s
residence resounded to the strains of Highlights of
Broadway Shows; the Tolora Quartet performed at
the home of Mrs. Glenn Usher; Mrs. Robert Wolfe’s
musician guests included a soloist, pianists, violinist
and clarinetist; and at the Ottawa Hills High School,
the Toledo Ballet performed the "New York World’s
Fair Program.”
Even the January luncheon meeting of the Lucas
women featured a musical program given by one of
its own members, Mrs. Robert Hauman, who was
the Grinnell Opera Scholarship winner for 1965. The
Finance Study Group also got under way in January.
The hostess was Mrs. Everett Kasher and the topic
was "Services of the Bank” presented by Mrs. Claude
May of the public relations department of the Toledo
Trust Company. A second Finance Study group pro-
gram in January was on "Life Insurance and Finan-
cial Security.” An interesting sidelight — the Lucas
group had its own "Woman’s Auxiliary” page in
Protect Your Family — Now — With the OSMA- PLAN
of comprehensive group major medical insurance sponsored by the
Ohio State Medical Association for its members and their families
NEW —
Also available to Ohio Physicians:
up to $100,000
DISABILITY
PRACTICE
ACCIDENTAL
OVERHEAD
DEATH AND
and INCOME and
EXPENSE
DISABILITY
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INSURANCE
INSURANCE
(All three at low group rates)
Call or write: DaNIELS-HeAD & ASSOCIATES, INC.
Daniels-Head Building, Portsmouth, Ohio 45662 Tel. 353-3124
182
The Ohio State Medical Journal
gii
■iisii™
ill
hhHI
Indications: ‘Miltown’ (meprobamate) is ef-
fective in relief of anxiety and tension states.
Also as adjunctive therapy when anxiety
may be a causative or otherwise disturbing
factor. Although not a hypnotic, ‘Miltown’
fosters normal sleep through both its anti-
anxiety and muscle-relaxant properties.
Contraindications: Previous allergic or idio-
syncratic reactions to meprobamate or
meprobamate-containing drugs.
Precautions: Careful supervision of dose
and amounts prescribed is advised. Consider
possibility of dependence, particularly in pa-
tients with history of drug or alcohol addic-
tion; withdraw gradually after use for weeks
or months at excessive dosage. Abrupt with-
drawal may precipitate recurrence of pre-
existing symptoms, or withdrawal reactions
including, rarely, epileptiform seizures.
Should meprobamate cause drowsiness or
visual disturbances, the dose should be re-
duced and operation of motor vehicles or
machinery or other activity requiring alert-
ness should be avoided if these symptoms
are present. Effects of excessive alcohol may
An eminent role in
medical practice
» Clinicians throughout the world con-
sider meprobamate a therapeutic
standard in the management of anxi-
ety and tension.
* The high safety-efficacy ratio of
‘Miltown’ has been demonstrated by
more than a decade of clinical use.
Miltown*
(meprobamate)
possibly be increased by meprobamate.
Grand mal seizures may be precipitated in
persons suffering from both grand and petit
mal. Prescribe cautiously and in small quan-
tities to patients with suicidal tendencies.
Side effects: Drowsiness may occur and,
rarely, ataxia, usually controlled by decreas-
ing the dose. Allergic or idiosyncratic re-
actions are rare, generally developing after
one to four doses. Mild reactions are char-
acterized by an urticarial or erythematous,
maculopapular rash. Acute nonthrombocy-
topenic purpura with peripheral edema and
fever, transient leukopenia, and a single
case of fatal bullous dermatitis after admin-
istration of meprobamate and prednisolone
have been reported. More severe and very
rare cases of hypersensitivity may produce
fever, chills, fainting spells, angioneurotic
edema, bronchial spasms, hypotensive crises
(1 fatal case), anuria, anaphylaxis, stoma-
titis and proctitis. Treatment should be
symptomatic in such cases, and the drug
should not be reinstituted. Isolated cases of
agranulocytosis, thrombocytopenic purpura,
and a single fatal instance of aplastic ane-
mia have been reported, but only when other
drugs known to elicit these conditions were
given concomitantly. Fast EEG activity has
been reported, usually after excessive me-
probamate dosage. Suicidal attempts may
produce lethargy, stupor, ataxia, coma,
shock, vasomotor and respiratory collapse.
Usual adult dosage: One or two 400 mg.
tablets three times daily. Doses above 2400
mg. daily are not recommended.
Supplied: In two strengths: 400 mg. scored
tablets and 200 mg. coated tablets.
Before prescribing, consult package circular.
WALLACE LABORATORIES
\^fsCranbury, N.J. Cm-57si
the December Academy Bulletin, edited by Betty Jen-
kins. I don’t know if this is a regular monthly
feature or not, but it certainly is a fine idea and
opportunity.
Trumbull County auxiliary received excellent
newspaper coverage on its Health Career Day project.
Members held conducted tours at St. Joseph and
Trumbull Memorial Hospitals in Warren for inter-
ested students from the area high schools. The
group’s rural chairman has come up with a poster
campaign to encourage immunizations. The safety
and disaster control chairman is busy with "Good
Emergency Mothers,” a training course for baby sit-
ters. The mental health chairman works in close
cooperation with the director of the Trumbull County
Guidance Center. Sorry I can’t give you the names
of these wonderful women, but they just weren’t
mentioned in the material sent me.
Help Wanted!
Help wanted from all you local publicity chair-
men, that is . . . You’ve been so good for so many
months now about sending me clippings (at least,
most of you have) but suddenly there’s a lull and
that’s bad for my business — and yours ! How can
I report local auxiliary activities if I’m not kept in-
formed?? So please — get those clippings, reports
or what have you headed my way — right away !
Diseases of the Colon, One
Of Courses at OSU
On Wednesday, February 23, Ohio State University
College of Medicine is offering a short course for
physicians entitled "Diseases of the Colon.” Reg-
istration opens at 8:00 a. m. with the program start-
ing at 8:30.
Guest speaker will be Dr. Harold P. Roth, direc-
tor of the gastroenterology program at Western
Reserve University School of Medicine, and chief
of the gastroenterology service at the Veterans Ad-
ministration Hospital, Cleveland.
Other faculty members will be from the various
services at Ohio State University — medicine, gas-
troenterology, radiology, surgery, and pathology.
Additional information on this and other courses
may be obtained by contacting The Center for Con-
tinuing Medical Education, 320 West Tenth Avenue,
Columbus 43210.
Other OSU courses scheduled in the near future
include the following:
Ninth Annual Postgraduate Course in Ophthal-
mology, March 7, 8.
Pediatric Invitational Clinic, March 16.
Lederle Symposium, March 27.
Seventh Annual Pediatric PG Course, March 31 -
April 2.
Carroll County Medical Society
Announces Medical Seminar
On Wednesday, April 13, the Carroll County Medi-
cal Society will sponsor its Second Annual Post-
graduate Medical Seminar at the Atwood Yacht Club,
Atwood Lake, Route 1, Dellroy, across from the new
Atwood Lodge.
Faculty will be a team from the University of
Cincinnati College of Medicine, with two internists,
one surgeon and one psychiatrist participating. There
also will be a ladies program, and all physicians and
their wives of the area are invited. Category I con-
tinuation study credit of the American Academy of
General Practice has been applied for.
Dr. Thomas J. Atchison, 292 East Main Street,
Carrollton, is secretary of the Society.
Medical Ethics Essay Contest
Open to Medical Students
The American Medical Association, through the
Judicial Council, is sponsoring a Medical Ethics Essay
Contest for the academic year 1965-1966. The con-
test is a part of the Judicial Council’s Expanded
Program on Medical Ethics.
The contest is being named in honor of the late
Norman A. Welch, M. D., who died September 3,
1964, while serving as the 118th President of the
American Medical Association. The contest is open
to junior and senior students in any accredited medi-
cal school in the United States.
Cash prizes totaling $1,000 will be awarded for
the winning essays. First prize will be $500; second
prize $300; and third prize $200.
Lists of suggested topics will be available from the
AMA. Deadline for entries this year is June 1.
New Members . . .
Following are names of new members of the Ohio
State Medical Association certified to the Headquar-
ters Office during December. List shows name of
physician, county and city in which he is practicing or
temporary addresses for those taking graduate work.
Columbiana
Ranulfo V. Gracilla, Salem
Cuyahoga
Pete N. Poolos, Jr., Cleveland
Franklin
Calvin B. Early, Columbus
Flamilton
Daniel J. Kindel, III,
Cincinnati
John D. Pottschmidt,
Cincinnati
David Van Ginkel, Cincinnati
Lucas
Paul J. Raglow, Toledo
The film "Radioisotope Scanning in the Clinical
Management of Patients,” is available for showing
to professional audiences from E. R. Squibb & Sons,
745 Fifth Ave., New York, N. Y. 10022, or from
regional offices of the company. The 16 mm. color,
sound film runs 35 minutes.
184
The Ohio Slate Medical Journal
^How much would it be
with no munufucturer3s profit ?
$2.09? $.93? $3.18?
Somewhat amazingly, $3.18 is correct. Even if you eliminated pharma-
ceutical manufacturer’s net profit, your patient would pay only about
17 cents less for the average prescription— hardly a deciding factor in
having it filled. Of course, this assumes that pharmaceuticals could con-
tinue to be available without profit (where do new miracle drugs come
from, if not profit?).
American pharmaceuticals today may well be America’s biggest bargain.
Pharmaceutical Manufacturers Association/1 155 Fifteenth Street, N.W, Washington, D.C. 20005
This message is brought to you as a courtesy of this publication on behalf of the producers of prescription drugs .
'"Average prescription price, 1963. National Prescription Audit, R.A. Gosselin, Dedham, Mass.
State Association Officers and Committeemen
Headquarters Office: Room 1005, 79 East State Street, Columbus 43215. Telephone 221-7715
Henry A. Crawford, President
1058 Hanna Bldg., Cleveland 44115
Lawrence C. Meredith, President-Elect
205 Elyria Block, Elyria 44035
Robert E. Tschantz, Past-President
515 Third Street, N.W., Canton 44703
Philip B. Hardymon, Treasurer
350 East Broad St., Columbus 43215
Mr. Hart F. Page, Executive Secretary
Mr. W. Michael Traphagan, Administrative Assistant
Mr. Charles W. Edgar, Director of Public Relations
and Assistant Executive Secretary
Mr. Herbert E. Gillen, Administrative Assistant
Perry R. Ayres, Editor
Mr. R. Gordon Moore, Executive Editor
THE COUNCIL
First District, Robert E. Howard, 2600 Union Central Bldg., Cincinnati 45202 ; Second District, Theodore L. Light, 2670 Salem Ave.,
Dayton 45406 ; Third District, Frederick T. Merchant, 1051 Harding Memorial Pky., Marion 43305 ; Fourth District, Robert N. Smith,
3939 Monroe St., Toledo 43606 ; Fifth District, P. John Robechek, 10525 Carnegie Ave., Cleveland 44106; Sixth District, Edwin R.
Westbrook, 438 North Park Ave., Warren; Seventh District, Benj. C. Diefenbach, 30 S. 4th St., Martins Ferry; Eighth District, Robert
C. Beardsley, 2236 Maple Ave., Zanesville; Ninth District, George N. Spears, 2213 So. Ninth St., Ironton ; Tenth District, Richard
L. Fulton, 1211 Dublin Rd., Columbus 43212; Eleventh District, William R. Schultz, 1749 Cleveland Rd., Wooster 44691.
COMMITTEES
Committee on Education — Thomas E. Rardin, Columbus, Chair-
man (1966) ; Clyde W. Muter, Warren (1970) ; Thomas S. Brow-
nell, Akron (1969) ; John G. Sholl, Cleveland (1968) ; Elmer R.
Maurer, Cincinnati (1967).
Judicial and Professional Relations Committee — Frank F. A.
Rawling. Toledo. Chairman (1968) ; Homer A. Anderson. Colum-
bus (1970) : Chester H. Allen, Portsmouth (1969) ; David Fish-
man, Cleveland (1967); Paul A. Mielcarek, Cleveland (1966).
Committee on Public Relations and Economics — Frederick P.
Osgood, Toledo. Chairman (1969) ; Luther W. High, Millers-
bnrgh (1970) ; John H. Budd, Cleveland (1968) ; John J. Cranley,
Cincinnati (1967); Horace B. Davidson, Columbus (1966).
Committee on Scientific Work — Samuel Saslaw, Columbus,
Chairman (1968) ; Jack Schreiber, Canfield (1970) ; Walter J.
Zeiter, Cleveland (1970) ; John D. Battle, Jr., (1969) ; Harold
J. Schneider, Cincinnati (1969) ; Isador Miller, Urbana (1968) ;
William Hamelberg, Columbus (1967) ; F. A. Simeone, Cleveland
(1967) ; Ralph K. Ramsayer, Canton (1966) ; G. Douglas Talbott,
Dayton (1966).
Committee on Care of the Aging — Charles W. Stertzbach,
Youngstown, Chairman; James O. Barr, Chagrin Falls; Dwight
L. Becker, Lima; Robert A. Borden, Fremont; Edwin W.
Burnes, Van Wert; Philip T. Doughten, New Philadelphia;
Robert B. Elliott, Ada ; George T. Harding, Sr., Worthington ;
Roger E. Heering, Columbus; M. Robert Huston, Millersburg ;
John S. Kozy, Toledo; Francis M. Lenhart, Defiance; Harold
E. McDonald, Elyria; H. W. Porterfield, Columbus; Elliot W.
Schilke, Springfield; Bernard A. Schwartz, Cincinnati; Clar-
ence V. Smith, Canton ; Joseph B. Stocklen, Cleveland ; Don P.
VanDyke, Kent; William M. Wells, Newark; Roger Williams,
Columbus.
Committee on Cancer — Arthur G. James, Columbus, Chairman ;
Thomas D. Allison, Lima; Andrew M. Barone, Lima; William
F. Boukalik, Cleveland; William J. Flynn, Youngstown; Douglas
P. Graf, Cincinnati; Stanley O. Hoerr, Cleveland; William A.
Newton, Jr., Columbus; W. D. Nusbaum, Lancaster; Arthur E.
Rappoport, Youngstown ; Carl A. Wilzbach, Cincinnati.
Committee on Eye Care — Arthur D. Collins, Cleveland, Chair-
man ; Martin J. Cook, Springfield ; Thomas L. Edwards, Lima ;
Robert H. Magnuson, Columbus ; Russell J. Nicholl, Cleveland ;
Claude S. Perry, Columbus ; Norman W. Pinschmidt, Gallipolis ;
Barnet R. Sakler, Cincinnati ; Robert L. Willard, Toledo.
Committee on Hospital Relations — William R. Schultz, Woo-
ster, Chairman ; L. A. Black, Kenton ; L. Fred Bissell, Aurora ;
Oscar W. Clarke, Gallipolis ; Robert M. Craig, Dayton ; John
V. Emery, Willard ; Harvey C. Gunderson, Toledo ; Philip B.
Hardymon, Columbus ; Middleton H. Lambright, Cleveland ;
Lloyd E. Larriek, Cincinnati ; Joseph S. Lichty, Akron ; James
C. McLarnan, Mt. Vernon ; Ben V. Myers, Elyria ; Robert A.
Tennant, Middletown ; V. William Wagner, Port Clinton ; Wil-
liam A. White, Canton.
Committee on Insurance — David A. Chambers, Cleveland,
Chairman ; William F. Bradley, Columbus ; Walter A. Daniel,
Tiffin; Chester R. Jablonoski, Cleveland; William A. Knapp,
Zanesville; Marvin R. McClellan, Cincinnati; William Neal,
Archbold ; Oliver Todd, Toledo ; Robert E. Tschantz, Canton ;
Allan L. Wasserman, Dayton; John W. Wherry, Elyria; Wil-
liam A. White, Canton.
Committee on Laboratory Medicine — Horace B. Davidson, Co-
lumbus, Chairman; William H. Benham, Columbus; John B.
Hazard, Cleveland ; Melvin Oosting, Dayton ; Arthur E. Rap-
poport, Youngstown; William Sinclair, Cleveland; Gilbert B.
Stansell, Toledo; Philip B. Wasserman, Cincinnati.
Committee on Legislation — James T. Stephens, Oberlin, Chair-
man ; Donald R. Brumley, Findlay ; George D. J. Griffin, Cin-
cinnati ; Jack L. Kraker, Lancaster; Maurice F. Lieber, Canton;
Ralph F. Massie, Ironton ; James C. McLarnan, Mt. Vernon ;
Robert E. Rinderknecht, Dover; John H. Sanders, Cleveland;
Carl R. Swanbeck, Sandusky; William W. Trostel, Piqua.
Committee on Maternal Health — Anthony Ruppersberg, Co-
lumbus, Chairman ; Otis G. Austin, Medina ; Raymond E. Bar-
ker, Columbus ; William D. Beasley, Springfield ; Keith R.
Brandeberry, Gallipolis; Thomas E. Byrne, Mentor; C. Ray-
mond Crawley, Dover; Mel A. Davis, Columbus; Marion F.
Detrick, Jr., Findlay; John P. Garvin, Columbus; Richard P.
Glove, Cleveland; Robert A. Heilman, Columbus; John F. Hil-
labrand, Toledo; Robert E. Johnstone, Cincinnati; Albert A.
Kunnen, Dayton; James F. Morton, Zanesville; Ralph K. Ram-
sayer, Canton; Robert E. Swank, Chillicothe ; Densmore Thomas,
Warren ; Robert S. VanDervort, Elyria.
Committee on Medicine and Religion — George W. Petznick,
Cleveland, Chairman; John D. Albertson, Lima; Eugene F.
Damstra, Dayton: Francis M. Lenhart, Defiance; Ralph W.
Lewis, Portsmouth ; J. Kenneth Potter, Cleveland ; Charles A.
Sebastian, Cincinnati ; John R. Seesholtz, Canton ; William B.
Smith, Zanesville; James T. Stephens, Oberlin; Donald J. Vin-
cent, Columbus ; Don G. Warren, West Lafayette.
Committee on Mental Health — Wendell A. Butcher, Columbus,
Chairman ; Homer A. Anderson, Columbus ; Max D. Graves,
Springfield ; Charles W. Harding, Worthington ; Warren G.
Harding, II, Columbus ; Henry L. Hartman, Toledo ; J. Robert
Hawkins, Cincinnati ; William H. Holloway, Akron ; Nathan
B. Kalb, Lima ; Thomas E. Rardin, Columbus ; Philip C. Rond,
Columbus ; Victor M. Victoroff, Cleveland ; John A. Whieldon,
Columbus.
Committee on Disaster Medical Care — Thomas D. Allison,
Lima, Chairman ; Thomas P. Bowlus, Toledo ; Nino M. Cam-
ardese, Norwalk ; Drew L. Davies, Columbus ; John H. Davis,
Cleveland ; Gregory G. Floridis, Dayton ; Robert D. Gillette,
Huron ; Robert S. Heidt, Cincinnati ; N. J. M. Klotz, Wads-
worth ; Thomas W. Morgan, Gallipolis ; Sterling W. Obenour,
Jr., Zanesville; Vol K. Philips, Columbus; Elden C. Weckesser,
Cleveland; (Liaison with the American Medical Association)
Wendell A. Butcher, Columbus.
Military Advisory Committee — Drew L. Davies, Columbus,
Chairman ; A. A. Brindley, Maumee ; Ralph G. Carothers, Cin-
cinnati; Homer D. Cassel, Dayton; Henry A. Crawford, Cleve-
land; Walter L. Cruise, Zanesville; Charles R. Keller, Mans-
field ; Ralph W. Lewis, Portsmouth ; Edward L. Montgomery,
Circleville ; Frank T. Moore, Akron ; Earl Rosenblum, Steuben-
ville.
Committee on Occupational Health — Rex H. Wilson, Akron,
Chairman ; Drew J. Arnold, Columbus ; William W. Davis, Co-
lumbus; Winfred M. Dowlin, Canton; Harold M. James, Day-
ton ; H. W. Lawrence, Middletown ; Daniel M. Murphy, Marion ;
Anthony M. Puleo, Cleveland ; George W. Wright, Cleveland ;
H. P. Worstell, Columbus.
Committee on Poison Control — John A. Norman, Akron,
Chairman; William G. Gilger, Cleveland; Mason S. Jones, Day-
ton ; James H. Bahrenburg, Canton ; Edward V. Turner, Co-
lumbus; William M. Wallace, Cleveland; Hugh Wellmeier,
Piqua; John A. Williams, Cincinnati.
Committee on Radiation — Charles M. Barrett, Cincinnati,
Chairman ; Eldred B. Heisel, Columbus ; George F. Jones, Lan-
caster; Carey B. Paul, Jr., Columbus; Thomas C. Pomeroy, Co-
lumbus ; Denis A. Radefeld, Lorain ; Eugene L. Saenger, Cin-
cinnati; Robert E. Schulz, Wooster; John P. Storaasli, Cleve-
land; Robert P. Ulrich, Troy; Robert L. Wall, Columbus; John
Robert Yoder, Toledo; James G. Kereiakes, Ph. D. (Advisory
Member, Special Consultant), Cincinnati.
186
The Ohio State Medical Journal
State Association Officers and Committeemen (Continued)
Committee on Rural Health — Robert E. Reiheld, Orrville,
Chairman ; Chester J. Brian, Eaton ; J. Martin Byers, Green-
field : Walter A. Campbell, Coshocton ; E. Joel Davis, East Can-
ton ; Victor R. Frederick, Urbana ; Benjamin W. Gilliotte, Zanes-
ville ; Jerry L. Hammon, West Milton; Jasper M. Hedges, Circle-
ville ; Luther W. High, Millersburg ; E. D. Mattmiller, Athens;
John R. Polsley, North Lewisburg : Leonard S. Pritchard, Co-
lumbiana ; Harold C. Smith, Van Wert : Kenneth W. Taylor,
Pickerington ; Edmond K. Yantes, Wilmington.
Committee on Scientific and Educational Exhibit — Charles V.
Meckstroth, Columbus, Chairman ; Harvey C. Knowles, Jr., Cin-
cinnati ; W. Arnold McAlpine, Toledo ; Arthur E. Rappoport,
Youngstown; Arnold M. Weissler, Columbus; Walter J. Zeiter,
Cleveland ; Robert E. Zipf, Dayton.
Committee on School Health — Charles H. McMullen, Loudon-
ville. Chairman; Walter Felson, Greenfield; Paul D. Hahn, New
Philadelphia ; Howard H. Hopwood, Cleveland ; Dale A. Hudson,
Piqua ; Howard J. Ickes, Canton ; Charles L. Kagay, Dayton ;
Lawrence L. Maggiano, Warren ; Robert C. Markey, Bowling
Green ; Robert J. Murphy, Columbus ; Carey B. Paul, Jr., Colum-
bus ; Carl L. Petersilge, Newark ; William H. Rower, Ashland ;
Thomas E. Shaffer, Columbus ; Aubrey L. Sparks, Warren ;
Albert E. Thielen, Cincinnati; Homer B. Thomas, Gallipolis.
Committee on Traffic Safety— N. J. Giannestras, Cincinnati,
Chairman ; Howard W. Brettell, Steubenville ; Drew L. Davies.
Columbus; Clark M. Dougherty, New Philadelphia: Wesley L.
Furste, Columbus: Thomas W. Morgan, Gallipolis; Lester G.
Parker, Sandusky ; Thomas N. Quilter, Marion ; Stewart M.
Rose. Columbus; John F. Tillotson, Lima; Robert C. Waltz,
Cleveland ; Paul L. Weygandt, Akron ; Robert E. Zipf, Dayton.
Committee on Workmen’s Compensation — H. P. Worstell, Co-
lumbus, Chairman; A. L. Berndt, Portsmouth; Thomas H.
Brown, Jr., Toledo; Charles A. Browning, Jr., Bellefontaine ;
Oscar W. Clarke, Gallipolis : Frederick A. Flory, Columbus ;
Lawrence T. Hadbavny, Cleveland; Clyde O. Hurst, Portsmouth;
Edmund F. Ley, Tiffin; Joseph Lindner, Sr., Cincinnati: John
D. Osmond, Jr., Cleveland; James G. Robei*ts, Akron; George
L. Sackett, Sr., Painesville ; Joseph H. Shepard, Columbus;
William V. Trowbridge, Cleveland; Rex H. Wilson, Akron;
Frederick A. Wolf, Cincinnati; James N. Wychgel, Cleveland.
OSMA Members of the Joint Advisory Committee on Athletic
Injuries — Robert J. Murphy, Columbus ; John R. Jones, Toledo :
Sol Maggied, West Jefferson ; Charles H. McMullen, Loudonville :
Carey B. Paul, Jr., Columbus ; Thomas E. Shaffer, Columbus ;
Don A. Kelly, Cleveland: Marvin R. McClellan, Cincinnati;
Walter A. Hoyt, Jr., Akron.
OSMA Members of the Joint Committee on School Bus Driver
Examinations — Carey B. Paul, Jr., Columbus ; Thomas N. Quil-
ter, Marion ; Stewart M. Rose, Columbus.
DELEGATES AND ALTERNATES
Delegates and Alternates to the American Medical Association
— George W. Petznick, Cleveland; H. T. Pease, Wadsworth, alter-
nate; Carl A. Lincke, Carrollton; Robert S. Martin, Zanesville,
alternate; Theodore L. Light, Dayton; Kenneth D. Arn, Dayton,
alternate; Edmond K. Yantes, Wilmington; Harry K. Hines,
Cincinnati, alternate; John H. Budd, Cleveland; P. John Robe-
chek, Cleveland, alternate ; Richard L. Meiling, Columbus ; Rob-
ert E. Tschantz, Canton, alternate; Frederick F. Osgood, Toledo;
Robert N. Smith, Toledo, alternate ; Charles A. Sebastian, Cin-
cinnati ; J. Robert Hudson, Cincinnati, alternate ; Edwin H.
Artman, Chillicothe ; Philip B. Hardymon, Columbus, alternate.
County Societies’ Officers and Meeting Dates
First District
Councilor: Robert E. Howard, Cincinnati 45202
2600 Union Central Bldg.
ADAMS — Gary J. Greenlee, President, Manchester 45144 ; Stan-
ley H. Title, Secretary, Manchester 45144.
BROWN — John A. Powell, President, 117 Cherry St., George-
town ; Kevin C. McGann, Secretary, 121 N. Main St., George-
town. 3rd Sunday, monthly.
BUTLER — Robert Johnson, President, 500 S. Breiel Boulevard,
Middletown 45042 ; Mr. Charles G. Greig, Executive Secretary,
110 North Third Street, Hamilton 45011. 4th Wednesday
monthly.
CLERMONT — Cecil F. Barber, President, State Route 133, Feli-
city 45120 ; Phillips F. Greene, Secretary, Route 1, Box 509.
New Richmond 45157. 3rd Wednesday monthly, except July
and August.
CLINTON — Richard R. Buchanan, President, 115 West Main,
Wilmington 45177 ; Mary Ranz Boyd, Secretary, Box 629,
Wilmington 45177. 4th Tuesday monthly.
HAMILTON — Robert M. Woolford, President, 320 Broadway,
Cincinnati 45202 ; Mr. Edward F. Willenborg, Executive
Secretary, 320 Broadway, Cincinnati 45202. Monthly meet-
ing dates, 1st Tuesday; Academy, 3rd Tuesday, except June,
July and August.
HIGHLAND — Thomas C. Sharkey, President, 216 S. High St.,
Hillsboro; Kenneth L. Upp, Secretary, 528 South St., Greenfield.
1st Wednesday, every other month.
WARREN — O. Williard Hoffman, President, 20 East Fourth
Street, Franklin 45005 ; Ray E. Simendinger, Secretary, 901
North Broadway Street, Lebanon 45036. 2nd Tuesday monthly.
Second District
Councilor: Theodore L. Light, Dayton 45406
2670 Salem Ave.
CHAMPAIGN — Myron J. Towle, President, 848 Scioto Street,
Urbana 43078 ; Fred R. Denkewalter, Secretary, 848 Scioto
Street, Urbana 43078. 2nd Wednesday monthly.
CLARK — Henry M. Tardif, President, 2608 E. High Street,
Springfield 45505 ; Mrs. Marion L. Wilcoxson, Executive
Secretary, Hotel Shawnee, Room 207, Springfield 44501. 3rd
Monday monthly, except June, July and August.
DARKE — Edward H. Kirsch, President, 261 East Main Street.
Gettysburg; Delbert Blickenstaff, Secretary, South West St.,
Versailles. 3rd Tuesday, monthly.
GREENE— Clement G. Austria, President, 1142 North Monroe
Drive, Xenia 45385 ; Mrs. C. K. Elliott, Executive Secretary,
225 Pleasant Street, Xenia 45385. 2nd Thursday monthly
except July and August.
MIAMI — David Brown, President, 1060 North Market Street,
Troy 45373 ; Jack P. Steinhilber, Secretary, 145 Sunset Drive,
Piqua 45356. 1st Tuesday monthly.
MONTGOMERY — Charles E. O’Brien, President, 600 Fidelity
Building, Dayton 45402 ; Mr. Robert F. Freeman, Executive
Secretary, 280 Fidelity Medical Building, Dayton 45402. 1st
Friday monthly October through May — -1st Wednesday June.
PREBLE — W. C. Clark, Jr., President, 228 N. Barron St., Eaton :
John D. Darrow, Secretary, 1302 N. Aukerman St., Eaton.
SHELBY — George J. Schroer, President, 322 Second Ave., Sid-
ney ; Alfonsas Kisielius, Secretary, Ohio Bldg., Sidney.
Third District
Council : Frederick T. Merchant, Marion 43305
1051 Harding Memorial Pky.
ALLEN — Carl H. Zinsmeister, President, 729 W. Market Street,
Lima 45801 ; Thomas D. Allison, Secretary, 401 Metropolitan
Bank Building, Lima 45801. 3rd Tuesday monthly.
AUGLAIZE — Robert Sobocinski, President, 75 Blackhoof Street,
Wapakoneta 45895 ; J. F. Bowling, Secretary, 319 West Spring
Street, St. Marys 45885. 1st Thursday monthly except July.
CRAWFORD — Don E. Ingham. President, 201 N. Market Street,
Galion 44833 ; Johnson H. Chow, Secretary, 1040 Devonwood
Drive, Galion 44833. Called meetings.
HANCOCK — Thomas W. Darnall, President, 1809 South Main
Street, Findlay; Herbert L. Queen, Secretary, 827 Woodworth
Drive. Findlay. 3rd Tuesday, monthly.
HARDIN — William D. Dewar, President, 405 North Main Street,
Kenton 43326 ; John J. Roget, Secretary, Belle Center 43310.
2nd Tuesday monthly.
LOGAN — Thomas Seitz, President, 223 E. Columbus Street,
Bellefontaine 43311 : Glen Miller, Secretary, R. D. 2, West
Liberty 43357. 1st Friday monthly.
MARION — Ransome Williams, President, 1035 Harding Me-
morial Parkway, Marion 43302 ; Alice Fisher, Secretary, 1040
Delaware Avenue, Marion 43302. 1st Tuesday monthly.
MERCER — R. Duane Bradrick, President, Rockford 45882. 3rd
Thursday monthly. (Secretary not definite as of December 10,
1965.)
SENECA — Olgierd C. Garlo, President, 53 Clay Street, Tiffin
44883 ; Leonard M. Gaydos, Secretary, 233 South Monroe
Street, Tiffin 44883. 3rd Tuesday monthly.
VAN WERT — Harold C. Smith, President, Medical Arts Bldg.,
Van Wert; Donald E. Hughes, Secretary, Van Wert County
Hospital. Van Wert. 4th Tuesday, monthly.
WYANDOT — Franklin M. Smith, President, E. Saffie Ave., Box
68, Sycamore; Robert E. Goyne, Secretary, 482 N. 7th St..
Upper Sandusky. 2nd Tuesday, monthly.
Fourth District
Councilor: Robert N. Smith, Toledo 43606
3939 Monroe St.
DEFIANCE — L. F. Berry, Jr., President, 1400 East Second
Street, Defiance 43512 ; W. S. Busteed, Secretary, Box 218,
Defiance 43512.
FULTON— B. H. Reed, Jr., President, Delta 43515 ; R. L. Davis,
Secretary, Wauseon 43567. 2nd Tuesday quarterly March,
June, September, December.
HENRY — J. J. Harrison, President, 113 East Clinton Street,
Napoleon 43545 ; Gamble S- Hall, Secretary, 834 Strong
Street, Napoleon 43545. 1st Tuesday monthly.
LUCAS — R. Philip Whitehead, President, 424 W. Woodruff Ave.,
Toledo 43602 ; Mr. Robert W. Elwell, Executive Secretary,
3101 Collingwood Blvd., Toledo 10. 3rd Tuesday.
OTTAWA — V. Wm. Wagner, President, 122 East Perry, Port
Clinton 43452 ; William Coon, Secretary, 120 East Perry, Port
Clinton 43452. 2nd Thursday monthly.
PAULDING — Don K. Snyder, President, Payne; Roy R. Miller,
Secretary. 220 W. Perry St., Paulding. Meetings as called.
PUTNAM — John R. Brown. President, 135 South Hickory Street.
Ottawa: Oliver N. Lugibihl, Secretary, Pandora. 1st Tuesday
monthly.
for February, 1966
187
SANDUSKY — J. L. Zimmerman, President, Memorial Hospital
of Sandusky County, Fremont 43420 ; Mrs. Patsy J. Askins,
Executive Secretary, Memorial Hospital of Sandusky County,
Fremont 43420. 3rd Wednesday monthly.
WILLIAMS — Donald F. Cameron, President, Central Drive,
Bryan; John E. Moats, Secretary, Central Drive, Bryan.
WOOD — Roger A. Peatee, President, 140 S. Prospect Street,
Bowling Green 43402 ; William B. Elderbrock, Secretary,
Health Service, Bowling Green State University, Bowling
Green 43402. 3rd Thursday monthly.
Fifth District
Councilor: P. John Robechek, Cleveland 44106
10525 Carnegie Ave.
ASHTABULA- — J. R. Nolan, President, 2736 Lake Avenue, Ash-
tabula 44004 ; Richard Millberg, Secretary, 430 West 25th
Street, Ashtabula 44004. 2nd Tuesday monthly.
CUYAHOGA — William F. Boukalik, President, 20030 Scottsdale
Boulevard, Cleveland 44122 ; Mr. Robert A. Lang, Executive
Secretary, 10525 Carnegie Avenue, Cleveland 44106.
GEAUGA — Bruce F. Andreas, President, 400 Downing Drive,
Chardon 44024 ; Arturo J. Dimaculangan, Secretary, 8400 May-
field Road, P. O. Box 277, Chesterland 44026. 2nd Friday
monthly.
LAKE — Robert W. Colopy, President, 89 E. High Street, Paines-
ville 44077 ; Mrs. Owen A. McLaren, Executive Secretary,
7408 Cadle Avenue, Mentor 44060. 4th Wednesday evening
monthly, January, May, March, September and November
unless otherwise ordered by Council.
Sixth District
Councilor; Edwin R. Westbrook, Warren 44481
438 North Park Ave.
COLUMBIANA — Peter Cibula, President, 356 E. Lincoln Way,
Lisbon ; Ernst P. Schaefer, Secretary, 412 N. Lincoln Ave.,
Salem. 3rd Tuesday, monthly.
MAHONING — F. A. Resch, President, Doctoi’s Park, Canfield
44406 ; Mr. Howard C. Rempes, Jr., Executive Secretary, 245
Bel-Park Building, 1005 Belmont Avenue, Youngstown 44504.
3rd Tuesday monthly except July and August.
PORTAGE — David Palmstrom, President, 124 North Prospect
Street, Ravenna 44266 ; William R. Brinker, Secretary, 141
East Main Street, Kent 44240. 3rd Tuesday monthly.
STARK — A. R. Furnas, Jr., President, 420 Lake Avenue, N. E.,
Massillon 44646 ; Mr. John H. Austin, Executive Secretary,
405 4th Street, N. W., Canton 44702. 2nd Thursday monthly.
SUMMIT — James G. Roberts, President, 655 West Market Street,
Akron 44303 ; Mr. Sidney H. Mountcastle, Executive Secretary,
437 Second National Building, 159 South Main Street, Akron
44308. 1st Tuesday monthly.
TRUMBULL — John F. McGreevey, President, 297 Hawthorne
Lane N. E., Warren 44484 ; Mrs. Kay Ticknor, Executive
Secretary, 280 North Park Avenue, Warren 44481. 3rd
Wednesday monthly September through May.
Seventh District
Councilor: Benj. C. Diefenbach, Martins Ferry 43935
30 S. 4th St.
BELMONT — James Sutherland, President, 9 North 4th Street,
Martins Ferry 43935 ; Bertha M. Joseph, Secretary, 100 South
4th Street, Martins Ferry 43935. 3rd Thursday of February,
March, April, June, September, October, November and
December.
CARROLL — Glen C. Dowell, President, 207 West Main, Car-
rollton 44615 ; Thomas J. Atchison, Secretary, 292 East
Main, Carrollton 44615. 1st Thursday monthly.
COSHOCTON — Don Warren, President, 600 East Main Street,
West Lafayette 43845 ; Harold Lear, Secretary, 133 South
Fourth Street, Coshocton 43812. 2nd Tuesday monthly.
HARRISON — Charles D. Evans, President, 159 South Main
Street, Cadiz 43907 ; G. E. Vorhies, Secretary, Scio 43988,
Quarterly.
JEFFERSON — Jacob R. Cohen, President, 341 Market Street,
Steubenville 43952 ; Irving Dreyer, Secretary, P. O. Box 308,
Steubenville 43952. 4th Tuesday monthly except December’
January, February.
MONROE — Byron Gillespie, Secretary, S. Main St., Woodsfield.
TUSCARAWAS — S. H. Winston, President, 658 Boulevard,
Dover; G. W. Johnston, Secretary, 658 Boulevard, Dover.
2nd Thursday, monthly.
Eighth District
Councilor : Robert C. Beardsley, Zanesville 43705
2236 Maple Ave.
ATHENS — D. R. Johnson, President, 52 West Washington
Street, Nelsonville 45764 ; L. A. Hamilton, Secretary, 400 East
State Street, Athens 45701. 2nd Tuesday monthly except July
and August.
FAIRFIELD — George W. LeSar, President, 216 Harmon Avenue,
Lancaster 43130 ; Stephen R. Hodsden, Secretary, 1423 West
Market Street, Baltimore 43105. 2nd Tuesday monthly.
GUERNSEY — A. C. Smith, President, 1115 Clark Street, Cam-
bridge 43725 ; Dayle O. Snyder, Secretary, 840 Wheeling
Avenue, Cambridge 43725. 1st Tuesday monthly.
LICKING — Carl L. Petersilge, President, 104 Hudson Avenue,
Newark 43065 ; Robert P. Raker, Secretary, 317 N. Granger
Street, Granville 43023. 4th Tuesday monthly.
MORGAN — A. H. Whitacre, President, Chesterhill 43728 ; Henry
Bachman, Secretary, Box 199, Malta 43758.
MUSKINGUM — Paul A. Jones, President, 838 Market Street,
Zanesville 43701 ; Myron Powelson, Secretary, 2825 Maple
Avenue, Zanesville 43705. 2nd Tuesday monthly.
NOBLE — Frederick M. Cox, President, Caldwell 43724 ; Edward
G. Ditch, Secretary, 415 Main Street, Caldwell 43724. 1st
Tuesday monthly.
PERRY — O. D. Ball, President, 203 N. Main St., New Lexing-
ton ; Michael P. Clouse, Secretary, W. Main St., Somerset.
WASHINGTON — Donald Fleming, President, Vincent; Archbold
M. Jones, Jr., Secretary, 326 Third St., Marietta.
Ninth District
Councilor: George N. Spears, Ironton 45638
2213 S. 9th St.
GALLIA — Quentin Korfhage, President, Gallipolis Clinic, Gal-
lipolis 45631; John Groth, Secretary, Holzer Clinic, Gallipolis
45631. Monthly meetings at called times.
HOCKING — Jan S. Matthews, President, 9 East Second Street,
Logan 43138 ; H. M. Boocks, Secretary, Route 3, Logan 43138.
2nd Tuesday monthly.
JACKSON — A. R. Hambrick, President, Wellstou ; John C.
MacLennan, Secretary, Oak Hill. Meeting date varies.
LAWRENCE — Frank W. Crowe, President, 2110 South 9th
Street, Ironton 45638 ; George Newton Spears, Secretary, 2213
South Ninth Street, Ironton 45638. Quarterly at called times.
MEIGS — Selim J. Blazewicz, President, Lasley St., Pomeroy ;
Roger P. Daniels, Secretary, 110 Ebenezer St., Pomeroy. Ap-
proximately once monthly.
PIKE — A. M. Shrader, President, E. Water St.., Waverly ; K.
A. Wilkinson, Secretary, 330 E. North St., Waverly. 1st
Tuesday, monthly.
SCIOTO — Chester H. Allen, President, 1405 Offnere Street,
Portsmouth 45662 ; Erich Spiro, Secretary, 1735 Waller Street,
Portsmouth 45662. 2nd Monday in February, April and Octo-
ber ; December meeting and summer meeting decided by the
Council and members notified one month in advance.
VINTON — Richard E. Bullock, President, 203 S. Market St.,
McArthur; David Caul, Secretary, 107 W. Main St., McArthur.
Called meetings.
Tenth District
Councilor: Richard L. Fulton, Columbus 43212
1211 Dublin Rd.
DELAWARE — Robert S. Caulkins, President, 265 West Lincoln
Avenue, Delaware; Tennyson Williams, Secretary, Box 266,
Delaware. 3rd Tuesday at 6:30 P.M., monthly.
FAYETTE — R. D. Woodmansee, President, 403 East Market
Street, Washington C. H. 43160 ; M. H. Roszmann, Secretary,
1005 East Temple Street, Washington C. H. 43160. 2nd
Friday monthly
FRANKLIN — Joseph A. Bonta, President, 3100 Olentangy River
Road, Columbus 43202 ; Mr. W. “Bill” Webb, Jr., Executive
Secretary, 79 East State Street, Room 601, Columbus 43215.
3rd Tuesday monthly.
KNOX — Richard L. Smythe, President, Medical Arts Building,
Mt. Vernon ; Robert E. Sooy, Secretary, 426 Wooster Road,
Mt. Vernon.
MADISON — Sol Maggied, President, 15 East Pearl Street, West
Jefferson 43162 ; Michael Meftah, Secretary, 11 East 2nd
Street, London 43140. 1st Wednesday monthly.
MORROW — Francis W. Kubb, President, 140 North Main, Mt.
Gilead 43338 ; William S. Deffinger, Secretary, Box 8, Marengo
43334. 1st Tuesday monthly.
PICKAWAY — V. D. Kerns, President, 143 E. Main Street,
Circleville 43113 ; Carlos Alvarez, Secretary, 147 Pinckney
Street, Circleville 43113. 1st Friday evening monthly, except
months of July and August.
ROSS — Joseph McKell, President, 174 W. Main Street, Chilli-
cothe 45601 ; Lowell O. Smith, Secretary, 217 Delano Avenue,
Chillicothe 45602. 1st Thursday evening monthly.
UNION — Malcolm Maclvor, President, 110 N. Court St.,
Marysville; May B. Zaugg, Secretary, 130 N. Maple St.,
Marysville. 1st Tuesday of February, April, October and
December.
Eleventh District
Councilor : William R. Schultz, Wooster 44691
1749 Cleveland Road
ASHLAND — Henry C. Chalfant, President, 309 Arthur Street,
Ashland 44805 ; H. W. Smith, Secretary, 414 Samaritan Ave-
nue, Ashland 44805. 1st Thursday monthly.
ERIE — Clinton F. Lavender, President, 1218 Cleveland Road,
Sandusky 44870 ; R. D. Gillette, Secretary, P. O. Box 127,
Huron 44839. Alternate Tuesday and Thursday monthly.
HOLMES — Charles H. Hart, President, 109 South Clay Street,
Millersburg 44654 ; William A. Powell, Secretary, 8 West
Adams Street, Millersburg 44654. Monthly meeting date to
be determined later.
HURON — W. R. Graham, President, 15 Main Street, Wakeman
44889 ; E. R. McLoney, Secretary, 257 Benedict Avenue, Nor-
walk 44857. 2nd Wednesday of February, April, June, Au-
gust, October, and December.
LORAIN — Joseph A. Cicerrella, President, 209 6th Street, Lorain
44052 ; Mrs. Gladys Davidson, Executive Secretary, 428 West
Avenue, Elyria 44035. 2nd Tuesday monthly except June,
July and August.
MEDINA — Myrl A. Nafziger, President, Albrecht Building,
Wadsworth 44281 ; Mr. A. Dana Whipple, Executive Secretary,
320 East Liberty Street, Medina, Ohio 44256. 3rd Thursday
monthly.
RICHLAND — C. J. Shamess, President, 74 Wood Street, Mans-
field 44903 ; Harold F. Mills, Secretary, 70 Madison Road,
Mansfield 44905. 3rd Thursday monthly except June, July and
August.
WAYNE — Howard MacMillan, President, 1740 Cleveland Road,
Wooster 44691 ; R. J. Watkins, Secretary, 1736 Beall Avenue,
Wooster 44691. 2nd Wednesday monthly, January, February,
April, September, November and December.
188
The Ohio State Medical Journal
Poison Information Centers in
Ohio
These centers have agreed to cooperate in a program to extend their services to any physician
requesting information from them. When a center is called the physician should have four basic
facts in mind (1) The full name or brand of the product ingested or
inhaled; (2) an accurate
estimation of the
amount of the particular agent ingested; (3) The time of ingestion; (4) The
age and weight of the patient.
Location
Facility
Telephone
Akron
Children’s Hospital
W. Bowery and W. Bechtel
BL 3-5531, Ext. 246
Cincinnati
The Academy of Medicine of Cincinnati
320 Broadway
PA 1-2345
Cleveland
Cleveland Academy of Medicine
10525 Carnegie Ave.
CE 1-4455
Columbus
Children’s Hospital
561 S. 17th St.
CL. 8-9783
Dayton
Poison Information Office
253-7111 Ext. 78335
United States Air Force Hospital
Wright-Patterson Air Force Base, Ohio
Mansfield
Mansfield General Hospital
LA 2-3411, Ext. 248
335 Glessner Ave.
-
Springfield
City Hospital
E. High St. and Burnett Rd.
FA 3-5531, Ext. 226
Toledo
Maumee Valley Hospital
2025 Arlington Ave.
EV 2-3435
Youngstown
Emergency Room Dept.
St. Elizabeth Hospital
1 0 44 Belmont Street
RI 6-7231, Ext. 220
Changed Your Address? If So. Send the New One to Us Promptly
If you have moved, you will want The journal and other OSMA mail sent to
your new address. Please complete the coupon and mail it to us immediately since it
takes several weeks to have new stencils made for the mailing list.
The Ohio State Medical Association
79 E. State Street, Room 1005
Columbus, Ohio 43215
Notice of Change of Address
NAME (print)
OFFICE ADDRESS
Street City
TELEPHONE
HOME ADDRESS
Street City
TELEPHONE
SEND MAIL TO Q Office address Q Home address
Zip code
Zip code
for February, 196b
189
Table of Contents
( Continued From Page 91)
Page
9 6 Life Insurance Research Fund Helps Projects
in Ohio
96 Current Comments in the Field of the Drug
Manufacturers
102 "Sponsored Funds’’ Putting Strain on Medical
School Finances
104 Ohio State Medical Journal Is Circulated
Abroad
117 Ohio Workmen’s Compensation Actuarial
Report
117 Drug Company Takes Steps To Keep Damaged
Products Off Market
117 What To Write For
158 Deadline for Submission of Resolutions for
OSMA Annual Meeting
158 Western Reserve Project Applies Smear Test
to Dental Patients
158 One in Ten Ohio Automobiles Found Unsafe
164 New Provisions in OSMA Bylaws Pertaining
to Nomination of President-Elect
169 Ohio Licensed Practical Nurses Announce New
Organization
169 Venerable Medical Board Secretary Retires
after 48- Year Record
171 Canton Physician Named to State Medical Board
171 VA Policy Regarding Treatment of Certain GIs
172 Obituaries
175 Activities of County Medical Societies
180 Woman’s Auxiliary Highlights
180 Roster of Woman’s Auxiliary State Officers
184 Diseases of the Colon, One of OSU Courses
184 Carroll County Medical Society Announces
Medical Seminar
184 Medical Ethics Essay Contest Open to Medical
Students
184 New Members of the Association
186 Roster of State Association Officers and
Committeemen
187 Roster of County Medical Society Officers and
Meeting Dates
189 Poison Information Centers in Ohio
189 Change-of- Address Coupon
190 The Journal’s Advertisers in This Issue
191 Classified Advertisements
JOURNAL ADVERTISERS
Advertisers in The Journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The Journal,
and help make it a quality publication. In return we
place their messages on the desks of Ohio’s physicians.
Please familiarize yourself with their services and pro-
ducts, and let them know that you see their advertising
in The Journal.
In This Issue :
Abbott Laboratories 107-108-109-110,
113-114-115-116
Allergy Laboratories of Ohio, Inc 95, 181
Ames Company, Inc Inside Back Cover
Appalachian Hall 100
Blessings, Inc 173
The Brown Pharmaceutical Co 179
Burroughs Wellcome & Co. (U.S.A.) Inc Ill
Chicago Medical Society 181
The Coca-Cola Company 100
Dairy Councils of Cleveland, Columbus
and Stark County District 123
Daniels-Head & Associates, Inc 182
Endo Laboratories Inc 122
Hynson, Westcott & Dunning, Inc 89
Lederle Laboratories, A Division of
American Cyanamid Company 92-93, 105
Lilly, Eli, and Company 124
The Medical Protective Company 179
Parke, Davis & Company Inside Front Cover
Pharmaceutical Manufacturers Association .... 185
Philips Roxane Laboratories 119-120
Robins, A. H., Company, Inc 97-98-99
Roche Laboratories, Division of
Hoffmann-La Roche Inc Back Cover
Roerig, J. B., and Company
Division, Chas. Pfizer & Co., Inc 157
Sanborn Division, Hewlett-
Packard Company 177
Searle, G. D., & Company 148-149
Smith Kline & French Laboratories 101
Turner & Shepard, Inc 178
Tutag, S. J., & Co 192
The Upjohn Company 166-167
The Vale Chemical Company, Inc 106
Wallace Laboratories 102-103, 183
Warner-Chilcott Laboratories, Division of War-
ner-Lambert Pharmaceutical Company 152-153
The Wendt-Bristol Company 176
Windsor Hosopital 175
Winthrop Laboratories 90
190
The Ohio State Medical Journal
OHIO STATE MEDICAL
journal
VOL. 62 MARCH, 1966 NO. 3 g
OSMA OFFICERS g§
President H
Henry A. Crawford, M. D. g
1058 Hanna Bldg., Cleveland 44115 g
President-Elect =
Lawrence C. Meredith, M. D. g
205 Elyria Block, Elyria 44035 ^
Past-President
Robert E. Tschantz, M. D. g
515 Third St., N. W., Canton 44703 g
T reasurer
I'd h ip B. Hardymon, M. D. g
350 E. Broad St., Columbus 43215 g
EDITORIAL STAFF
Editor ---
Perry R. Ayres, M. D. g
Managing Editor and g
Business Manager g
Hart F. Page g
Executive Editor and g
Executive Business Manager g
R. Gordon Moore g
OSMA EXECUTIVE STAFF jj
Executive Secretary §jf
Hart F. Page H
Director of Public Relations and g
Assistant Executive Secretary g
Charles W. Edgar g
Administrative Assistants g
W. Michael Traphagan g
Herbert E. Gillen H
Address All Correspondence: j|=
The Ohio State Medical Journal 1§
79 E. State Street g
Columbus, Ohio 43215 H
Published monthly under the direction of The §|§
Council for and by members of The Ohio State
Medical Association, 79 E. State Street, Columbus,
Ohio 43215, a scientific society, nonprofit organi-
zation, with a definite membership for scientific IH
and educational purposes. i=
Subscription, $6.00 per year to non-members;
single copy, 50 cents (outside Continental U.S., =
$7.50 and 75 cents). ss
Entered as second class matter July 5, 1905, at Ip
the Postoffice at Columbus, Ohio, under the Act m
of Congress of March 3, 1879; Acceptance for
mailing at special rate of postage provided for in
Section 1103, Act of Oct. 3, 1917. Authority =
July 10, 1918. g
The Journal does not assume responsibility for
opinions expressed by the essayists. Advertisers ~
must conform to policies and regulations estab- hh
lished by The Council of the Ohio State Medical =
Association. =
Table of Contents
Page Scientific Section
225 Carcinomatous Neuromyopathies. A Review of Neuro-
logical Syndromes Associated with Malignant
Neoplasms and Unrelated to Metastases. Timothy
Fleming, M. D., Cincinnati.
232 Supportive Psychotherapy. Harrison S. Evans, M. D., Los
Angeles, California.
236 Experimental Pulmonary Embolism. A Study of Serum
Lactic Dehydrogenase Levels. William Bogedain,
M. D., John Carpathios, M. D., Canton; Paoli Zerbi,
M. D., New York, N. Y.; Do Van Suu, M. D., and
Teh Cheng Huang, Ph. D., D. V. M., Canton, Ohio.
238 Pulmonary Hodgkin’s Disease with Cavitary Lesions.
Hema Gopinathan, M. D., and Lee R. Sataline, M. D.,
Lakewood.
242 A Clinicopathological Conference from The Ohio State
University Hospital, Columbus, Ohio.
247 Maternal Health in Ohio: Adequate Prenatal Care. "Be
Good to Mother Before Baby Is Born.” Anthony
Ruppersberg, Jr., M. D.
199 Letter To The Editor. (On Mustard and Heart Disease)
212 The Historian’s Notebook: Levi Rogers. Frontier Doc-
tor, Pastor, and Statesman. (Part II.) Phillips F.
Greene, M. D., New Richmond.
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
News and Organization Section
249 Utilization Review' Under Medicare
254 Medicare Intermediaries in Ohio Named
255 Preview of Practice — OSMA Lectures to Medical
Students
257 "Care of the Patient: 1966,” OSMA Annual Meeting
Theme
259 OMPAC Membership Now 2,228
261 Deadline for Submission of Resolutions for OSMA
Annual Meeting
273 Hotel Reservation Form for OSMA Annual Meeting
(Continued on Page 278)
STONEMAN PRESS, COLUMBUS , OHIO
[PRINTED 1
IN U S A-J
Blueprint for dealing with tension due to stress — Prolixin — once-a-day
For the patient who must be on the job mentally as well as physically, prescribe
Prolixin. The prolonged tranquilizing action of as little as one or two mg. helps
him cope with tension all day long. Markedly low in toxicity and virtually free
from usual sedative effects, Prolixin is effective in controlling both anxiety
associated with somatic disorders and anxiety due to environmental
or emotional stress. Patient acceptance is good — because Prolixin
is low in cost, low in dosage and low in sedative activity. Prescribe
Prolixin.
Side Effects, Precautions, Contraindications: As used for anxiety and tension, side
effects are unlikely. Reversible extrapyramidal reactions may develop occasionally. In
higher doses for psychotic disorders, patients may experience excessive drowsiness, visual
blurring, dizziness, insomnia (rare), allergic skin reactions, nausea, anorexia, salivation,
edema, perspiration, dry mouth, polyuria, hypotension. Jaundice has been exceedingly rare.
Photosensitivity has not been reported. Blood dyscrasias occur with phenothiazines; routine
blood counts are recommended. If symptoms of upper respiratory infection occur, discon-
tinue the drug and institute appropriate treatment. Do not use epinephrine for hypotension
which may appear in patients on large doses undergoing surgery. Effects of atropine may
be potentiated. Do not use with high doses of hypnotics or in patients with subcortical
brain damage. Use cautiously in convulsive disorders. Available: 1 mg. tablets. Bottles of
50 and 500. For full information, see Product Brief.
Squibb
Squibb Quality -the Priceless Ingredient
196
The Ohio State Medical Journal
ORAL
Photoprotective Agent
Trisoralerr Tablets
TRIOXSALEN — ELDER
before— Normal epidermis after— Epidermis follow-
before Trisoralen therapy ing Trisoralen therapy
• Provides added epidermal dimensions of protection for
light sensitive skin. Enhances pigmentation in vitiligo.
• Develops compact adherent melanin-saturated stratum
corneum.
• Thickens stratum corneum, stratum lucidum,13 and
Malpighian layers.
• Increases melanin concentration with retention in epi-
dermal layers.
• Six times the LD50 of methoxsalen— only half the dosage
of methoxsalen, due to 2X activity.
• No liver function test required.
CONTRAINDICATIONS: Diseases associated with photo-
sensitivity, such as porphyria, acute lupus erythema-
tosus, or leukoderma of infectious origin.
To date, the safety of this drug in young persons
(12 and under), has not been established and is, there-
fore, contraindicated.
DOSAGE: Adults and children over 12 years: two tablets
daily as directed in brochure.
SUPPLIED: Bottles of 28 and 100 coated tablets. Also
available: Oxsoralen Lotion when the natural botanical
is preferred.
References: (1) Becker. Jr., S. W.: J.A.M.A. 173:
1483-1485. 1960: (2) Pathak, M. A., and Fitzpatrick,
T. B.: J. Investig. Dercnat. 32:509-518. 1959: (3)
Pathak, M. A., Feilman, J. H., and Kautman,
K. D.: 33:165-183, 1960.
Write for literature and clinical supply of Trisoralen
PAUL B. ELDER COMPANY • Bryan, Ohio.
Letter To The Editor
December 22, 1965
Dr. Perry R. Ayres, Editor
The Ohio State Medical Journal
79 East State Street
Columbus, Ohio 43215
Dear Dr. Ayres:
The article by Dr. Jackson Blair [ Ohio State Med.
J., 61:732-734 (August) 1965] presents an interest-
ing hypothesis which relates coronary disease with
the ingestion of mustard. This hypothesis is based on
uncontrolled observations in a series of patients, a
laboratory study which showed the development of
statistically significant hypertension in rats maintained
on a mustard diet, and an unsubstantiated statement
reported in an abstract which relates hypertension in
rats with allyl isothiocyanate, a component of mustard.
Black mustard, Brassica nigra, contains a glucoside
which yields allyl isothiocyanate on hydrolysis. Guen-
ther (The Essential Oils, Vol. II, New York: Van
Nostrand, 1949, pp. 734-737, 742) states that this
pungent oil is widely used as flavoring in mustards
and table sauces. White mustard, Brassica alba, con-
tains a glycoside which yields p-hydroxy benzyl isothi-
ocyanate on hydrolysis. Both the volatile allyl isothi-
ocyanate and the non-volatile p-hydroxy benzyl isothi-
ocyanate are vesicants (Guenther).
A detailed evaluation of the methods, data, and
reasoning contained in the article by Dr. Blair will
not contribute to the verification or rejection of the
hypothesis. The individual scientist must decide
whether the data are sufficient to support a reason-
able hypothesis. If the hypothesis is reasonable it
can be verified by repeating the experiments, confirm-
ing the observations, and completing a detailed labor-
atory investigation. It is apparent that Dr. Blair
wrote this article in the hope that it would stimulate
further study. I am convinced that further study
would be stimulated most effectively by additional
laboratory data.
Sincerely yours,
( Signed ) David G. Cornwell
Professor and Chairman
Department of Physiological Chemistry
The Ohio State University
Editor’s Note: This letter of evaluation was
written by Dr. Cornwell at our request. — P.R.A.
The success of immunization against poliomyelitis
is reflected in the extremely low number of deaths
and cases reported in 1965. Only about 60 cases
were reported in the United States during the year.
This compares with nearly 29,000 cases reported in
1955, about the time that the Salk vaccine was in-
troduced. — Metropolitan Life.
for March, 1966
199
ili:
This tablet has
earned “ . . the
greatest clinical
acceptance" of
any long-acting
coronary
vasodilator
Medical Executive of Long Standing
In the Columbus Area Dies
Stanley R. Mauck, former executive secretary of the
Academy of Medicine of Columbus and Franklin
County and founder of the Columbus Bureau of
Medical Economics, died on February 5 at the age
of 72.
Mr. Mauck was executive secretary of the Colum-
bus Academy, on a part-time basis, from 1935 to
1957, and during much of that time was also part-
time executive secretary for the Columbus Dental So-
ciety. In 1935 also he estab-
lished the Columbus Bureau
of Medical Economics, and
in 1948 organized the Cen-
tral Answering Service, Inc.,
in Columbus.
His community services
included memberships in the
following organizations and
groups: Family and Chil-
dren’s Bureau, of which he
was a past-president; Com-
munity Chest budget com-
mittee; board of the District
Nurses Association; board of the Columbus Goodwill
Industries, of which he was past-president; board of
trustees of the Better Business Bureau of Columbus;
and the board of directors of Ohio Medical Idem-
nity, Inc.
Mr. Mauck was born in Point Pleasant, W. Va.,
and was brought by his family to Ohio at the age of
3. He graduated from Gallipolis High School and
received his B. A. degree from Ohio Wesleyan Uni-
versity, class of 1916. The next year he received
an M. A. degree from Harvard University. During
World War I, he served in the Infantry and attained
the rank of captain.
Business affiliations before he entered medical or-
ganization work were with the Goodyear Tire and
Rubber Company and the Firestone Tire and Rubber
Company.
An active church member, he served in a number
of offices at North Broadway Methodist Church and
as a lay delegate to church conferences. He was a
member of the Rotary Club, University Club, several
Masonic bodies, the National Alumni Association
of Ohio Wesleyan University and the Ohio Wesleyan
board of trustees, Beta Theta Pi and Omicron Delta
Kappa.
He was a member of the Columbus area Chamber
of Commerce, member and past-president of the Na-
tional Association of Medical-Dental-Hospital Bu-
reaus of America, also former interim executive
secretary and editor of the association’s magazine,
charter member of the National Association of Tele-
phone Answering Services, and author of its con-
stitution and bylaws, member of the National Society
of Professional Business Consultants.
In 1920, Mr. Mauck married Helen McKay, who
survives, with two sons, Robert S. Mauck, also af-
filiated with the Medical Bureau, and the Rev. Don-
ald M. Mauck, D. D., associated with the Methodist
Theological School of Ohio in Delaware; also six
grandchildren.
State Medical Board of Ohio
Issues Annual Report
The State Board of Ohio annual report for 1965,
submitted to the Governor, shows the following
information:
Four regular meetings, four called meetings, and
two special meetings were held. Examinations were
conducted in Columbus, June 17-19 and December
16-18.
By examination, 363 graduates in medicine were
issued certificates to practice. Sixty-seven osteopathic
applicants were successful and were issued certificates
to practice osteopathic medicine and surgery. Seventy-
one limited practitioners were awarded certificates to
practice in the limited fields. Twenty-four chiropo-
dists (podiatrists) were also issued certificates to prac-
tice in their branch. There were 15 physical ther-
apists licensed by examination during the year.
By endorsement, the Board issued certificates to
practice to 524 medical applicants who had qualified
in other states. Eight applicants also qualified by
endorsement for the practice of osteopathic medicine
and surgery, and 50 physical therapists were issued
certificates by endorsement.
The entrance examiner issued 1040 certificates of
preliminary education to medical and osteopathic ap-
plicants and 130 certificates to limited practitioners.
Hearings for violation of the law were held in 41
cases of licensed practitioners. Hearings were post-
poned to a later date for four doctors of medicine,
one osteopathic physician, and two limited practi-
tioners.
Placed on probation and requested to report again
were three doctors of medicine, one osteopathic physi-
cian and one limited practitioner. Three doctors of
medicine were discharged from probation.
Under the legal requirement for yearly renewal of
osteopathic licenses, 1353 renewals were issued, and
104 reinstatements made. Renewals of chiropodists’
licenses number 615, with 56 reinstatements. Physi-
cal therapy renewals numbered 565.
Investigators for the Board made 2854 calls and
investigated 317 cases in 60 counties during the year.
The Southwestern Ohio Society of Family Physi-
cians, in collaboration with the University of Cin-
cinnati, presented a seminar on "Forensic Medicine’’
on February 10.
for March, 1966
203
The older
patient
needs a
special laxative
The geriatric patient is notoriously
prone to constipation— and to an
atonic, 'tired' bowel □ Inadequate
nutrition, chronic diseases,
repeated use of cathartics, plus
the aging process itself all
interfere with the physiology of
elimination.
“ Few of the standard laxative agents,
whether long used or recently introduced,
exert fully corrective action on underlying
physiological defects that may be present.”*
1/1
204
The Ohio State Medical Journal
IN DICATIONS: moderate hypertension;
labile hypertension, particularly when
accompanied by tachycardia or neuro-
sis; and as adjunctive therapy to the
more powerful hypotensive drugs in
severe hypertension.
DOSAGE: The initial dosage of SER-
PATE® (reserpine) is 0.5 mg. to 1.0 mg.
in divided doses daily. Initial dosage
should not be continued more than
one week. After one week, the recom-
mended daily dosage is 0.1 mg. to 0.25
mg. An occasional patient will require
a maintenance dose of 0.5 mg., but if
adequate response is not obtained
from this dosage it is well to consider
adding another hypotensive agent
rather than increase the dosage.
Reserpine action is cumulative and
maximum response may not be ob-
served until several days to two weeks
elapse after therapy is initiated. Slight
residual effects may persist for several
weeks after discontinuation of therapy.
Important: Use SERPATE® (reserpine)
with caution in patients with history of
mental depression, peptic ulcer, or
ulcerative colitis. Members of patient’s
family should be alerted to watch for
and report any symptoms of mental
depression.
WARNING: Anesthetics have been
found to increase the hypotensive
effect of reserpine. Caution should be
taken to withdraw patients from
SERPATE® (reserpine) two weeks prior
to administering anesthetics or to
elective surgery. Use with caution in
gravid patients. Reserpine passes the
placental barrier and may affect the
newborn.
moja
is the number one , first drug
for moderate hypertension
As a first step:
SERPATE® (Reserpine) exerts a gradual, sustained reduction of
blood pressure
SERPATE® (Reserpine) relieves anxiety and tension in hypertensive
patients with low resistance to everyday crises
SERPATE® (Reserpine) is modestly priced
SERPATE® (Reserpine) in low oral dosage is characterized by a
minimum of serious reactions and low-yield side effects — thus, it
may be used with comparative assurance
SERPATE®(Reserpine) combines readily with more potent anti-
hypertensives for patients exhibiting severe hypertension
Physician samples and technical data sent on request
"T\ /'
(Supplied in doses of 0.1 mg. white tablets BVALE]
and 0.25 mg. yellow tablets)
THE VALE CHEMICAL CO., INC.
PHARMACEUTICALS • ALLENTOWN, PENNSYLVANIA
in any language
serpate
(RESERPINE)
for March , 1966
209
M. D.’s in the News
Dr. John A. Prior, associate dean of the Ohio State
University College of Medicine, spoke at the annual
staff dinner meeting of the St. Luke’s Hospital in
Toledo, where he discussed the changing approach to
medical school curricula and the problems facing
modern medical education.
sfc
Dr. Jack Schreiber, Canfield, was guest speaker at
a meeting of the Massillon American Education Coun-
cil. He discussed the encroachment of increasing
governmental programs into the American way of
life.
* * *
Dr. Clyde W. Muter, was elected president of the
Warren Board of Education.
* * *
Dr. Franklin C. Hugenberger spoke to the Colum-
bus Downtown Sertoma Club’s Ladies Day Meeting.
He discussed his recent Caribbean voyage.
* * *
Dr. Lester G. Parker, Sandusky, was speaker for
the Sandusky Area Industrial Management Club, on
the topic "Prophylectic Health Measures and Related
Problems.”
^ ^
Dr. C. Joseph Cross discussed the heart and heart
disease at a meeting sponsored by the Junior and
Senior Leagues of the First Lutheran Church in
Columbus.
* * *
Dr. David W. Sprague discussed "Emotional Prob-
lems,” especially those related to retirement, at a
meeting of the Lakewood Women’s Club.
5fC jjj
"Causes and Types of Mental Retardation” was the
topic discussed by Dr. Robert D. Mercer, Cleveland,
at a meeting in Mansfield sponsored by the Richland
County Association for Mentally Retarded.
sjs :jc
Three physicians participated in a public forum on
"Emotional Problems of Everyday Life,” sponsored
by the Jewish Community Center and Mt. Sinai Hos-
pital in Cleveland. Speakers were Dr. Benjamin Ber-
ger, Dr. Ernest Friedman, and Dr. Alvin Sutker.
^
"The Heart of the Executive” was the theme of
the Central Ohio Heart Association meeting in
Columbus. Keynote speaker was Dr. Eugene Z.
Hirsch, research physician in radioisotope service at
the Veterans Administration Hospital in Cleveland.
sfc
As president of the East Central Ohio Heart As-
sociation, Dr. Igor Nikishin, Canton, delivered the
kick-off address for the Tuscarawas County Heart
Association fund-raising campaign.
210
DEPROL
meprobamate 400 mg. +
benactyzine hydrochloride 1 mg.
Indications: ‘Deprcl’ is useful in the manage-
ment of depression, both acute (reactive) and
chronic. It is particularly useful in the less
severe depressions and where the depression is
accompanied by anxiety, insomnia, agitation,
or rumination. It is also useful for management
of depression and associated anxiety accom-
panying or related to organic illnesses.
Contraindications: Benactyzine hydrochloride
is contraindicated in glaucoma. Previous aller-
gic or idiosyncratic reactions to meprobamate
contraindicate subsequent use.
Precautions: Meprobamate— Careful super-
vision of dose and amounts prescribed is
advised. Consider possibility of dependence,
particularly in patients with history of drug or
alcohol addiction; withdraw gradually after use
for weeks or months at excessive dosage. Abrupt
withdrawal may precipitate recurrence of pre-
existing symptoms, or withdrawal reactions in-
cluding, rarely, epileptiform seizures. Should
meprobamate cause drowsiness or visual dis-
turbances, the dose should be reduced and
operation of motor vehicles or machinery or
other activity requiring alertness should be
avoided if these symptoms are present. Effects
of excessive alcohol may possibly be increased
by meprobamate. Grand mal seizures may be
precipitated in persons suffering from both
grand and petit mal. Prescribe cautiously and
in small quantities to patients with suicidal
tendencies.
Side effects: Side effects associated with recom-
mended doses of ‘Deprol’ have been infrequent
and usually easily controlled. These have in-
cluded drowsiness and occasional dizziness,
headache, infrequent skin rash, dryness of
mouth, gastrointestinal symptoms, paresthesias,
rare instances of syncope, and one case each of
severe nervousness, loss of power of concen-
tration, and withdrawal reaction (status epilep-
ticus) after sudden discontinuation of excessive
dosage.
Benactyzine hydrochloride— Benactyzine
hydrochloride, particularly in high dosage, may
produce dizziness, thought-blocking, a sense of
depersonalization, aggravation of anxiety or
disturbance of sleep patterns, and a subjective
feeling of muscle relaxation, as well as anti-
cholinergic effects such as blurred vision, dry-
ness of mouth, or failure of visual accommoda-
tion. Other reported side effects have included
gastric distress, allergic response, ataxia, and
euphoria.
Meprobamate— Drowsiness may occur and,
rarely, ataxia, usually controlled by decreasing
the dose. Allergic or idiosyncratic reactions are
rare, generally developing after one to four
doses. Mild reactions are characterized by an
urticarial or erythematous, maculopapular rash.
Acute nonthrombocytopenic purpura with pe-
ripheral edema and fever, transient leukopenia,
and a single case of fatal bullous dermatitis
after administration of meprobamate and pred-
nisolone have been reported. More severe and
very rare cases of hypersensitivity may produce
fever, chills, fainting spells, angioneurotic
edema, bronchial spasms, hypotensive crises (1
fatal case), anuria, anaphylaxis, stomatitis and
proctitis. Treatment should be symptomatic in
such cases, and the drug should not be reinsti-
tuted. Isolated cases of agranulocytosis, throm-
bocytopenic purpura, and a single fatal instance
of aplastic anemia have been reported, but only
when other drugs known to elicit these con-
ditions were given concomitantly. Fast EEG
activity has been reported, usually after exces-
sive meprobamate dosage. Suicidal attempts
may produce lethargy, stupor, ataxia, coma,
shock, vasomotor and respiratory collapse.
Dosage: Usual starting dose, one tablet three or
four times daily. May be increased gradually
to six tablets daily and gradually reduced to
maintenance levels upon establishment of relief.
Doses above six tablets daily are not recom-
mended even though higher doses have been
used by some clinicians to control depression
and in chronic psychotic patients.
Supplied: Light-pink, scored tablets, each con-
taining meprobamate 400 mg. and benactyzine
hydrochloride 1 mg.
Before prescribing, consult package circular.
Wallace Laboratories / Cranbury, N. J.
CD-6405
A NX
The Historian’s Notebook
Levi Rogers
Frontier Doctor, Pastor and Statesman
PHILLIPS F. GREENE, M. D.*
PART II
( Continued from February Issue )
EVI ROGERS soon convinced himself that its cen-
tral location made Franklin County the better
^ site for Ohio’s permanent seat of government
and worked for that location. It turned into a touch-
and-go legislative battle. The Chillicothe group was
strong and very alert. Their bill came up the first time
in the Tenth Session in the Senate on December 12,
1811. The vote was tied 11-11.
Early in February 1812, four able, far-sighted men
from Franklin County came to Zanesville with a free
offer of 100 acres of suitable land plus an offer to
build a capitol, a government office building, and a
prison if their offer were accepted for the permanent
seat of government. The Senate accepted this offer
February 14, 1812, by a vote of 17-7, first reading
and appointed Joel Wright of Warren County as
director. [When I read this far in the Senate Journal,
I in my simple ignorance, thought the matter settled.]
However, in the next few days, three times amend-
ments were offered which would have substituted
Chillicothe. When these failed to pass, the Chilli-
cothe party strategy shifted. Their first suggestion was
to postpone the bill for one year. This brought a
tie vote, 12-12. The next was a request that U. S.
Military lands be used, (lost 10-14); then that Chil-
licothe be made the temporary seat (lost 11-13); still
another similar amendment the same day failed 9T6.
Levi Rogers, who had been closely following every
move, sensed that the opinion of the Senate was
beginning to crystalize against the blocking tactics
from Ross County. He jumped to his feet and called
for the third reading of the bill. It passed 17-5. The
next day when the final question was asked, "Shall
this bill pass?” it was carried 13-11- On February
19, 1812 the four proprietors signed their bond to
build the capitol.
On February 21st, the last day of the session, Levi
Rogers rose in the Senate and proposed that "the
land opposite Franklinton selected for the permanent
*Dr. Greene, New Richmond, is a member of the staff, Brown
County Hospital at Georgetown; Yale in China, emeritus Professor
of Surgery.
Submitted February 3, 1965.
seat of government be named Columbus.” His
motion passed without a roll call. Some history books
tell us that the name Columbus was originally put
forward by Gen. Joseph Foos of Franklinton.3 Per-
haps Senator Rogers was following his suggestion.
Medical Legislation
Bancroft in writing of Levi Rogers as a State Sen-
ator only mentions the first Ohio laws regulating
the practice of medicine. He credits Rogers with
writing and securing their passage and considers these
laws a lasting monument to the good doctor. There
is ample evidence that Rogers played an active part
in drafting and passing the medical bills of 1812 and
1813.
The first mention of a bill in Ohio To Regulate
the Practice of Medicine occurs in the House Journal
of the Eighth General Assembly stating that a medi-
cal bill is being held over to the Ninth Session. Early
in the Ninth Assembly, Dr. Samuel P. Hildreth was
appointed chairman of a House committee to pick
up this medical bill, and eventually it did become
the first law regulating the "Practice of Physic and
Surgery” for Ohio. Effective January 14, 1811, the
law set up five medical licensing districts, each one
corresponding roughly with the five historical settle-
ment areas, each with its own local board of doctors,
each board setting its own standards. There seems
to have been much dissatisfaction with this effort.
So, in the Tenth Assembly, the House set up a
new committee to improve the bill. This committee
ended up by bringing in a substitute bill entitled
"An Act to Incorporate a Medical Society.” This
was in line with the precedent first set by Massachu-
setts, of delegating the responsibility of medical li-
censing to a state medical society. On receiving this
bill from the House, the Senate appointed a commit-
tee of three of whom Levi Rogers was the second
man named, to study it. He was well aware that
Ohio at that time contained more quacks than doc-
tors and he was eager to see the people protected.
He considered that medical societies in the older
212
The Ohio State Medical Journal
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BADEfl & SOACK SUPPORTS DIVISION
for March , 1966
213
states were proving helpful but had some question
how well a society could be set up by law instead of
growing up through the efforts of the medical profes-
sion itself.
When this senate committee failed "to make pro-
gress,” it was discharged and this medical bill re-
delegated to an entirely new committee. It was finally
passed February 6, 1812, with Hildreth voting
"nay” and Rogers "yea.” But the War of 1812
blocked its implementation. Of the 21 delegates
elected to organize the Medical Society only five
showed up and, as the law specified the quorum at
ten, no action was taken.
So the Eleventh General Assembly had to tackle
medical legislation again. This time the Senate ap-
pointed a committee with Levi Rogers chairman.
They promptly brought in a bill to "regulate the
Practice of Physic and Surgery” which went through
all the necessary procedures and became law January
19, 1813. It resembled the law of 1811 but had
seven instead of five districts and each district had
seven censors instead of three. It also added a fine
of from $5 to $75 for every offense of practicing
without a license. Any Justice of the Peace was em-
powered to handle such cases.
It would seem from these records that when his-
torian Bancroft writes, "the medical Acts of 1811
and 1812, introduced and passed by him (Levi Rog-
ers) of themselves are a permanent monument of his
ability and zeal as a physician,”4 that he was reflect-
ing the local Clermont County tradition of about
1880, rather than history.
Levi Rogers took his senate responsibilities seri-
ously. According to the Senate Journals for the
Tenth and Eleventh sessions he did not miss a single
roll call. He was chairman of 13 different com-
mittees and served as a member of 11 other com-
mittees. He was a witness against Judge John
Thompson, President of the Court of Common Pleas,
at his trial for impeachment as well as one of the
Senators trying him.
Rogers voted for all bills furthering education and
libraries, for curbing the abuses of liquor, for road
improvements and for better state organization.
Army Surgeon, War of 1812
Sometime in March 1813 Dr. Rogers was called up
for active duty as Surgeon of the 19th regiment, U. S.
Infantry. He was assigned to the contingent under
Col. John Miller which was sent to Ft. Meigs. Gen.
William Henry Harrison was in charge of the ef-
forts to prevent the British from invading from De-
troit and was erecting this fort. By April this camp
also included several companies of Ohio Militia.
Later some Kentucky forces joined them. Dr. Rogers
noted "much colds and some pneumonia.”5
This camp stands on the east bank of the Maumee
River. In late April word came that British Gen-
eral Proctor commanding regulars and Canadian
Volunteers had left Detroit and that thousands of
Indians under Tecumseh were joining him to wipe
out Ft. Meigs. By April 27th the British reconnoit-
ering party was on the west bank watching the Fort.
Soon their full force arrived; 600 British regulars,
veterans from the Napoleonic Wars, 800 Canadian
Volunteers and some 1800 Indians — a total of
3,200 men. The American forces totaled 1,200 of
whom some 200 were sick.
During the next two days British artillery was
placed along the west bank and on May 1st the
bombardment of Ft. Meigs began.
We were not prepared for this. That night all hands
fell to and raised a huge mound of earth running through
the middle of the camp parallel to the river. Two days
later a second shorter mound was raised at right angles
to the first, protecting the men in the fort from batteries
placed north of the camp on the east bank. These traverses
were 17 feet high and sufficiently thick to withstand the
enemy fire. In the one quarter of the camp behind these
earthworks our men found complete shelter.6
May 3rd the Indians attempted to entice an Ameri-
can sally but Gen. Harrison did not budge. On
May 4th General Proctor sent over a demand for the
surrender of the Fort. Harrison sent back, "Take
the Fort if you can. You will gain more honor than
by a thousand surrenders.”7
To destroy the buildup of British forces on the
east bank, Harrison decided to make a surprise at-
tack on the Indian concentration in the woods north
of Ft. Meigs. He ordered Col. Miller to take the
British batteries while this attack was in progress.
The 19th Infantry formed the main body for this
sortie. It was successfully executed the night of the
4th. There were 350 Americans against an estimated
850 British. The American losses were 28 killed
and 125 wounded, — 44 per cent of their force.
The result of this victory exceeded expectation.
Tecumseh, completely fed up with Proctor, made no
move to hold his Indians, who "drifted away in
droves.” General Clay arrived from Kentucky with
reinforcements, some of whom succeeded in getting
into the Fort. By May 9th an epidemic of dysentery
was raging through the British camp. Gen. Proctor
decided to "await a better time” and withdrew.
And Levi Rogers was an active participant in all
this. At the end of the fighting Gen. Harrison re-
ported the American casualties as "81 killed and 189
wounded. None captured.” On May 11th he left
for Chillicothe taking with him all the 19th Infantry
able to travel and leaving Surgeon Rogers to care for
the sick and wounded.
(To Be Concluded in April Issue )
References
1. Everts, L. J.: History of Clermont County, Ohio, Philadel-
phia: J. B. Lippincott Co., 1880, p. 142.
2. Ibid, p. 144.
3. Moore, Opha: History of Franklin County, Ohio, Topeka,
Indiana: Historical Publishing Co., 1930, vol. 1, p. 126.
4. Everts: p. 144.
5. Personal communication from memorandum of Dr. J. G.
Rogers.
6. Bourne, Col. Alexander: Siege of Ft. Meigs, an Eyewitness
Account, Toledo: Northwest Ohio Quarterly. 1840. Vol. 17. p. 149-
7. Averil, J. P.: Siege of Ft. Meigs, Toledo: Toledo Blade
Printing Co., 1886, p.23.
214
The Ohio State Medical Journal
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sions and other clean lesions, abrasions and minor
cuts and wounds.
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measures should be taken if this occurs.
Contraindication: This product is contraindicated
in those individuals who have shown hypersensi-
tivity to any of its components.
Complete literature available on request from
Professional Services Dept. PML.
BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York
for March, 1966
215
Ohioan to Play Leading Role in
ACP New York Meeting
Dr. A. Carlton Ernstene, Cleveland, will play a
leading role as president when the American College
of Physicians holds its 47th annual meeting in New
York City, April 18-22.
Dr. Ernstene will address the college on Monday
morning, April 18, and preside at business meetings
of the organization. He will be honored at the
president’s reception and dinner dance on Thursday
evening.
Advance programs, mailed to physicians, listed five
days of scientific sessions at the Americana and New
York Hilton hotels with presentations by more than
300 medical scientists. Among the highlights will
be award lectures by international experts in the
fields of liver disease, cardiology, cellular replace-
ment, cholera and dietary protein deficiency.
The internists will also hear a report on the present
status of kidney transplantation by Boston surgeon,
Dr. John P. Merrill, and a presentation on drugs and
the public safety by Dr. Joseph F. Sadusk, Jr., Wash-
ington, D. C., medical director of the Food and Drug
Administration.
Information on late developments in the diagnosis
and treatment of diseases will be offered to the spe-
cialists via plenary sessions, panel discussions, special
lectures, closed-circuit television programs, basic-sci-
ence and clinical-investigation presentations. Through-
out the week, the physicians will visit selected
medical facilities in Manhattan.
Additional information may be obtained from the
college at 4200 Pine Street, Philadelphia, Pa. 19104.
Seminar on Premature Care Scheduled
At Cincinnati Good Samaritan
The Good Samaritan Hospital, Cincinnati, Ohio,
has announced the Fourth Annual Seminar on Pre-
mature Care to be held April 21, from 1:00 p. m. to
6:00 p. m. Guest speakers will include Dr. Mary
Engle, associate professor of pediatrics, Cornell Uni-
versity Medical College; Dr. Alvin Zipursky, assistant
professor of paediatrics (haematology), University of
Manitoba, Faculty of Medicine; and Dr. William B.
Richardson, Department of Surgery, Good Samaritan
Hospital.
There are no registration fees but physicians plan-
ning to attend are requested to contact Ernst G.
Rolfes, M. D., Chairman, Seminar on Premature
Care, Good Samaritan Hospital, Cincinnati, Ohio
45220.
Ohio State University has been awarded a HEW
grant of $28,331 to establish the relationship of
maternal health to family solidarity among low in-
come families in 23 Appalachian counties.
Cameron-Miller offers you
255
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216
The Ohio State Medical Journal
“Death to Measles” Article
Poses Lesson in Latin
In the January issue of The Journal, the Ohio State
Medical Association announced the launching of an
educational program to stress the importance of im-
munization against measles.
The initial article on this subject was introduced
with a real eye-catcher — "Mortus a Morbilli.” As
authority for this slogan, The Journal, and all persons
concerned with publication of the article, fell back
to the American Academy of Pediatrics which used
the phrase in its statement on current status of measles
vaccine.
Even before the January issue was fully in circula-
tion, The Journal began to feel reverberations from
this liberty with the classical language. "Fractured
Latin,” wrote one Journal reader. Another doctor
referred to the phrase as "mock Latin” and deplored
the fact that such "trenchant remarks” should be
introduced with "a line of gibberish.” Still another
reader, who chose to remain anonymous, recom-
mended that persons responsible for the "deplorable
errors” might "go back to high school.”
The quotation intended to read "Death to Mea-
sles,” according to a spokesman for the American
Academy of Pediatrics.
And how does one translate "Death to Measles”
into Latin? One scholar did not find the word for
measles in his dictionary of the ancient language.
(Webster gives a Medieval Latin derivation.) This
same scholar would write the slogan as "mars mor-
billibus,” since the preposition "a” is not needed and
the word for measles takes the dative case.
Another scholar agrees that if the word for death
was intended it should be in the form of "mors,”
but he would write the phrase "a morbillis” since
"a” or "ab” is followed by the ablative.
All of which seems to indicate that literal trans-
lations into Latin may be awkward. In its predica-
ment, The Journal appealed to the Department of
Classical Languages at Ohio State University. A
spokesman there agreed that the original phrase was
an "ill-begotten” slogan and complimented those
readers who caught the mistake. "I was delighted
to peruse the various letters of protest written by
physician-Latinists (Latinist-physicians ?) occasioned
by the faulty slogan,” he wrote. "It is gratifying to
know that the average physician’s knowledge of the
Classical Languages goes beyond the hy sterosalpin go-
oophorectomy level.”
The OSU professor declined to give a literal trans-
lation of the phrase. His letter continued as follows :
"The Latin version which I should like to suggest
is Pereant Morbilli! The phrase, literally translated,
means 'May the measles perish!’ Idiomatically (and
I gather that you are primarily interested in good,
idiomatic Latin), the phrase means exactly what you
want: 'Death to Measles!’ ”
So be it ! And — slogan or no slogan — for an ex-
cellent article on immunization against measles, includ-
ing dosage schedules, refer to the January issue of
The Journal, pages 18-19. Pereant Morbilli! — rgm.
Do You Know? . . .
Dr. Charles L. Hudson, Cleveland, President-Elect
of the American Medical Association, opened a panel
discussion on the subject, "Medicare, Panacea or Pit-
full,” sponsored by the Western Reserve University
Adelbert Alumni Association. Robert A. Lang, ex-
ecutive secretary of the Academy of Medicine of
Cleveland, also participated in the panel discussion.
in ^
Dr. Richard L. Meiling, Columbus, dean of the
Ohio State University College of Medicine and di-
rector of University Health Center, was featured
speaker for the 48th annual banquet of the medical
staff at St. Rita’s Hospital in Lima.
H: Hs
Dr. George J. Hamwi, professor of medicine at
Ohio State University College of Medicine, was re-
elected president of the Central Ohio Diabetes As-
sociation at its recent annual meeting.
* * *
Two Ohio physicians were elected to the Board of
Chancellors of the American College of Radiology
at that group’s annual meeting in Chicago. They
are Dr. Benjamin Felson, of Cincinnati, and Dr. Paul
A. Jones, Zanesville.
❖ * *
Dr. James V. Warren, professor and chairman of
medicine in the Ohio State University College of
Medicine, gave the principal address at the Georgia
Heart Association’s annual meeting in Atlanta. He
also was presented a plaque by the association in com-
memoration of the first use of heart catheterization
to diagnose congenital heart disease. Dr. Warren
reported this technique in 1944. His collaborators
were Dr. H. Stephen Weens, chairman of radiology
at Emory University, and Dr. Emmett Brannon, who
is now in practice in Rome, Ga.
* * *
Dr. and Mrs. Max Roy Hickman, Columbus, have
been commissioned missionaries and will join the staff
of the Methodist Hospital at the Nyadiri Mission
Center in Rhodesia. Dr. Hickman has been a resident
in surgery at Riverside Methodist Hospital. Mrs.
Hickman will work in the field of medical technology.
% sH
Dr. William W. Davis, resident of Westerville,
and medical director of North American Aviation
in Columbus, has been promoted to the rank of Brig-
adier General in the U. S. Army Reserve. His mili-
tary assignment is as Commanding General of the
3391st U. S. Army Hospital.
for March, 1966
221
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Carcinomatous Neuromyopathies
A Review of Neurological Syndromes Associated with Malignant
Neoplasms and Unrelated to Metastases
TIMOTHY FLEMING, M. D.
The Author
• Dr. Fleming, Cincinnati, presently is an Intern
at Cincinnati General Hospital.
FOR YEARS it has been known that disorders
of the nervous system and the musculature can
occur in association with malignant tumors of
the viscera, unrelated to the presence of metastases. In
1888 Oppenheim21 reported a case of peripheral
neuritis associated with a malignant tumor and sug-
gested that a toxic process could be incriminated.
Numerous articles appeared on the subject in the early
twentieth century.
In 1948 Denny-Brown6 described in detail the
clinical and histological picture of two cases of sen-
sory neuropathy in patients with carcinoma of the
lung. He felt that the histologic picture resembled
changes associated with pantothenic acid and vitamin
E deficiency in animals. Selective degeneration of the
granular layer of the cerebellum was demonstrated in
patients with visceral carcinoma by Leigh and Meyer
in 1949. 19 In 1950 Lennox and Prichard20 drew at-
tention to peripheral neuropathy occurring in pa-
tients with lung cancer. In 1951 Brain, Daniel, and
Greenfield2 reported four cases of subacute cerebellar
degeneration associated with carcinoma. In 1958
Brain and Henson3 described 42 cases of carcinoma-
tous neuromyopathies. In 1961 Diamond7 reviewed
the literature concerning carcinomatous neuropathy.
The location and the structural involvement of
visceral tumors associated with changes in the nervous
A thesis submitted to the Department of Neurology, University
of Cincinnati College of Medicine, during the author s Junior year
of medical school — 1964.
Submitted for publication July 9, 1965.
system have been found to be fairly constant. Tu-
mors of the lung have long been known to be associ-
ated with deleterious effects on the nervous system.
Lennox and Prichard20 reviewed 299 records of pa-
tients with bronchial carcinoma admitted to the
Hammersmith Hospital, London, during the eight
years from 1939 to 1948, and found five cases with
peripheral neuritis. They also noted that of 11 patients
with whom they were familiar, the left lung alone
was involved. In a group of 1309 patients with
bronchial carcinoma studied at the Bernhard Baron
Institute of Pathology, London, between 1940-1952,
fifteen had neuropathies (1.1 per cent). However,
there were 276 necropsies on patients with lung
carcinoma during the 17 years 1936-1952 and these
included six with neuropathy (2.2 per cent). Five
of these six necropsies were done in 1950 and 195 1.16
This appears to represent a considerable and alarm-
ing increase in frequency of such lesions. Heathfield
and Williams15 reported four cases of peripheral neu-
ropathy and myopathy in the presence of bronchogenic
carcinoma. Charatan and Brierley4 described three
patients with bronchogenic carcinoma all of whom
225
demonstrated profound mental changes without as-
sociated neurological signs. In Brain’s series of 42
patients with carcinomatous neuromyopathies, 32 had
lesions in the lung (males 23, females 9), and 17
of the 19 patients studied by Henson, Russell and
Wilkinson also had lesions in the lung.3’16 It is of
interest that when the clinical picture has been one
of sensory neuropathy or polyneuritis, the accompany-
ing carcinoma, with but few exceptions,8- 23 has been
found in the lung.
A much higher incidence was reported by Croft
and Wilkinson.5 These investigators studied 250
men with carcinoma of the lung and 250 women
with carcinoma of the breast. The incidence of
neuropathy was found to be 16 per cent and 4.4 per
cent, respectively. This study would indicate that
carcinomatous neuropathy is much more frequent than
formerly believed.
A small number of patients have manifested neu-
rological syndromes in association with carcinoma
in regions other than the lung. Thus in Brain’s
series of 42 cases of neuropathy associated with car-
cinoma, four were found with tumors of the ovary,
two were associated with tumors in the prostate, two
involved the rectum (both males), and two mani-
fested tumors of the breast.3 In Henson’s study of
19 cases of neuropathy associated with carcinoma,
one was associated with a tumor of the ovary and
another was associated with a tumor of the breast.16
Both of these latter cases manifested subacute cere-
bellar degeneration. More recently Swan and Whar-
ton23 reported one case of polyneuritis in which
there was strong evidence to suggest that a "clear-
celled” carcinoma of the kidney was the primary
tumor.
The importance of the locations commonly found
to be harboring malignant tumors in association with
various neurological syndromes cannot be overem-
phasized. It can readily be seen that the possibility
of demonstrating a malignant tumor to which ef-
fective therapy can be directed may be greatly en-
hanced by familiarity with the specific neurological
syndromes frequently seen with such lesions and
familiarity with the areas from which they most com-
monly arise. With this goal in mind, it would be of
value to review these neurological syndromes both
from the pathological as well as from the clinical
viewpoint.
Clinical and Pathological Features
Brain and Henson3 found that their series of 42
patients who manifested neurological syndromes in
association with malignant tumors divided them-
selves into five fairly distinct clinical categories.
Eight of their patients manifested primarily cortical
cerebellar degeneration, seven patients demonstrated
mixed neurological forms, sensory neuropathy was
predominant in five patients, peripheral neuropathy
(sensorimotor) was the most frequent syndrome in
five patients, and neuromuscular disorders were pre-
dominant in 17 patients. Although the carcinoma-
tous neuromyopathies are rarely manifested as pure
clinical forms, this grouping will be utilized as a
classification to facilitate the discussion of the clinical
and pathological features which are frequently found.
Cortical Cerebellar Degeneration
As early as 1949, Leigh and Meyer19 found a
curious degeneration of the granular layer of the cere-
bellum in eight patients with visceral carcinoma. In
six of their cases there was a marked reduction in
nerve cells in the inferior olive. Two of the eight
cases, however, manifested secondary deposits in the
cerebrum. One patient’s illness was complicated
by Wernicke’s syndrome, another by Korsakoff’s
psychosis, and a third by oral signs of vitamin B
deficiency.
Brain and Henson3 found a striking loss of Pur-
kinje cells in the cerebellar cortex, one patient having
no demonstrable cells of this type remaining. In
addition to the loss of Purkinje cells there was slight
rarefaction of granule cells, but a remarkable pres-
ervation of the basket cells. Early degeneration of
the direct cerebellar tracts and dorsal columns as
well as lymphocytic cuffing in the cerebellum, med-
ulla, and spinal cord were also seen. Henson, Rus-
sell, and Wilkinson16 noted that the carcinomata
associated with cerebellar disorders in their series
were predominantly in the ovary, lung, breast and
uterus — those in the ovary and lung being the most
frequent (three in the lung, one in the ovary, one in
the breast) . Only one case showed significant degen-
eration of the cerebellar cortex. Two cases exhibited
histologic findings referred to as "subacute cerebellar
degeneration.” These patients manifested degenera-
tion and loss of motor neurons in the spinal cord and
medulla resulting in a picture of a chronic progres-
sive poliomyelitis. A cerebellar element was also
seen, however, with degeneration and loss of cells
of the dentate nucleus, loss of fibers in the cerebellar
peduncles, and degeneration of cells in the cerebellar
cortex in one case.
From the clinical viewpoint, all five of these pa-
tients had a mixed neurological picture. Euphoria
and dementia occurred in three of the five patients,
and mental anguish necessitated prefrontal leukotomy
in another. The mixed neurological picture will be
discussed in detail presently. As reported by Brain
and Henson3 in eight of their patients, the clinical
picture found in cortical cerebellar degeneration was
seen to be severe cerebellar deficit in the limbs, dys-
arthria, diplopia, and nystagmus. Mental changes
were predominant in this group and all but one of
their patients were eventually demented. Extensor
plantar signs were present in some patients and one
had continuous involuntatry movements. It was noted
that the deterioration may be quite rapid and progress
to inability to walk or stand within two weeks, or that
226
The Ohio State Medical Journal
it may take several years to progress to a full clinical
picture.
Mixed Neurological Form
This form of myelopathy associated with carcinoma
has been generally referred to as "subacute spinocere-
bellar degeneration,” although Henson, Russell and
Wilkinson have pointed out the inadequacy of this
term.16 The neoplasm associated with this neurologi-
cal syndrome has been found most commonly in the
lung or breast.13-3 In general its course has been seen
to be more chronic than that of the other neurop-
athies. In 1934 Greenfield13 described two cases
of subacute spinocerebellar degeneration in which
histologic examination revealed degeneration of the
long tracts of the cord, especially the dorsal columns
and cerebellar tracts, with earlier degeneration of the
pyramidal tracts. There was gross loss of Purkinje
cells in the cerebellar cortex. The superior cerebellar
peduncles and the longer tracts of the tegmentum of
the brain stem were involved in one case. The
nucelus of Luys and the strio-Luysial fibers were de-
generated in both cases. There was fairly intense
perivascular infiltration in the region of the degen-
erated tracts. Greenfield found a pleocytosis and an
excess of protein in the cerebrospinal fluid in both
of these cases.
Similar histologic changes were described by Brain
and Henson3 in seven of their cases manifesting clini-
cally a mixed neuropathy. These investigators found
degeneration of the cells of the dentate nucleus as-
sociated with loss of fibers in the superior cerebellar
peduncles. Degeneration of the motor cells in the
spinal cord and brain stem nuclei associated with
degeneration of the pyramidal tracts and posterior
columns in the spinal cord were similar to the changes
described by Greenfield. Cellular infiltration of the
meninges and perivascular cuffing of the vessels of
the spinal cord and the medulla below the floor of the
fourth ventricle were also prominent findings.
As one might imagine from the histologic picture,
the clinical features included muscular wasting and
weakness in many areas of the body. Frequently
there was an extensor plantar response, but the ten-
don reflexes were generally reduced. Involuntary
movements were occasionally prominent, pains and
dysesthesiae in the limbs were often severe, and im-
pairment of postural, vibratory, and occasionally
cutaneous sensation also occurred. Again mental
changes were frequently prominent. The course of
the illness was usually long, extending over two
years, but it was noticed that the symptoms were such
that the patient usually sought medical advice within
a few weeks of onset.
Greenfield’s cases13 also manifested pains in the
limbs and weakness and ataxia of the legs and arms,
dysarthria, and mental enfeeblement. It is of interest
that a small breast tumor had been removed nine
months before the onset of these signs and symptoms
in one patient, and the other patient demonstrated a
bronchogenic carcinoma at autopsy. Greenfield did
not, however, mention that a connection might be
made between the tumors and the neurological
findings.
Peripheral Neuropathies
One of the most widely recognized neurological
manifestations associated with visceral carcinoma has
been that of peripheral neuropathy, either purely
sensory or mixed sensorimotor. In general, the
sensory type has been associated most commonly with
bronchogenic carcinoma, although Dodgson and Hoff-
man8 reported one case associated with carcinoma
of the esophagus. In 1948 Denny-Brown6 eloquently
described the clinical and histological findings in two
patients with sensory neuropathy associated with
bronchogenic carcinoma:
The most remarkable change in the two patients presented
was the severe loss of nerve cells in the dorsal root ganglia,
without corresponding change in the ventral roots.
... In the two cases presented here a number of inter-
mediate changes in the process of disintegration of the
ganglion cells was seen.
. . . The whole process of ganglionic degeneration pre-
sented the appearance of a primary atrophic process of the
nerve cells, without inflammatory or vascular reaction.
. . . In both instances the lumbo-sacral ganglia were the
most heavily affected, but the disorder was widespread.
... In contrast to the ganglionic changes in tabes the
degeneration of the peripheral process of the ganglion cell
was as severe as of the central.
. . . The muscles also presented an unusual type of
change. Proliferation of sarcolemmal nuclei and increased
cellularity of the connective tissue of a kind seen in chronic
myositis, or rapidly progressive myopathy were found in
both cases.
. . . The condition therefore, points to a diffuse degener-
ative process affecting primarily dorsal root ganglion cells,
associated with a degeneration of striped, voluntary, muscle
fibre.
Essentially the same histologic features were found
in five similar cases of sensory neuropathy described
by Brain and Henson.3 In addition, however, they
found an intense lymphocytic infiltration of the pos-
terior root ganglia in association with degeneration
of the peripheral nerves and gross perivascular cuffing
in the medulla in the floor of the fourth ventricle.
Dodgson and Hoffman8 found similar histologic
changes in a patient manifesting sensory neuropathy
with an associated carcinoma of the esophagus.
Heathfield and Williams15 noted symmetrical and ex-
tensive degeneration of the posterior columns of the
cord and posterior nerve roots. Gliosis of the pos-
terior columns was severe. There was also various
degrees of degeneration of the posterior root ganglion
cells.
The clinical features seen in the sensory neurop-
athies are frequently quite striking, and a description
of some specific cases may be warranted. Denny-
Brown6 described two such cases, one of which be-
gan as an ache in his right ear radiating into the right
side of the neck. About two weeks later he devel-
jor March, 1966
227
oped numbness of the soles of both feet which ad-
vanced up the legs over a period of about three days.
At that time he developed numbness around his
mouth which gradually spread to involve his whole
face within several days. At the same time his hands
became numb. About one month later he began to
have intermittent tingling sensations in both hands
and both feet. During this period he had intermit-
tent stabs of pain in the medial aspect of the ankles
which radiated to the knees and buttocks, while the
numbness spread up the legs to the knees and up the
forearms to the elbows. On physical examination
hearing was found to be severely diminished, and
there was absence of pain over the entire face and
tongue. Light touch was also reduced in these areas
leaving only impaired deep sensibility and tempera-
ture sense remaining. Ataxia was prominent and he
was unable to sit up or walk without assistance.
All muscles of the lower extremities were atrophied
to a greater extent than could be accounted for by
general cachexia. Deep reflexes were diminished or
absent, but the plantar responses were flexor. Pain,
light touch, and temperature were impaired over the
whole body.
Henson, Russell and Wilkinson16 reported three
such cases, all of them occurring in association with
carcinoma of the lung. Pathologically and clinically
these cases were similar to those reported by Denny-
Brown except in this series there was selective wasting
of the intrinsic muscles of the hands in one case and
extensor plantar responses in another.
Five of the 42 patients in Brain and Henson’s
series3 had sensory disturbances. These authors
pointed out that although a pure sensory neuropathy
without motor weakness may be seen early in the
course, a sensorimotor disturbance usually followed
if the patient’s course was prolonged. They also
found associated symptoms of gross hysteria in two
patients, dementia in one, and extensor plantar signs
in another. The course varied from two months to
more than a year.
That the ataxia seen in these patients is primarily
due to a general deafferentation has been brought out
in the cases described by Heathfield and Williams.15
These investigators also stress that "there is often
a greater loss of joint position and vibration sense
than of cutaneous sensibility, and although a glove
and stocking type of anesthesia is usual, on careful
testing evidence of a radicular pattern may be found.
..." Root pains of a shooting and burning nature
were also present in two of their patients, one of
which was mistaken for lightning pains of tabes
dorsalis. One patient had "burning feet" which
failed to respond to massive doses of parenteral cal-
cium pantothenate.
Lennox and Prichard20 were impressed by the com-
plete lack of correlation between the size or rate of
growth of the tumor and the progress of the sensory
neuropathy. They noted that the neuritis may recede
while the patient is dying of the neoplasm, while
on the other hand, it may recur shortly after a
pneumonectomy.
Peripheral neuropathy of the mixed sensorimotor
type is one of the more common neurological compli-
cations of visceral carcinomata. Not infrequently the
peripheral neuropathy will be purely sensory early
in its course, yet weakness is often added to the clini-
cal picture as the disorder lingers on. Five of the
42 cases studied by Brain and Henson3 demonstrated
a mixed picture, but again the clinical picture was
not a pure one, and dementia and extensor plantar
responses were occasionally present. Lennox and
Prichard20 studied the histologic picture in one such
case and found the nervous lesion to be a demyelini-
zation of peripheral nerves, chiefly motor, but in an-
other case no lesion could be found in the brain, cord,
or peripheral nerves.
A case of polyneuritis in which a clear-celled car-
cinoma of the kidney and a perinephric abscess were
discovered at laparotomy has been described by Swan
and Wharton.23 The patient complained of pain
and paresthesiae in the legs and was found to have
loss of motor power and absence of all deep reflexes
in the extremities. Facial weakness, as well as glove
and stocking anesthesia and impaired proprioception,
were also found. Before operation the neurological
signs had remained unchanged despite treatment with
injections of vitamin B complex, ascorbic acid, and
corticotropin. One month after a left nephrectomy
was performed his facial weakness had improved con-
siderably, peripheral sensation had returned to nor-
mal, and there was only residual weakness in the
right leg. The patient gained weight and progres-
sively improved until the only physical signs were
bilaterally absent ankle jerks.
Polymyositis and Neuromuscular Disorders
Carcinomatous myopathies can be divided into a
purely muscular disorder (polymyositis) and a
neuromuscular disorder (myasthenia-like syndrome).
Howard and Thomas17 have discussed myositis or
polymyositis and feel that the same significant asso-
ciation with malignant conditions exists as occurs
with dermatomyositis. About 7 per cent of patients
with myositis or polymyositis have malignant lesions.
These are usually found in older people and fre-
quently involve the breast, rectum or colon, cervix,
ovary, and lung. The clinical picture is usually an
insidious onset of muscular weakness especially of
the pelvic girdle, although acute fulminating cases
have been seen.
In 1953 the neuromuscular disorder was first de-
scribed by Anderson.1 A patient with a myasthenia-
like syndrome was found to have a bronchogenic
carcinoma and a period of prolonged apnea followed
the administration of succinylcholine in combination
with anesthesia in preparation for surgery. Removal
of the tumor resulted in a dramatic symptomatic im-
228
The Ohio State Medical Journal
provement. Rooke, Eaton, Lambert and Hodgson22
studied 19 such patients at the Mayo Clinic in whom
the malignant tumor was most frequently located in
the lungs or mediastinum. Of importance is the
fact that several patients in whom the roentgenographic
appearance of the chest was normal when the initial
diagnosis was made, subsequently developed pul-
monary neoplasms. There has been no consistent
histologic abnormalities seen in the muscles in this
disorder. In five patients studied by the same investi-
gators,22 the muscle was normal in appearance save
for mild, scattered, nonspecific degeneration of
muscle fibers, with occasional focal collections of
sarcolemmal nuclei. In only one case did the ab-
normalities have the characteristics of myositis. This
neuromuscular syndrome is distinct from myasthenia
gravis but has many similar characteristics. It is of
interest that 85 per cent of the involved intrathoracic
carcinomata studied at the Mayo Clinic were of the
small cell type.
Henson, Russell, and Wilkinson16 found muscular
wasting and weakness in 15 of their 19 patients with
malignant disease which was over and above any
wasting due to malignant cachexia. They concluded
that lesions probably occur at more than one level
in the neuromuscular apparatus and sometimes there
is a disorder of the neuromuscular junction. These
investigators emphasized that in some patients the
basic pattern of the clinical picture was usually con-
stant enough to make their recognition a relatively
simple matter.
The clinical features of the myasthenia-like syn-
drome have been outlined by Greenberg, Divertie,
and Woolner,12 as follows: (1) proximal muscle
weakness, particularly the pelvic girdle; (2) tem-
porary increase in muscle strength after a few sec-
onds of voluntary exercise; (3) absent or decreased
tendon reflexes; (4) sensitivity to curare but poor
response to neostigmine or edrophonium; and (5)
associated peripheral paresthesiae. Brain and Hen-
son,3 found a similar clinical picture in 27 patients
in their series.
Eaton and Lambert9 have pointed out that the
neuromuscular syndrome associated with malignant
neoplasms may be differentiated from myasthenia
gravis by electromyography and stimulation of nerves.
In the neuromuscular syndrome associated with car-
cinoma the action potential of the motor unit is
reduced in the resting muscle after a single supra-
maximal stimulus of the nerve but increases to a
marked degree after a few seconds of exercise or
tetanic stimulation. In myasthenia gravis, on the
other hand, the action potential of resting muscle is
normal and decreases with exercise.
Mental Changes
Mental changes have been a frequent accompani-
ment of malignant neoplasms. Charatan and Brier-
ley4 published an account of three cases of carcinoma
of the bronchus associated with psychiatric symptoms
which were described as nonspecific and resembling
a fluctuating toxic confusional psychosis in which
'lucid intervals” were obvious. These clinicians also
had an opportunity to study their cases histologically.
They noted that there was no degeneration of the
cerebellar Purkinje cells, and no abnormalities in the
spinal cord, dorsal root ganglia, or nerve roots were
found. The white matter presented a honeycomb
appearance caused by dilated perivascular spaces,
which was felt to represent inter-fiber fluid of the
central white matter of such brief duration that
myelin damage and its associated glial reactions had
not yet occurred. A mild to moderate marginal,
subependymal, and white matter gliosis occurred in
two cases, which suggested typical involutional changes
occurring at a presenile age. In two of their cases
the psychotic symptoms preceded symptoms due to
the neoplastic growth. In all cases cerebral metastases
or meningeal infiltration were absent, but liver metas-
tases occurred in all three. Peripheral neuropathy
and myopathy were not clinically demonstrable, nor
was involvement of the cerebellum.
These authors suggested the possibility that some
connection might be made between the liver metas-
tases, which occurred in all patients, and the mental
changes. Seventeen of the patients in the series
reported by Brain and Henson3 had mental changes.
In none of these patients studied at autopsy were
metastases found. The most common mental change
seen was simple dementia (14 patients), but agitation
and depression occurred in some. These authors noted
that the dementia may become arrested with only
moderate deterioration but there was no tendency
toward remission. Dementia was most commonly
associated with cerebellar symptoms.
Onset of Neurological Symptoms and the
Appearance of the Malignant Tumor
A malignant neoplasm may be suspected from
characteristic neurological findings and investigations
instituted to identify the malignant lesion while it
may still be amenable to therapy. Brain and Hen-
son3 point out that although the neuromyopathy may
develop pari passu with the tumor, neurological
symptoms may antedate the clinical manifestations or
diagnosis of the growth by periods of at least three
years. One such case had an eight year survival, at
the time of the writing, after the surgical removal
of a carcinoma of the lung. Occasionally, however,
the neurological picture did not develop until the
terminal stages of the carcinoma. The premonitory
signs and symptoms of an early malignant lesion are
frequently fleeting and elusive, however. In general,
the surgical removal of the cancer has no effect on
the course of the neurological syndrome. On the
other hand, Henson, Russell, and Wilkinson16 have
been impressed with the tendency to spontaneous re-
mission in carcinomatous neuropathies, as well as the
for March, 1966
229
apparent lack of constant relation between the course
of the neurological disorder and the carcinoma.
Investigations
Information gleaned from laboratory investigations
in the carcinomatous neuromyopathies is usually dis-
appointing. Brain and Henson3 found abnormalities
in the cerebrospinal fluid in five of eight patients with
cortical cerebellar degeneration and in four of seven
patients with the encephalomyelitic type. The changes
included pleocytosis (up to 48 cells per cubic mil-
limeter), increased protein (up to 120 milligrams
per 100 cubic centimeters), and first zone Lange
curve. No organisms were cultured, and the Wasser-
mann reaction was always negative in the blood and
the cerebrospinal fluid. A raised protein content,
rarely with cellular increase, was common in sensory
and sensorimotor peripheral neuropathies. The
cerebrospinal fluid frequently returned to normal in
a few weeks from the first examination.16 In Char-
atan and Brierley’s three cases4 of mental change
associated with carcinoma of the bronchus no abnor-
malities were noted in the blood or the cerebrospinal
fluid.
Differential Diagnosis
Since considerable time may pass from the onset
of the manifestations of the carcinomatous neuropathy
until an underlying carcinoma is found, the etiology
may be mistaken. Cerebellar forms must be differen-
tiated from disseminated sclerosis, which they may
simulate closely, as well as other forms of cerebellar
degeneration.16 Carcinomatous forms of subacute
cerebellar degeneration are said to be the most fre-
quent type seen in a general hospital.3 A pure sen-
sory neuropathy remains a rare manifestation of
carcinomatous neuropathy and also of diabetes mel-
litus. The neuromuscular disorders are the most
difficult to differentiate. The differential diagnoses
of these disorders must include myasthenia gravis,
motor neurone disease, dermatomyositis, myopathy
of late onset and chronic thyrotoxic myopathy.3- 16
Pathogenesis
One of the most intriguing aspects of the car-
cinomatous neuromyopathies lies in speculation on
their causation. Many of the theories suggested in
the past have been little more than speculation and
significant data are limited. The lack of involvement
of the nervous system by primary or metastatic spread
of tumor raises many questions as to the pathogenesis
of the neurological syndromes. Brain and Henson3
have brought out certain factors which must be con-
sidered: (1) Only a small proportion of patients
suffering from carcinoma develop neuromyopathy.
(2) There is no relationship between the size of the
growth and liability to neuropathy. (3) The inci-
dence of neuropathy is much higher in lung carcinoma
than in carcinoma elsewhere.
These authors have discussed five etiologic factors
that may be invoved: (1) Toxins may be produced
by the tumor, which in turn damage the nervous
system. However, in such cases there should be some
correlation of the size of the tumor and the severity
of the neurological syndrome, which does not seem to
occur. (2) The possibility of viral infection has also
been considered, since some tumors are thought to
harbor certain viruses. (3) A constitutional problem
in resistance in some people known as "sensitization”
may exist. (4) Since there has been a relatively
high incidence of myxedema found in these patients,
endocrine factors may be involved. (5) Metabolic
factors, which at present are receiving the most at-
tention, may be responsible for the neurological syn-
dromes associated with carcinoma.
The latter mechanism has been discussed by Denny-
Brown6 who has noticed that the only disorder com-
parable to that seen in his cases, in which simple
ganglionic degeneration is seen, is the ataxia of swine
studied by Wintrobe and co-workers.24 This type of
picture was produced when swine were made deficient
in pantothenic acid. Denny-Brown6 has suggested
that the bronchogenic carcinoma acts either by captur-
ing some essential metabolite or by producing a sub-
stance of antivitamin type. However, since reversal of
such degeneration as a result of feeding pantothenic
acid, or pyridoxine, or vitamin E has not occurred,
other factors are probably involved.
Lennox and Prichard20 have challenged Denny -
Brown’s theory because of several apparent incon-
gruities. The lack of relationship between the size
or rate of growth of the tumor and the progress of
the neuritis seem to cast doubt on the possibility
that the mechanism could be the capture or produc-
tion of a metabolite by the tumor. Also, since the
bronchial carcinomata are varied in histologic type,
including oat cell, squamous cell, and adenocarci-
noma, it is difficult to explain why neuritis occurs
more frequently in carcinoma of the bronchus, for
if a metabolic effect is peculiar to neoplasms of the
bronchial mucosa, it would seem odd that histologi-
cally they may be of diverse types. Finally, Denny-
Brown looked to the damage in the posterior root
ganglia to incriminate pantothenic acid; however,
other studies have shown different lesions, including
a pure demyelinizing peripheral neuropathy, predomi-
nantly motor.
Henson and associates16 feel that the neuropathy
and the carcinoma are linked by a common cause and
do not feel that the condition is carcinotoxic. These
workers found an abnormality in the pyruvate toler-
ance test in one patient as did Kremer and Pratt18
and Heathfield14 in similar cases. The latter author
reported a case of peripheral neuritis, predominantly
motor, associated with bronchial carcinoma. This
case appeared to be of nutritional origin conditioned
by histamine-fast achlorhydria; there was an asso-
ciated nicotinic acid deficiency glossitis. The periph-
eral neuritis improved with administration of
thiamine and the pyruvate tolerance returned almost
230
The Ohio State Medical Journal
to normal. These cases would lend support to the
theory suggested by Denny-Brown that the condition
may be nutritional in origin. Other investigators
have reported nutritional deficiencies in patients they
have studied.19
The possibility that a deficiency of vitamin E may
be involved must also be considered. Einarson10
studied the effects of vitamin E deficiency in rats by
examining fluorescent, acid-fast tissues. He found
fluorescent, acid-fast deposits in the neurones of the
central nervous system and elsewhere in vitamin-
deficient rats. Einarson found greater amounts of
this substance in five of the patients studied by Hen-
son and associates than in the controls.16 Histologic
examination of the nervous system and muscles of
vitamin E deficient rats by Einarson10 demonstrated
findings which are in many ways similar to those
found in patients with carcinomatous neuromyopathies.
Heathfield and Williams,15 however, stressed that
their cases did not demonstrate lesions which ap-
peared as acute as the lesions seen in experimental
vitamin E deficiency. They described one patient
with a pulmonary neoplasm who showed myotonia
and responded well to quinine. One of their patients
also responded to neostigmine. These investigators
found inconsistent results in blood pyruvate estima-
tions. Large parenteral doses of B-vitamins were of
no value. Dimercaprol was also of no value. These
authors concluded that there must be a multiplicity of
factors involved in the pathogenesis of such lesions.
Brain, Daniel, and Greenfield2 have stressed the
special vulnerability of the Purkinje cells both in
human disease and in experimental studies. The
toxins of typhus fever, various poisons including
lead, and ischemia of only brief duration are all
known to cause detrimental effects to the Purkinje
cell. But toxic factors had been previously chal-
lenged by Wyburn-Mason25 who reported three cases
of bronchial carcinoma presenting as polyneuritis.
He suggested that the dysfunction of the nervous sys-
tem was produced reflexly from the lungs:
From the lungs afferent nerve-fibres enter the upper dorsal
and vagus nerve-roots. Lung disease is not infrequently
accompanied by the changes of hypertrophic pulmonary
osteoarthropathy, the manifestations of which may be dra-
matically relieved by removal of the lung ... In two cases
known to me mere ligature of the pulmonary artery with-
out removal of the lung had the same immediate effect.
This shows that the changes in the tissues are not due to
"toxic” aborption or anoxia, which would be increased by
this procedure. They are probably reflex in causation. The
polyneuritic syndrome might be of a similar nature.
There has been no subsequent work to verify this
theory, and little credence is given to it.
An oat-cell carcinoma of the bronchus has been
reported in which the tumor appeared to be pro-
ducing 5 -hydroxy tryptophan. 11 What role such sub-
stances play in the genesis of neuromyopathies has
yet to be determined.
It can be seen, then, that although the pathogenesis
of the neurologic syndromes associated with visceral
carcinoma have been explored from many aspects,
the question is far from solved and a great deal of
investigation is still necessary.
Treatment
The treatment is directed toward the associated
cancer, adequate eradication of which may alleviate
or diminish the neurologic symptoms. Physiotherapy
is helpful in patients with neuromuscular disorders,
and neostigmine may be of value in myasthenic cases.
Cortisone should be of value in dermatomyositis.3
It is doubted that vitamin therapy is of any value, but
it is generally agreed that in our present state of
knowledge adequate doses of vitamins, especially B
and E, should be provided.16
References
1. Anderson, H. J.; Churchill-Davidson, H. C., and Richard-
son, A. T. : Bronchial Neoplasm with Myasthenia. Prolonged
Apnoea after Administration of Succinylcholine. Lancet, 2:1291-
1293, Dec. 19, 1953.
2. Brain, W. R.; Daniel, P. M., and Greenfield, J. G.: Sub-
acute Cortical Cerebellar Degeneration and Its Relation to Carcinoma.
/. Neurol. Neurosurg., Psychiat., 14:59-74, 1951.
3. Brain, R., and Henson, R. A.: Neurological Syndromes As-
sociated with Carcinoma; the Carcinomatous Neuromyopathies.
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/. A. M. A., 163:1117-1124, March 30, 1957.
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C. H.: Myasthenia and Malignant Intrathoracic Tumor. Med. Clin.
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23. Swan, C. H., and Wharton, B. A.: Polyneuritis and Renal
Carcinoma. Lancet, 2:383-384, Aug. 24, 1963.
24. Wintrobe, M. M.; Miller, M. H.; Follis, R. H.; Stein, H. J.;
Mushatt, C., and Humphreys, S.: Sensory Neuron Degeneration in
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for March, 1966
231
Supportive Psychotherapy*
HARRISON S. EVANS, M. D.
N THE PRACTICE of medicine there is the ever
present need on the part of people for supportive
help in times of medical and other life crises.
Corollary to this ever present need, there is also the
opportunity for physicians in their daily practice on
innumerable occasions and in innumerable ways to
use supportive therapy for the benefit and welfare
of their patients. It is my feeling that even though
supportive psychotherapy is used by all physicians,
its use is not generally well understood nor its im-
portance fully appreciated. Because of the contribu-
tions of dynamic psychiatry, supportive therapy no
longer needs to be or should be used haphazardly or
willy-nilly, but rather it can be used intelligently and
scientifically, the same as any other treatment measure.
Definition
Psychotherapy can be defined as a treatment meas-
ure which is administered through psychological
techniques, which follows scientific principles, and
which is designed to accomplish definite goals. While
psychotherapy is a treatment measure for those pa-
tients suffering primarily from psychological and
emotional disorders, it is an important and often a
helpful adjunct to general medical and surgical
therapies, because even in physical illness the pa-
tient’s emotional and psychological life is often in-
volved and should receive appropriate therapeutic
attention.
Types of Psychotherapy
Psychotherapy can be divided into three main types :
(1) supportive psychotherapy; (2) relationship ther-
apy; and (3) psychoanalytic therapy, which is also
known as uncovering or interpretative therapy. For
this discussion I am not including such pluralistic and
social approaches as group therapy and group ac-
tivities of a social, recreational, and occupational
therapeutic nature.
The type of psychotherapy to be used in a given
patient is determined by three things: (1) the pa-
tient’s emotional needs; (2) the treatment that the
patient is capable of using and responding to; and
(3) the capacity, training, skill, and competence of
the physician. For each treatment there should be
definite indications, goals, and techniques.
Supportive versus Other Psychotherapies
Psychoanalysis: Psychoanalytic psychotherapy is
currently the most popular and prestigious form of
* Presented at the Seminar for Family Physicians, sponsored by the
Neurological Hospital, Kansas City, Missouri, February 21, 1965.
The Author
• Dr. Evans, Los Angeles, California, formerly
Medical Director, The Harding Hospital, Worth-
ington, Ohio, presently is Professor and Chairman,
Department of Psychiatry, Loma Linda University
School of Medicine in Los Angeles.
psychotherapy. However, in considering the broad
spectrum of psychiatric and emotional disorders, it
has a somewhat limited use. It is a type of psy-
chotherapy that requires a heavy investment of time,
both for the therapist and the patient. Also in most
instances it is an expensive form of treatment, which
many people cannot afford. The psychoanalyst’s
training and preparation are long and expensive,
which in itself limits the number of available ther-
apists. Furthermore, the candidate for psychoanalytic
therapy has to have certain qualifications making him
suitable for such a technique. Besides having to have
the resources of time and money, the patient must
also have certain psychological assets and strengths.
He must have normal or above normal intelligence.
He must have a capacity to develop insight, which re-
quires the ability to reflect and to correlate inter-
pretation with personal experiences. Many patients
who are emotionally sick and in real need of help
do not have the psychological sophistication, insight,
or motivation to utilize the psychoanalytic approach
but they can be helped by other approaches.
Relationship Therapy: Relationship therapy is now
a widely used therapeutic technique in the field of
psychiatry. It utilizes the conception of dynamic psy-
chiatry but in practice represents a compromise be-
tween psychoanalysis and supportive psychotherapy.
Rather than emphasizing free association, introspec-
tion, interpretation, and insight, which are major
tools of psychoanalysis, it emphasizes a relationship
which embodies educated and insightful responses
on the therapist’s part to the patient’s overt and
hidden behavior. The emphasis is not on what the
therapist says or interprets but upon his attitudes
and upon what he does. Its goal is to provide a
corrective emotional experience through the provision
of a continuing constructive attitude and reaction
on the therapist’s part. From such a relationship,
the patient can learn it is safe and possible to behave
232
The Ohio State Medical Journal
and to respond differently than his earlier life experi-
ences had led him to believe.
Relationship therapy has this distinction from psy-
choanalysis in that it does not emphasize introspection
or interpretation, it is not as time consuming or as
expensive, and it does not require the same degree of
psychological strength and sophistication of the pa-
tient. It differs from supportive psychotherapy in
that it does emphasize a prolonged relationship, for
example a therapeutic session once a week extending
over many months or several years. It does not de-
mand of the therapist as much intervention or active
participation. In short, relationship therapy provides
the opportunity for growth and change because of a
continuing contact with a trained person who serves
as a model around whom the patient’s life can achieve
a new organization and behavior pattern out of the
process of learning and identification.
Supportive Psychotherapy: Supportive psychother-
apy is designed to be more of a crisis therapy. Its
goals are not to effect a basic change within the
person’s personality or behavior patterns. Rather it
attempts to shore up a patient’s faltering defenses
which ordinarily are reasonably adequate, and to
enable the patient to re-establish the status quo ante.
It assists the ego to meet problems that are currently
overwhelming. After the problems have been sur-
mounted and the ego is once again functioning
smoothly and comfortably, supportive therapy is, as
a rule, no longer necessary and can be discontinued.
Dynamics of Supportive Psychotherapy
Regression: In times of crisis and unusual stress,
most people tend to regress emotionally and psy-
chologically. Attitudes and needs that would nor-
mally be a part of childhood become reactivated.
For example, a person facing a critical issue may lose
his self-confidence and may develop attitudes and
feelings of helplessness, fear, guilt, and dependence.
As a consequence of regression and the arousal of
childhood attitudes and fears, the patient instinctively
seeks out a person to whom he can turn for assistance,
security, and dependency gratification. Appropriate
to the reactivation of childhood feelings and attitudes,
the individual would intuitively and unconsciously
seek out a person who seemed to have those qualities
which the patient, as a child, felt his parents pos-
sessed: strength, wisdom, security, et cetera.
Transference : The physician, because of the pecu-
liarities of his professional role, consisting of things
that are secret and of matters of life and death, fills
this required role perfectly. In the patient’s mind,
he is not just another well trained, educated, or
highly skilled person. Rather, the patient’s infantile
needs and wishes, once again unconsciously focused
on omnipotent and omniscient figures of childhood
(father or mother), are displaced onto the figure of
the physician, creating in him a person with ususual
attributes and powers for helping, healing, and for-
giving, and, one should also say, hurting! This in
psychiatric terminology is referred to as the transfer-
ence, meaning that a person in the present is treated
as if he were a person in the patient’s past life.
This, then, is the emotional climate and situation
that exists in the doctor-patient relationship. The
physician has far more significance than he usually
realizes. He also has far more power than he usually
appreciates. His leverage is the deepest feelings of a
person’s mind and emotional life. As Binger1 has
said, "Because of the particular kind of authority
with which we are vested by our patients, our words
and deeds have a power enhanced far beyond the
commonplace.” He also says that physicians
too often do not appreciate, as their patients do, the magic
and power of their own words and acts. What is not ap-
preciated by some doctors, though it is apperceived by their
patients, is the power for good or ill that lies in the inter-
play of personalities. The doctor’s words not only have
wings but carry a charge of dynamite behind them.
The Application of Supportive Therapy
In providing supportive therapy, the physician must
rely upon three things: (1) his presence, (2) his
attitudes, and (3) his words.
The Physician’s Presence: No person who oc-
cupies an influential position should discount the im-
portance of his presence. Physicians who have a
busy practice frequently pass off many routine treat-
ment procedures to their nursing assistants. Some
of this is all right. But from time to time the patient
needs to see the physician, hear his voice, and feel
his touch. The Bible tells us that the sick woman,
with an issue of blood for 12 years, wanted only to
touch the hem of Christ’s garment and from Him
to draw healing, strength, and virtue. Zaccheus
climbed a tree that he might see Christ. The im-
portance of seeing the significant object, hearing his
voice, and feeling his presence is a powerful source of
strength, support, and security. During war, the
presence of the medics in the field adds a great sense
of security to the combatants. They feel that in their
hour of need they will be cared for. All people
need to draw strength and a sense of identity from
figures who are symbolically significant. As the
masses turn to their president or their king, a sym-
bolic father, and will stand for hours to catch a
glimpse of him in a passing parade, so the patient
turns to and looks for the presence of his physician.
All great physicians have a commanding and an
influential presence. Farrar2 in recounting his ex-
periences with Osier, says of him,
When Osier approached a patient's bedside, his very
presence brought healing. His silent downward glance (at
the bedside) was a cheerful communication and his voice
partook of the quality that Richard Grant White long ago
characterized in a tribute he paid to a great singer, of
whom he wrote: "Her voice is vocal velvet!"
Farrar goes on to say of both Bernheim and Osier,
Each of these great physicians brought with him when
he entered the ward an atmosphere of confidence and com-
for March, 19 66
2?3
fx>rt. The voice of each, as his nature was, in converse with
patients was "ever soft, gentle and low,” and that too was
a natural and not a studied part of his own (Osier’s)
psychotherapy.
Israel3 illustrates how another outstanding doctor
was aware of the value of his presence. He says,
The master gynecologic surgeon, Victor Bonney, impressed
visitors who had come to observe his surgical dexterity by
his cheery, social-minded ward walks. With a deft pinch
of the cheek here and a quick chuck of the chin there, each
gesture delivered to the patient with a ringing "Good
morning, dearie!” and followed by a genuine question
concerning her husband’s gout or the effect of yesterday’s
storm upon the roses in her garden, he made effective
rounds. Bonney’s knowledge of and interest in his patients’
affairs bespoke the wisdom of onemanship — he knew the
unity of person and illness.
The child in a darkened room, an elderly confused
patient in a strange situation, a patient facing surgery,
a difficult life situation, or death needs the presence
of a significant person who has symbolic significance
at the deepest emotional level.
Knowing, then, the meaning of the physician to
patients in crisis, his presence takes on new and added
therapeutic significance. Presence can be and is
therapy.
The Physician’s Attitude: It has become increas-
ingly evident that the physician’s attitude, even though
unverbalized, can be an extremely important ther-
apeutic tool. It is common practice now in many
psychiatric centers to evaluate a patient’s emotional
needs and then prescribe for the treatment personnel
the attitude they should use in the relationship with
the patient. An attitude can be supportive or
destructive.
A variety of attitudes can be used in one’s attempt
to be supportive to a patient, depending on the situa-
tion and on the patient’s needs. There are some
attitudes that are basic and always essential such as
respect for the patient as a person, interest in the
patient and his problem, the manifest desire to under-
stand and to be helpful, and to be non-condemning
and accepting. Many patients have feelings of help-
lessness, rejection, and guilt. These basic attitudes
help neutralize such feelings by fostering a sense of
tmst, confidence, and personal significance, all of
which are so important in the recovery of a sick
patient. To be listened to and attended to by an
accepting significant figure (father) reassures one
that he is no longer rejected or alienated — that he
is not an outcast but is once again loved and valued.
There are other attitudes that a physician can use,
depending on the situation and the needs of the pa-
tient. A common listing of these useful attitudes
includes — matter-of-factness, active or passive friend-
liness, and kind firmness.
Matter-of-Factness: This attitude is not to be mis-
construed with indifference. Rather, it is a non-
anxious, unperturbed response to the patient’s crisis
and the patient’s behavior. If in time of crisis the
physician shows his concern in anxiety and alarm,
234
the patient’s cause is thereby damaged considerably.
Matter-of-factness does not only serve to avoid the
display of anxiety and over-concern, but it is also
useful in avoiding the display of irritation, annoy-
ance, or anger when a patient is being provocative and
neurotically challenging. Many neurotic patients try
to stir up their physician by making him feel re-
sponsible or guilty for problems that are solely their
own. The physician must avoid being trapped by
this maneuver. He must not become defensive. He
must calmly identify the basic issues in the situation
as well as the patient’s responsibility. He should
express a willingness to help in every way that he can
but point out the limits of his responsibility.
Osier4 extols the attribute of calmness and imper-
turbability in his famous address, Aequanimitas. It
is still an important attitude for every physician to
cultivate. Physicians should not react as anxious
parents do when the child is injured or ill. We
all know what a devastating effect this has on chil-
dren. By reacting just the opposite to a patient’s
problem, illness, or crisis, we are undoing what might
have been done earlier in the patient’s life, and we
become a source of strength and stability. A phy-
sician’s power of iatrogenicity exists in the attitude
of anxious concern as well as in what he says.
Active and Passive Friendliness: To be recog-
nized, to be received with a warm smile, to have
someone take an active step forward, with a firm
handshake and meaningful salutation, can be of great
therapeutic value. We are told that a vital phase in
the organization of the infant’s personality — a phase
that enhances the development of confidence, out-
goingness and increasing exploration — is the phase
that occurs at about the third month of life and is
referred to as the ''smiling response.”5 The infant
at this period has a dim awareness of his mother. He
searches her face and ''looks” for tangible evidence
of love, kindness, and acceptance. When she smiles,
it reassures the infant and he smiles back in delight.
This is a period of primitive trust and confidence,
and her smile encourages the infant in his further
development.
Many patients who are basically insecure, who find
it hard to trust, who are too fearful to take the initia-
tive, who would without assistance sit in the corner
passively and lonely, need someone to draw them out.
This is what an attitude of friendliness is designed
to do. Active friendliness means that the physician
is going to take that extra step or show that extra
thoughtfulness in striving to reassure and draw his
patient out. Passive friendliness attempts to display
equal warmth and acceptance but encourages the pa-
tient to take some initiative on his own, to try his
own wings, and to learn that it is safe and satisfying
to be more independent and aggressive.
Kind Firmness: As a good father needs to show
strength and to set limits on his children’s behavior
on occasions, so are there occasions when a good
The Ohio State Medical journal
physician needs to be firm in his leadership and
management of his patients. Kind firmness would
approximate the ''authoritative approach” used rou-
tinely by some physicians. However, not all patients
should be managed at all times this way because it
tends to foster dependency and to stifle growth. But
at times a patient who is in a period of great anxiety
and instability might need a firm hand and might
need to be actively told what he should or should not
do. Some patients in a crisis welcome being told
what they can or cannot do. For example, a com-
pulsive, overly conscientious person, who is threaten-
ing his health by overwork, may be able to change
his behavior pattern if his physician firmly sets limits
for him. The patient then does not need to feel
guilty because he can say to himself, my physician
(father) not only gave me permission to slow down
but he insisted that I do so. In many psychiatric
disorders, ranging from guilt-ridden patients, poorly
controlled manic patients, to spoiled, undisciplined
patients, unyielding firmness might be the patient’s
salvation.
The Words of the Physician: Words are an in-
strument of the physician. They implement what he
already stands for in the patient’s unconscious mind.
Without the already established relationship and its
unconscious significance, words would have much less
influence. However, because of the powerful emo-
tional leverage the physician has, it is important
that he measure his words carefully. Thoughtless
words can do infinite harm, while the appropriate
word that is well-timed can do great good.
Words can be used for some of the following
purposes: to reassure an unnecessarily anxious per-
son; to explain and clarify the meaning of symptoms;
to identify certain problems and behavior as being
common among all human beings, thus enabling the
patient to feel he is not alone in the mistakes he
has made or in the conflicts he has experienced; this
is referred to as softening the sense of guilt through
the process of universalizing; to persuade and to
encourage; and, with caution and good sense, to
give advice.
Patients wish to please and to be accepted. They
want to obey the physician. They want to believe.
Therefore a physician, because of his role and be-
cause of the patient’s basic attitude, can in many
instances "heal” through suggestion, reassurance,
and persuasion. Through combinations of trust, be-
lief, and faith and of the physician’s attitude and
words, many patients have been made well.
The Limitations and the Risks
Of Supportive Psychotherapy
This kind of psychotherapy is indicated primarily
for people in crisis but is also useful in chronically
ill (psychologically and physically) patients for
whom "curative” therapy is not possible. Patients
who could benefit from more penetrating therapy,
such as electroshock therapy, relationship therapy, or
psychoanalytic therapy, should receive it. Also it
should be remembered that supportive therapy should
meet an acute (and in some instances a chronic)
need. As soon as possible the patient should be
encouraged to use once again his own assets and
strengths and not to exploit the use of supportive
therapy, which in the end will only lead to further
decompensation and protracted dependency. The
physician has the responsibility to gauge carefully
his patients’ strengths and resources and encourage
their use as rapidly as is possible. Out of ignorance
or for other reasons, both the physician and patients
can abuse the use of supportive therapy. But this
is true of all treatment measures. These warnings
and qualifications concerning the use of supportive
therapy in no wise reduce the fact that supportive
psychotherapy is a major therapeutic instmment in
medicine. When used with understanding, skill, and
integrity, it can make the difference between a doctor
and a great physician — a man whose patients will
rise up and call him blessed!
References
1. Binger, C. A. L. : The Doctor’s Job, New York: W. W. Nor-
ton & Co., 1945, 243 pp.
2. Farrar, C. B.: I Remember Osier, Psychotherapist. Amer. J.
Psychiat., 121:761-767 (Feb.) 1965.
3. Israel, S. Leon: Teaching the Art of Caring for Women.
JAMA, 191:393-396, Feb. 1, 1965.
4. Osier, W. : Aequanimitas with Other Addresses, ed. 3, Phil-
adelphia: Blakiston Co., 1932, 451 pp.
5. Spitz, R. A.: The Smiling Response: A Contribution to the
Ontogenesis of Social Relations. Genet. Psychol. Monogr., 34:57-
125, 1946.
FOLLOW THE WAY OF WISDOM, and do unto others as you would do
unto yourselves, heeding the voice of conscience, love, and compassion. — A.
M. Dogliotti, Turin, Italy: Moral Dramas and Dilemmas in the Practice of Surgery,
Bulletin of the New York Academy of Medicine, 41:1107-1116, November 1965.
for March, 1966
235
Experimental Pulmonary Embolism
A Study of Serum Lactic Dehydrogenase Levels
WILLIAM BOGEDAIN, M. D„ JOHN CARPATHIOS, M. D., PAOLI ZERBI, M. D.,
DO VAN SUU, M.D., and TEH CHENG HUANG, Ph. D., D.Y. M.
IT HAS been suggested by Coon and Willis that
pulmonary embolism may be the cause of as
many as 47,000 deaths annually in the United
States.1 Death occurs suddenly and, in the majority
of cases, within the first 12 hours after the attack.2-4
During this short time, the diagnosis is usually dif-
ficult. Rosenberg found that the electrocardiogram
may show significant changes in only 70 per cent of
cases.5 These changes may not be diagnostic but only
suggestive of pulmonary embolism. Other methods
of diagnosis such as x-ray, angiograms, and the meas-
urement of alveolar C02 content may all be helpful.
However, all of these methods have their limitations.
Measurement of the serum lactic dehydrogenase
(L. D. H.) activity has been mentioned as an addi-
tional method of differentiating cases of myocardial
infarction, pneumonia, and pulmonary infarction. The
L. D. H. may be increased but the serum glutamic
oxalacetic transaminase (S. G. O. T.) activity usually
remains normal in cases of pulmonary infarction.6’ 7
The following investigation was made to study the
activity of these enzymes during the first 24 hours
immediately, following experimental infarction, when
the diagnosis is most difficult.
Method
Twenty-four dogs were used to study the blood
chemistries and physiological changes following the
production of artificial emboli to the lungs. The ani-
mals were first anesthetized with a single dose of
intravenous sodium Pentothal®. A small incision was
made in the neck over the external jugular vein.
Emboli were then inserted into the jugular vein using
aseptic technique. Emboli were made from 20 parts
of barium sulfate and 80 parts of paraffin, which had
been previously mixed and sterilized by dry heat. An-
other type of embolus employed the use of the dogs’
own blood mixed with barium sulfate in the center
of the clot. By producing clots or emboli mixed with
barium, we were able to assure ourselves, by x-ray,
that the clots had gone to the lungs. Size and
number of emboli were recorded on each animal.
Physiological changes were recorded, including the
This study was supported by a grant-in-aid from the East Central
Ohio Heart Association.
Submitted May 27, 1965.
The Authors
• Dr. Bogedain, Canton, is Chief of Staff, Mercy,
Timken Mercy Hospitals; Research Investigator,
Department of Thoracic Surgery, Mercy Hospital.
• Dr. Carpathios, Canton, is a member of the
active staffs. Department of Thoracic Surgery,
Mercy, Timken Mercy Hospitals.
• Dr. Zerbi, New York, N. Y., is a Resident in
Surgery, Columbus Hospital, New York City.
• Dr. Van Suu, Canton, is Chief Surgical Resi-
dent, Mercy Hospital.
• Dr. Huang, Canton, is Director of Research,
and Director of Clinical Laboratory, Timken
Mercy Hospital.
body temperature, respiratory rate, heart rate, and the
electrocardiogram.
Chest x-rays were taken immediately after the in-
troduction of the emboli to ascertain the presence of
all emboli in the lung fields. Chemical changes were
also studied including the arterial pH, pC02, p02,
lactic dehydrogenase (L. D. H.), and serum glutamic
oxalacetic transaminase (S. G. O. T.). Measurements
of the chemical studies were recorded before the em-
boli were introduced and at intervals of one, two, four,
six, 12, and 24 hours. Central venous pressure was
also monitored by a catheter in the left femoral vein.
Results
A summary of the results is shown in Table 1.
Three types of clinical reactions were produced de-
pending on the number of emboli introduced into
the jugular vein. This is the reason for dividing the
animals into three groups. Both types of emboli
produced a similar anatomical change by x-ray
(Fig. 1). Physiological changes did not vary in the
two groups of emboli. In Group I, ten or more
emboli were introduced into the jugular vein. Since
all the animals in this group died, we studied only
seven animals. Five of the seven animals died
within 30 minutes after the introduction of the
emboli.
The first physiological change noted in each case
was a rise in the venous pressure from a normal of
236
The Ohio State Medical Journal
6 or 7 centimeters of water to as much as 40 centi-
meters of water. There was always acceleration of
the heart rate and the respiratory rate. Heart rate
usually increased 20 to 30 beats per minute while the
respiratory rate increased from a normal of 13 to
nearly 85 per minute. Cyanosis was conspicuous in
this group. The arterial pH diminished and the pOo
diminished. There were no changes noted in the
lactic dehydrogenase or serum glutamic oxalacetic
transaminase during the short observation period
prior to death. The two animals that did not die
within the first 30 minutes subsequently died within
the first nine hours.
In Group II, all nine of the animals studied have
survived the acute embolization. In this group, we
had introduced less than 10 emboli and more than
five emboli. This group did not manifest any im-
mediate physiologic changes. The animals showed
symptoms of pneumonia 24 hours following the em-
bolization. These symptoms consisted of persistent
dry cough, dyspnea, tachycardia, and elevated tem-
perature. Three of the nine animals coughed blood
starting as early as the third day. S.G.O.T. and
L.D.H. studies varied from animal to animal. The
elevation of these enzymes after pulmonary emboliza-
tion was not as high as that seen after experimental
coronary embolization in a previous study.8 The
highest L.D.H. recorded was 1480 on the third day
in one animal. Another animal showed L.D.H. of
640, and two others were as high as 550. Serum
bilirubin levels were observed and were not elevated
in any of these cases. There was no elevation noted
in any of the enzyme studies during the first 24 hours
after embolization.
In Group III, we studied eight animals. All sur-
vived the embolization and were entirely asympto-
matic. Each of these animals received less than five
emboli per animal. The enzyme levels in this group
were not elevated during the first 24 hours. In only-
one of the animals did the L.D.H. reach 520 on the
third day. All animals lived normally as long as one
year. At autopsy, emboli were embedded in dense
connective tissue and fixed to the arterial wall in all
cases.
Summary
Experimental pulmonary emboli were produced in
24 dogs. Physiological and chemical changes were
recorded. A study of the serum L.D.H. and S.G.O.T.
failed to demonstrate any change during the first 12
hours. Our study would indicate that these enzymes
have not been clinically helpful in making a differ-
ential diagnosis between early pulmonary infarction,
pneumonia, or myocardial infarction during the first
24 hours following the onset of the illness in the dog.
References
1. Coon, W. W. , and Willis, P. W. : Deep Venous Thrombosis
and Pulmonary Embolism; Prediction, Prevention and Treatment.
Amer. J. Cardiol., 4:611-621 (Nov.) 1959.
2. Hampson, J.; Milne, A. C., and Small, W. P.: Surgical Treat-
ment of Pulmonary Embolism. Lancet., 2:402-404, Aug. 19, 1961.
3. Donaldson, G. A.; Williams, C.; Schnnel, J. G., and Shaw.
R. S.: Reappraisal of the Application of Trendelenburg Operation
to Massive Fatal Embolism. Report of a Successful Pulmonary-
Artery Thrombectomy Using a Cardiopulmonary By-pass. New Eng.
J. Med., 268:171-174 (Jan.) 1963.
4. Rosenberg, D. M.; Eckman, P. J., and Pearce, C. W. : Sur-
gical Treatment of Massive Pulmonary Embolism with Use of Extra-
corporeal Circulation. /. Cardiov. Snrg., 3:428-435 (Dec.) 1962.
5. Israel, H. L., and Goldstein, F.: Varied Clinical Management
of Pulmonary Embolism. Ann. Intern. Med., 47:202-226 (Aug.)
1957.
6. Fred, H. L., and Alexander, J. K. : Pulmonary Embolism.
Lippincott’ s Med. Sci., 15:54-59 (Oct.) 1964.
7. Coletta, D. F., and Siegel, P. D. : Clinical Laboratory Inter-
pretations. Med. Sci., 15:97-101 (Jan.) 1964.
8. Bogedain, W. ; Raftery, A.; Carpathios, J.; Pelecanos. N. T.;
Lallanilla, A., and Huang, T. C. : Coronary Insufficiency. Correction
by Internal Mammary Ligation. Arch. Surg. (Chicago), 84:674-676
(June) 1962.
Table 1. Physiological and Chemical Changes m 24 Dogs Following Experimental Pulmonary Embolism
No. of animals studied
No. of emboli introduced
Central venous pressure
GROUP I
Lived Died
10 or more
GROUP II
Lived Died
GROUP III
Lived Died
More than 5 and
less than 10
5 or less
Normal
Normal
Heart rate
Respiratory rate
Normal
Normal
Normal
Normal
Arterial pH
pOa
Normal
Normal
Normal
Normal
Serum L.D.H.
;; S.G.O.T.
Bilirubin
Clinical observations
No change
No change
No change
All died in 30
minutes to 9 hrs.
No change early
t after 24-48 hrs.
No change
Pneumonia on 1st
day and 1/3 had
hemoptysis by 3rd
day.
No change
t after 48 hrs.
No change
Asymptomatic
for March, 1966
237
Pulmonary Hodgkin’s Disease
With Cavitary Lesions
HEMA GOPINATHAN, M. D., and LEE R. SATALINE, M. D.
WHILE mediastinal and bronchial lymph
nodes are generally affected in Hodgkin’s dis-
ease, involvement of pulmonary parenchyma
occurs only in approximately 30 per cent of the
cases.1 Several distinct radiological types of intra-
pulmonary lesions have been described: (a) reticular
patterns; (b) scattered infiltrations; (c) miliary foci;
(d) massive lobar infiltrations.2 Rarely, however,
cavitary lesions may be observed, and in a collective
analysis of 245 cases of pulmonary Hodgkin’s dis-
ease, only 11 cases with cavitation were found.1'6 An
additional 19 individual cases have been reported in
the world literature.1’ 7- 12 In all instances, other
causes of pulmonary cavitation were excluded.
Recently we observed two patients with pulmonary
Hodgkin’s disease with cavitation. We wish to re-
port these cases and to briefly review certain pertinent
aspects of this uncommon complication of lymphoma.
Case 1
A 30 year old white woman was admitted to Lakewood
Hospital on June 29, 1964, because of fever, anorexia, and
a cough producing mucopurulent sputum.
At age 17 years, Hodgkin’s disease was first diagnosed
by lymph node biopsy. At age 23, she developed cervical
and right paratracheal adenopathy for which she received
radiation therapy (1300r and 1500r tumor dose to each
respective area). There followed complete disappearance
of the adenopathy. At 25 years of age, she developed
pelvic and hilar adenopathy. She received radiation therapy
(lOOOr) to the mid-line of the pelvis which was followed
by a course of nitrogen mustard therapy (24 mg.). One
year later, she developed bilateral inguinal and left cervical
adenopathy. Tumor infiltration of both upper lung fields
was also seen on x-ray. Radiation therapy (I900r) ad-
ministered to each inguinal area resulted in regression of
the adenopathy: chemotherapy with nitrogen mustard (26
mg.) following this, produced only a partial regression of
the pulmonary infiltrations. Five months later, the bilateral
pulmonary lesions had increased in size and she received
radiation therapy (900r to each site). Complete disap-
pearance of the infiltrations was observed in subsequent
chest films. At this time, splenomegaly was first noted and
the spleen was irradiated with 600r.
At 28 years of age, the patient developed obstructive
jaundice which subsided following chemotherapy with
Velban® (vinblastine sulfate, 5.8 mg.). Ten months later,
the patient was re-admitted with a large nodular infiltration
in the right middle lobe and smaller, scattered, bilateral
pulmonary nodules. Chemotherapy with Velban (14.5 mg.)
produced a complete disappearance of the lesions. At 29
Submitted June 17, 1965.
Reprint requests to Lakewood Hospital, 14519 Detroit Ave., Lake-
wood, Ohio 44107 (Dr. Sataline).
The Authors
• Dr. Gopinathan, Cleveland, is First-Year Resi-
dent in Medicine, Lakewood Hospital.
• Dr. Sataline, Cleveland, is Director of Medical
Education at Lakewood Hospital, and Instructor
in Medicine, Western Reserve University School of
Medicine.
years of age, fine nodular lesions recurred in both lungs.
They again responded to chemotherapy with Velban (6.5
mg.). One year later, the patient developed a large con-
solidation in the left lower lobe, as well as left hilar
adenopathy (Fig. l). Within five months, a thick-walled
cavity, with a fluid level, developed within the consolidation.
Fig. 1. Chest x-ray of Case 1 six months prior to cavitation.
A second, smaller cavity was observed in the left para-hilar
region (Fig. 2). Her sputum became purulent but not foul
smelling.
Following hospitalization, cultures of the sputum pro-
duced a mixed growth of commensal organisms but no
pathogens. No fusiform or spirochetal organisms were seen
on direct smear. Repeated sputum examinations and cul-
tures for tubercle bacilli and fungi were negative. The
intermediate tuberculin skin test was negative. No Reed-
Sternberg cells could be demonstrated in the sputum. Her
hemoglobin was 8 Gm. and the white blood cell count
13,000 with 93 per cent neutrophils, and 7 per cent
238
The Ohio State Medical Journal
lymphocytes. She was placed on treatment with tetracy-
cline, and postural drainage was instituted. Irradiation
(2400r) and Velban therapy (16 mg.) resulted in a 50
per cent diminution in the size of the large cavity (Fig. 3).
After discharge, subsequent chest films showed complete dis-
appearance of the cavitations during a four-week period.
Four months later, her x-ray shows no recurrence of the
cavitations (Fig. 4).
Fig. 2. Two cavitary lesions in Case 1.
Fig. 3. Reduction in size of cavities in Case 1 following
treatment. Note the fluid level in lower cavity.
Case 2
A 48 year old woman was admitted to Lakewood Hospital
on September 2, 1964, because of anorexia and a nonproduc-
tive cough.
She had Hodgkin’s disease of eight years’ duration, which
was first manifested in 1956 by cervical adenopathy. This
responded to radiation therapy (1500r). In I960, the
patient developed right hilar and upper mediastinal ade-
nopathy for which she received nitrogen mustard (30 mg.).
Complete resolution was noted radiographically. One year
later, she developed a pulmonary infiltration in the left
para-hilar lung field and a right lower lobe consolidation
with an effusion. Radiation to the left and right lung
infiltrations (l600r and l400r respectively) resulted in a
75 per cent reduction in the size of both lesions. The right
pleural effusion was completely resorbed. However, a
recurrence of both infiltrations was noted within six months.
Again, they were irradiated (2200r and 2000r respectively)
and complete resolution was noted within two months.
Nine months later, left hilar adenopathy accompanied by
a para-hilar pulmonary infiltration was observed. Irradiation
of the lesions (l400r) produced no substantial change.
During the next four months the lesions further increased
in size and chemotherapy with Velban (20 mg.) resulted
in a partial regression.
In September, 1964, ten months after the last treatment
with Velban, the patient was found to have bilateral lung
infiltrations with cavitation in the left upper lobe (Fig. 5).
The cavity appeared irregular and thick-walled by laminog-
Fig. 4. Disappearance of cavities in Case 1 four months
later.
Fig. 5. Left upper lobe cavitation in Case 2.
for March, 1966
239
raphy (Fig. 6). Sputum cultures grew out commensal
organisms but were negative for tubercle bacilli. No fusi-
form or spirochetal organisms were seen in sputa smears.
The tuberculin and histoplasmin skin tests were negative.
Her hemoglobin was 10 Gm. and her white blood cell count
9,400 with 73 per cent neutrophils, 9 per cent eosinophils
Fig. 6. La?ninogram of cavity in Case 2.
and 18 per cent lymphocytes. Chemotherapy with Velban
(40 mg.) and antibiotics produced no substantial change in
the lesions. Subsequent x-rays of the chest have shown an
increase in the infiltrations, and, clinically, the patient has
continued to deteriorate.
Discussion
Although cavity formation was mentioned as early
as 1888 by Claus,1 the first detailed report was pub-
lished by Vieta and Craver1 in 1941. These authors
described three cases of cavitation in a series of 134
patients with parenchymal lung involvement by Hodg-
kin’s disease. More recently, Steel6 reported four
cases. There appear to be no specific signs or symp-
toms for cavitation since fever, weakness, and cough
are common occurrences in Hodgkin’s disease with-
out cavitation. Radiographic studies would seem to
be the best method for detecting pulmonary cavities,
but as the cavities do not have any specific appearance
which would distinguish them from other causes of
cavitation,8 diagnosis is one of exclusion.
Pulmonary cavitation in patients with Hodgkin’s
disease of the lung seems to occur more frequently
in long-standing cases. In reviewing the literature,
the average duration of the disease, prior to the de-
velopment of the cavities, was 12 to 15 years. Fur-
thermore, it would appear that life expectancy
following the appearance of the cavities, is consider-
ably shortened. This may be related to the increased
resistance to the anti-tumor treatment which is noted
at this stage. Although pulmonary involvement in
Hodgkin’s disease occurs with equal frequency in
both males and females, the literature indicates there
is a definite increase in the frequency of cavitation
in females, the male to female ratio being one to five.
The significance of this is unknown.
The cause of cavitation in Hodgkin’s disease re-
mains uncertain. Pulmonary cavitations are most
frequently associated with granulomatous disease
(tuberculosis, histoplasmosis, etc.); primary lung ab-
scesses and primary or metastatic malignant tumors.11
The not uncommon development of granulomatous
infections in patients debilitated by Hodgkin’s dis-
ease makes it imperative that these diseases be ex-
cluded by repeated sputum examinations and sero-
logic tests. Skin testing may be misleading, as anergy
is not uncommon with lymphomatous disease.
Primary lung abscesses result from partial necrosis
of the lung parenchyma and most frequently occur in
debilitated patients and alcoholics following aspira-
tion and/or respiratory infections.13 Neither patient
had foul smelling sputum and spirochetal or fusi-
form organisms were not found in the sputa. Fur-
thermore, no predominate pathogenic organisms were
cultured, thus excluding putrid and so-called "non-
putrid” lung abscess.11 The roentgenologic findings
and response to irradiation also mitigate against infec-
tion as the cause of cavitation in these two patients.
Cavitation occurring in malignant tumors may re-
sult from: (a) occlusion of the bronchus with sub-
sequent infection and abscess formation; (b) central
necrosis of the tumor following irradiation or chemo-
therapy; (c) breakdown of a rapidly expanding
tumor which outgrows its blood supply.14'15 In
neither of these cases was bronchoscopy or bronchog-
raphy performed, and some element of obstruction
cannot be excluded. Peribronchial lymphatic involve-
ment by lymphoma frequently compresses and oc-
cludes the bronchus.2
Tumor necrosis following antitumor therapy can
be excluded as a cause of cavitation as the last course
of treatment in both patients had been almost one
year prior. We believe, therefore, that the cavi-
tations resulted from necrosis due to an insufficient
blood supply to a fast-growing tumor. Irrespective
of size, the blockage of nutrient arteries by tumor
cells, as has been demonstrated at autopsy, may se-
verely compromise the tumor vascular requirements.15
There is no specific treatment for cavitation occur-
ring in Hodgkin’s disease. Drainage and appropriate
antibiotic therapy following sputum cultures should
be instituted. Radiation and/or chemotherapy may
be necessary before adequate drainage can be estab-
lished. Pulmonary resection has been performed in
one case of primary Hodgkin’s disease of the lung,
but no follow-up report was given.12 However, re-
section appears of doubtful value in generalized
240
The Ohio State Medical Journal
lymphoma as the prognosis appears to be consider-
ably worse following the development of cavities.
Synopsis
Involvement of the pulmonary parenchyma occurs
in approximately 30 per cent of the cases of Hodg-
kin’s disease. The pulmonary lesions may present
several radiological patterns, the rarest of which is
cavitation. Approximately 30 cases have been men-
tioned in the literature.
In this paper we report two women with long-
standing Hodgkin’s disease, who developed pulmo-
nary cavitations. In one patient the cavitation re-
sponded to combined radiation and chemotherapy.
Pulmonary cavitation in Hodgkin’s disease appears
to develop more frequently in long-standing cases and
in women. The clinical and radiological findings
are not specific. The most frequent causes of lung
cavitation are: (1) granulomatous disease; (2) ab-
scess formation, and (3) tumor necrosis. The diag-
nosis of cavity formation in Hodgkin’s disease is
mainly one of exclusion. Treatment consists of drain-
age, antibiotics and chemotherapy, and/or radiation.
Acknowledgments: We wish to thank Dr. Vishwa Kapur, De-
partment of Medicine, Cleveland Metropolitan General Hospital, for
his helpful criticisms while preparing this paper. Acknowledgments
are due Dr. Arthur F. Young for the use of his cases and to Dr. H.
R. Claypool for his guidance in the radiological study and therapy of
these patients. Mrs. Dorothy Jorgens was of great help in compil-
ing the bibliography.
References
1. Vieta, J. O., and Craver, L. F.: Intrathoracic Manifestations
of Lymphomatoid Diseases. Radiology, 37:138-158 (Aug.) 1941.
2. Robbins, L. L.: Roentgenological Appearance of Parenchymal
Involvement of the Lung by Malignant Lvmphoma. Cancer, 6:80-88
(Jan.) 1953.
3. Wolpaw, S. E.; Higley, C. S., and Hauser, H.: Intrathoracic
Hodgkin’s Disease. Am. J. Roentgenol.. 52:374-387 (Oct.) 1944.
4. Dickson, R. J., and Smitham, J. H.: Cavitation of Lung
Lesions in Hodgkin’s Disease; Report of 2 Cases. Brit. J. Radiol.,
New Series, 25:48-52 (Jan.) 1952.
5. Ellman, P., and Bowdler, A. J.: Pulmonary Manifestations of
Hodgkin's Disease. Brit. J. Dis. Chest., 54:59-71 (Jan.) I960.
6. Steel, S. J. : Hodgkin’s Disease of the Lung with Cavitation.
Amer. Rev. Resp. Dis., 89:736-744 (May) 1964.
7. Efskind, L., and Wexels, P.: Hodgkin’s Disease of Lung with
Cavitation; Report of 3 Cases. J. Thoracic Surg., 23:377-387 (Apr.)
1952.
8. Holesh, S.: Unusual X-Ray Appearances in Hodgkin’s Dis-
ease. Proc. Royal Soc. Med., 48:1049-1052 (Dec.) 1955.
9. Cooley, J. C.; McDonald, J. R., and Clagett, O. T.: Primary
Lymphoma of Lung. Ann. Surg., 143:18-28 (Jan.) 1956.
10. Leszler, A.: Research on Cavernous Disintegration of the Lung
in Lymphogranulomatosis. Acta Med. Scand.. 168:29-33, Sept. 21,
1960.
11. Rubin, E. H., and Rubin M. : Thoracic Diseases; Emphasizing
Cardiopulmonary Relationships. Philadelphia, W. B. Saunders Co.,
1961, p. 968.
12. Billinglsey, J. G., and Fukunaga, F. F.: An Unusual Case of
Hodgkin’s Disease Presenting the X-Ray Appearance of Lung Ab-
scess. New Eng. J. Med., 269:1025-1027, Nov. 1, 1963.
13- Schweppe, H. L. ; Knowles, J. H., and Kane, L.: Lung Ab-
scess. An Analysis of Massachusetts General Hospital Cases 1943-
1956. New Eng. J. Med., 265:1039-1043, Nov. 23, 1961.
14. Bernhard, W. F., Malcolm, J. A., and Wylie. R. H.: The
Carcinomatous Abscess. A Clinical Paradox. New Eng. J. Med.,
266:914-919, May 3, 1962.
15. Molnar, W. , and Riebel, F. A.: Bronchography: An Aid in
the Diagnosis of Peripheral Pulmonary Carcinoma. Radiol. Clin. N.
Amer., 1:303-314 (Aug.) 1963.
SOME DISPOSABLE SYRINGES CAN YIELD CONTAMINANTS.—
Disposable syringes may contaminate aqueous solutions contained in them. The
source of this contamination is the rubber portion of the plunger according to
Mario A. Inchiosa of the Harvard Medical School.
Writing in a recent issue of the American Pharmaceutical Association’s
Journal of Pharmaceutical Sciences *, Dr. Inchiosa points out the significance of
this contamination in view of the extensive utilization of disposable syringes, not
only for administering injections but also for transferring solutions and blood in
both clinical practice and in the laboratory. Because of prepackaging procedures,
solutions may remain in these syringes for long periods of time.
Two commercial brands of disposable syringes (selected at random and de-
signated as types A and B) were subjected to various extractive procedures. The
parts of the syringes were soaked in water or normal saline at room temperature
for varying periods of time. The plastic parts of these particular syringes yielded
no extractives. However, the rubber portion of the plunger contained water-soluble
contaminants which were detected by absorption of ultraviolet light.
2- (Methyl thio) benzothiazole was the principal contaminant extracted from
type A plunger. Small amounts of other compounds were detected but not
identified. The compound has insecticidal action and was shown to be an effective
spray in a concentration of 0.2 per cent against three of four species. Following
42 -hour extraction of the type A plunger, the concentration of this compound
reached 0.1 per cent in the extraction solution.
The extract from the type B plunger has not been identified, but was shown
to be different from that extracted from the type A plunger. The contaminant in
the type B plunger inhibited the in vitro hydrolysis of adenosine triphosphate by
cardiac actomyosin.
Glass syringes subjected to the same procedures yielded no contaminants. —
Abstract furnished by the American Pharmaceutical Association.
* Inchiosa, M. A., Jr.: J. Pharm. Sci., Vol. 54, No. 9, p. 1379, September (1965).
for March, 1966
241
A Clinicopathological Conference
From The Ohio State University Hospital, Columbus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
COLIN R. MACPHERSON, M. D., President
PRESENTATION OF CASE
FIRST ADMISSION: This Negro man, aged
35 years, was first seen at Ohio State University
Hospital on November 11, 1963, when his fam-
ily physician sent him in for evaluation of swelling of
his legs that had been present for one year and had
been unresponsive to diuretic therapy and digitalis.
At age 3, the patient had received trauma resulting
in kyphoscoliosis and necessitating spinal fusion at
age 14. He had always had shortness of breath on
exertion and used two pillows to sleep. There was
no history of chest pain, cyanosis, angina, hemoptysis,
or pneumonia. From 1958 to 1961 he had gained 50
lbs., with worsening of his dyspnea on exertion, and
swelling of his legs. On treatment with digitalis and
diuretics he lost 40 lbs., but in November 1962 he
noted the rather sudden onset of leg swelling that
gradually progressed to the time of admission, with
more rapid progression in the last three months.
Physical examination revealed marked kypho-
scoliosis. His weight was 1 65 lbs. The neck veins
were distended at 45° with A and V waves present.
The heart rhythm was normal with a rate of 90.
The blood pressure was 120/80. There were no
murmurs or gallops. The pulmonic second sound
was increased with a fixed split. Rales were heard
in both lung bases. The abdomen was distended
and a fluid wave was elicited. The liver was non-
tender and its edge was palpable 10 fingerbreadths
below the right costal margin. There was 3 plus
pitting edema of both legs, slightly more marked on
the right, with scattered blebs and some questionable
cellulitis. The penis was edematous. There was
questionable cyanosis of the nail beds.
Laboratory Studies: The hemoglobin was 19.7
Gm., the hematocrit 66 per cent; the white blood cell
count was normal with a normal differential count.
The urine was normal except for 5 mg. of protein.
The blood urea nitrogen was 37 mg. and the creati-
nine 2.5 mg. per 100 ml. The direct van den Bergh
was 2.1 mg., the total bilirubin 3.1 mg. per 100 ml.
Sodium, potassium, and chloride values were normal;
Submitted December 21. 1965.
Presented by
• C. D. Schoenfeld, M. D., Columbus, and
• C. R. Macpherson, M. D., Columbus.
Edited by Dr. Macpherson.
the C02 combining power was 36 mEq/liter. Liver
function tests were normal. The prothrombin time
was 60 per cent of normal. The alkaline phosphatase
was 9 units. The total protein was 7.1 Gm. per 100
ml. (albumin 3.3, globulin 3.8 Gm.). The serologic
test for syphilis was nonreactive. A tuberculin skin
test was negative. The venous pressure was 390.
The electrocardiogram revealed right ventricular hy-
pertrophy and incomplete right bundle branch block.
The intravenous pyelogram was normal. Cardiac
fluoroscopy revealed right ventricular enlargement
with pulmonary congestion and a gibbus at the cervi-
codorsal level.
The patient was treated with digitalis and various
diuretics and had one phlebotomy. This treatment
produced a weight loss of 8 lbs. in 23 days. His
dyspnea improved slightly. At the time of discharge
his left leg was slightly larger than the right.
After his discharge, he was followed in the Out-
patient Department and during the first month he
lost 25 lbs. on oral diuretics, but from January of
1964 until his second admission he gradually gained
15 lbs. Pulmonary function studies showed 33 per
cent timed vital capacity.
Second Admission
In July 1964 he was readmitted to University Hos-
pital with increased shortness of breath and ab-
dominal swelling. One week prior to admission he
developed a cold with a cough productive of yellow
sputum. There had been no hemoptysis. He also
noted anorexia and a watery diarrhea for three days,
associated with increase in abdominal girth and leg
edema. He denied any chills or fever.
On admission he was in mild respiratory distress
with a respiratory rate between 26 and 30 per minute.
242
The Ohio State Medical Journal
His temperature was 98°F. The blood pressure was
120/90, the pulse 110. There was obvious cyanosis
of the lips and nail beds. There was marked kypho-
scoliosis. The neck veins were distended at 90°.
Generalized rales were heard over both lungs. The
heart was in normal sinus rhythm. A right ventricu-
lar heave was present. No murmurs were heard.
The liver edge was palpated 15 cm. below the right
costal margin. The abdomen was nontender and
distended, but no fluid wave was elicited. There was
4 plus pitting edema of both legs to the presacral area.
Laboratory examinations showed a hematocrit of
70 per cent, hemoglobin of 21 Gm.; the white blood
cell count was 10,800 with a normal differential
count. The urine was normal. The prothrombin
time was 34 per cent of normal. The blood urea
nitrogen was 51 mg., the creatinine 2.4 mg., and the
fasting blood sugar was 82 mg. per 100 ml. The
serum electrolytes were normal, the C02 41 mEq/
liter. Sputum cultures were noncontributory. The
electrocardiogram was unchanged from that of the
first admission.
Treatment of the patient was started with procaine
penicillin, 600,000 units every 14 hours, in addition
to digitalis and various diuretics. He lost 13 lbs. in
the first three hospital days. Because of thick sputum,
increased shortness of breath, and a semicomatose
state, tracheotomy was performed on the second hos-
pital day, and he was placed on a Bird respirator.
Arterial gas studies done on the following day
showed an 02 saturation of 99.5 per cent, a C02
content of 99.5 per cent. The pH was 7.27, the
pC02 was 96. He was on the Bird respirator at this
time, breathing 40 to 60 per cent oxygen.
On his fourth hospital day a Rochester catheter
broke off at the hub and it was believed that the
plastic end had remained in the patient’s arm. An
x-ray showed no foreign body present in the left
upper arm or elbow. A cutdown was performed im-
mediately above the site to prevent any dislodgment.
On his sixth day he had two episodes of ventricular
fibrillation. The first converted, but the second did
not respond to resuscitative efforts and he died. He
had remained afebrile throughout this stay.
CLINICAL DISCUSSION
Dr. Schoenfeld: One of the ways in which
a person faced with the task of discussion at a
clinicopathological conference can tell whether he is
doing well is to go to the library and find that all
the recent journals containing the references he
wanted to see are missing. This is what happened
to me, so I had to go to the older literature. The
forty-sixth aphorism of Hippocrates states, "Such
persons as become humpbacked from asthma or cough
before puberty die.” In this interesting man’s work
there is this other quotation:
In those cases where the gibbosity (that is, the hump) is
above the diaphragm, the ribs do not expand properly in
width, but forward, and the chest becomes sharp-pointed
and not broad and they become affected with difficulty of
breathing and hoarseness, for the cavities which inspire and
expire the breath do not attain their proper capacity.
We know that this is a classic disease and I think
that we are facing today a classic example of kypho-
scoliotic cardiorespiratory failure, the heart failure of
the hunchback.
This was a relatively young man when he died,
35 years of age. He had been sick for approximately
a year with leg swelling. The deformity of his
thorax began at the age of 3 years, and a spinal
fusion was done at the age of 14 years. Apparently
this did not result in adequate correction, as is so
often the case when there has been such a long delay.
He had always had shortness of breath. In the three
years prior to admission he gained 50 lbs. but lost
40 of it with digitalis and diuretics. We are not
told the size of the heart and this is not surprising.
One would expect that they couldn’t tell the size
by physical examination.
Laboratory data give us some clues. He had
marked polycythemia with a normal white count and
a normal differential, indicating that this is probably
a secondary polycythemia. The elevated blood urea
nitrogen, creatinine, and liver function tests I am
going to attribute to the presence of heart failure
and not discuss them any further. The electrocardi-
ogram showed signs of right ventricular enlargement.
The venous pressure was what we would expect it
to be. His left leg was slightly larger than the right.
He did pretty well after he was sent home, losing
another 25 lbs. of weight, but he began to gain it
back. Pulmonary function tests showed a marked
decrease in his breathing capacity.
Then in July of last year he caught cold and had
yellow sputum. He began to have anorexia and a
watery diarrhea. He was admitted and shown to be
in mild respiratory distress. I doubt that it was mild.
He was now quite cyanotic and had evidence of heart
failure. From the laboratory findings he was even
more polycythemic, yet his white count was still nor-
mal. His carbon dioxide combining power was
elevated. The electrocardiogram was unchanged. The
patient then lived for about six days. He lost weight
but became comatose and the arterial blood gases are
highly interesting. The oxygen saturation is normal
or supernormal, indicating that the Bird respirator
was getting some air down there or he was getting
it down there himself. However, the carbon dioxide
content and the carbon dioxide tension in his arterial
blood were markedly increased, indicating that many
of the alveoli, most of them in fact, were not being
ventilated.
Then we have the red herring. A Rochester cath-
eter broke off at the hub. I would choose to ignore
this. These little plastic things have been broken
off within the right heart many times and have not
caused any particular disability. They just lie along
the pulmonary artery and don’t do much of anything.
Then our patient, still in his semicomatose state,
for March , 1966
243
died suddenly with ventricular fibrillation and did
not respond to resuscitative efforts.
1 don’t think there is any question about the diag-
nosis, but I think the basis for our discussion should
be the nature of this disease.
The etiology of the kyphosis is interesting. Eighty
per cent of cases in the orthopedic literature are now
classified as "idiopathic.” A large number used to
be due to polio. An equally large number were due
to tuberculosis in childhood. Often children are ex-
amined and told that they don’t have enough scoliosis
to worry about. This is a rather dangerous thing
because most of them will progress. The idiopathic
and general varieties do progress relentlessly. They
all have small lung volumes; the vital capacity is re-
duced; the residual volume is reduced; the total lung
capacity is reduced. Second, the work involved in
breathing is very great. The work is increased by
a factor of four or five times.
Work of Ventilation
It has been shown that the patient with kypho-
scoliosis must exert a greater pressure difference in
order to distend his lungs. In normal people, about
20 per cent of the work they do in breathing is to
overcome the elastic resistance of the chest; the re-
maining 80 per cent is to overcome the elastic resist-
ance of the lungs. In these patients the ratio may
be virtually reversed, so that 50 to 60 per cent of
the work they do in breathing is to move the chest.
What else do they do? They breathe rapidly and
very shallowly. Their vital capacity is usually a
third to a half normal. What does this do? The
dead space in most of us is about 150 ml. We cannot
change our dead space at will. They take more
breaths and shallower breaths, but the dead space
thwarts the mechanism. It leads to an inadequate
delivery of air to the alveoli — alveolar hypoventila-
tion. They don’t deliver enough oxygen to the ar-
terial blood, so there is arterial hypoxemia. They
don’t extract enough C02 from the venous blood,
so that some goes on past the alveolus; the carbon
dioxide content and tension in the arterial blood go
up. He has now much the same situation as the
patient with emphysema.
Carbon Dioxide Narcosis
Next, he becomes insensitive to carbon dioxide.
This is an important factor. The main stimulus to
breathing is the retention of carbon dioxide. If you
are faced with large concentrations of this you can’t
go around hyperventilating all day. The brain pro-
tects itself from becoming insensitive to carbon
dioxide administration. When the C02 goes up too
high these patients no longer respond to it and they
develop carbon dioxide narcosis. They become som-
nolent and if you bring them into the hospital and
give them oxygen they get pink and they go to sleep.
Carbon dioxide narcosis doesn’t respond to simple
oxygen administration; in fact, this is the most com-
mon cause of death in people with kyphoscoliotic heart
disease. They are given Demerol® or morphine, and
oxygen to breathe. These people are dependent
upon their arterial hypoxia to keep them breathing. If
you take that away, they lose the stimulus to breathe.
Also they are so very sensitive that if you depress
their respiratory centers with narcotics, then virtually
they have no drive toward breathing. The literature
is full of cases that said, "The patient received l/?
grain of morphine (or 100 mg. of meperidine) and
died two hours later.”
Arterial Hypoxia and Sequelae
The other thing they have is arterial hypoxia and
it causes pulmonary hypertension. This may not be evi-
dent at rest, but with mild exercise it increases. An-
other response to hypoxia of course is polycythemia.
Polycythemia leads to an increased blood viscosity
that may be a factor in pulmonary hypertension. We
are not sure.
So the patients can be divided into three groups.
First, there is the large group of patients who show
no symptoms. These are people who have a scoliosis
of less than 100°. Kyphosis in itself causes little
respiratory difficulty until it becomes very severe. The
scoliosis is essential. The second group patients have
dyspnea on exertion as their only cardiorespiratory
symptom. Patients in the third group have cor pul-
monale and are usually cyanotic.
Treatment
What can we do to treat them? We can attack the
problem of alveolar hypoventilation by using a Bird
respirator. You can apparently increase the tidal
volume at no energy cost. They should not receive,
when they are severely ill, pure oxygen or even 40
per cent oxygen; they should only receive intermit-
tent positive pressure breathing. If they are in-
fected, of course we can treat them with antibiotics.
They respond to digitalis and diuretics just like any-
body else. The increased blood viscosity and blood
volume that go along with polycythemia can be re-
lieved by phlebotomy. This is one group that should
be phlebotomized to as near a normal hematocrit as
possible. Many of these patients used to die within
a year after they became cyanotic. The more recent
reports indicate that they can be carried three, four,
five and six years and a few even longer.
These patients at autopsy often have pulmonary
emboli or pulmonary thrombi of long or short dura-
tion. I think that may well have happened to our
patient here — something made him worse in a hurry
while he was under good medical management. So
I would predict that we will find all the usual changes
with kyphoscoliotic heart disease, and that in addi-
tion we may find severe bronchial infection and
possibly pulmonary emboli or thrombi.
Dr. Carhart: Would you anticoagulate these
people when they are in serious difficulties, with
polycythemia ?
244
The Ohio State Medical Journal
Dr. Schoenfeld : Nobody has much experience,
but I suspect we should anticoagulate as well as do
phlebotomies.
Medical Student: What about evaluating the
children? I presume that’s where you have to try to
prevent kyphoscoliotic heart disease?
Dr. Schoenfeld: This is an excellent point. It
has been shown that the patients who have no more
than 40 per cent decrease in their vital capacity do
not go on to develop cardiorespiratory difficulties.
So that a good way to follow the patient when he is
a child is to do repeated vital capacities upon him.
If this begins to diminish, then we should seriously
consider a surgical approach to try and stabilize him.
CLINICAL DIAGNOSIS
1. Kyphoscoliotic heart disease, traumatic origin.
2. Bronchopneumonia.
3. Cor pulmonale.
4. Pulmonary emboli.
PATHOLOGIC DIAGNOSIS
1. Kyphoscoliotic heart disease, traumatic origin.
2. Bronchitis.
3. Pulmonary emphysema.
4. Pulmonary thromboemboli.
5. Cor pulmonale.
6. Cardiac cirrhosis.
7. Sickle-cell trait.
8. Stress ulcers of stomach.
DISCUSSION OF PATHOLOGY
Dr. Macpherson: Dr. Schoenfeld’s discussion
was very complete, but there are a few additional
points that I think are of some interest. One obser-
vation in the literature is that the kyphosis is much
more significant if the gibbus is to the right rather
than to the left. Nobody seems to have a good
explanation for this, but there is probably more
obstruction to the free passage of air and to the aera-
tion of the alveoli. However, these patients are very
difficult pathologically because if you take a long-
standing pulmonary lesion you get secondary vascular
changes. This patient indeed showed these features.
In addition, one of the consequences of lesions
leading to inadequacy of pulmonary function is stress
ulceration of the stomach.
There is a highly significant statistical correlation
between pulmonary disease and gastric ulceration or
duodenal ulceration. In this case there were two
ulcers in the stomach which we assume to be stress
ulcers. He also showed a remarkably active bone
marrow for a man of his age. As possible explana-
tions of his hemolysis and bilirubinemia, we have
two factors. Patients with chronic pulmonary disease
develop congestion of the liver and eventually a
cardiac cirrhosis, which he had. In addition he had
a sickle-cell trait which was not picked up during
life but which shows up in some of the sections.
The first of the pictures shows one of the primary
lesions and you will notice there that he had disrup-
tion of the pulmonary parenchyma. These are the
broken off alveoli. Here is a small thrombus in a
vessel, and here he has a very abnormal vessel with
marked thickening of the muscular wall and some
thickening of the endothelium. He also has definite
thickening of the interalveolar septa. So there is
an emphysematous change in the lung which will of
course further embarrass his expiratory exchange, and
the vascular changes will further embarrass his cardiac
reserve. This is a really vicious cycle at this point.
The next slide shows quite a bit of hemorrhage
into the alveolar spaces. You will notice that the
red cells are irregularly shaped: they are crescent-
shaped, they are spiked, and here you have a sickle
— a classical crescent shape. The picture is suffici-
ently characteristic to diagnose sickle-cell trait. He
obviously didn’t have sickle-cell anemia with 20 Gm.
of hemoglobin, but there is no law that says that
you can’t have polycythemia on top of a sickle-cell
trait. I would think from the number and distribu-
tion of the thrombi that these were probably inci-
dental and did not contribute very greatly to his
death.
Here we have a picture of the trachea. You will
notice that the lining of the trachea shows massive
infiltration with red cells, edema, and acute ulceration
of the epithelium with some evidence of metaplasia.
This was taken from near the tracheostomy site.
Frequently we don’t realize that the various pieces
of equipment we insert do produce changes — some
of them significant, some of them not. In this case
you don’t see the associated infection which you often
see. He did have bronchitis but he did not have
bronchopneumonia, and I don’t think infection played
a significant part in his terminal stages. It may well
have done so a little earlier.
His liver was definitely cirrhotic to the naked eye,
and the histologic pattern is that of diffuse inter-
mingling of fibrous tissue with the trabeculae of the
liver. Bile stasis is not a prominent feature. This
is the picture of cardiac cirrhosis.
The only other point that remains to be dealt with
is the question of the catheter. The piece that broke
off was 3 cm. in length and at the autopsy the cath-
eter was found in the pulmonary artery. The pres-
ence of a catheter or other foreign body in the pul-
monary artery does not generally lead to arrhythmias.
However, foreign objects in the outflow tract of the
right ventricle characteristically lead to arrhythmias.
Under experimental conditions it can be shown that
a shower of artificial emboli, if injected into experi-
mental animals, causes an increase, in some cases a
sudden increase, in pulmonary artery pressure. Since
the catheter was lying loose in the pulmonary artery,
for March, 1966
245
somewhere close to the right ventricular outflow tract,
it is possible that the catheter did trigger off attacks of
ventricular fibrillation. It might have given rise to
minute emboli from intimal abrasion. There is no
way we can prove it.
This is then a case of classical kyphoscoliotic heart
disease. There were vascular changes in the lung
that were probably part of the normal progession
of the disease. He also showed stress ulcerations of
the stomach and a coincidental sickle-cell trait which
was probably not of any great significance except that
it does account for the hemolysis. Finally, he had
a cardiac cirrhosis which was interesting because at
autopsy the liver edge was still 10 cm. below the
costal margin. With kyphoscoliosis you get dis-
placement, and actually his liver weighed only 1200
grams. So he had a small, cirrhotic liver that was
pushed down a long way by his anatomic distortion.
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246
The Ohio State Medical Journal
Maternal Health in Ohio
Adequate Prenatal Care
“Be Good to Mother Before Baby Is Born”
ANTHONY RUPPERSBERG, Jr., M. D.*
THE primary purpose of this column is to present
material obtained from experiences gained
through operation of the Ohio Maternal Mor-
tality Study, for the information and education of
Ohio physicians who practice obstetrics.
At a meeting last year of The Council of the Ohio
State Medical Association, as the author delivered
the official annual report of the Committee on Mater-
nal Health, members displayed maximum interest in
the "Ohio Study.” One member of Council asked
questions concerning "Child Outcome” in maternal
deaths, while another posed a question related to
the significance of prenatal care connected with mater-
nal mortality.
Based upon these points of inquiry, this article is
devised to present a preliminary survey of statistics
from the Ohio Maternal Mortality Study relative to
"Child Outcome” and "Prenatal Care” associated
with maternal mortality. The article is not to be
considered as a primary personal accomplishment of
the author, but rather as a tribute to the committee
and numerous other physicians throughout Ohio,
who have contributed richly to the study in both time
and effort.
Child Outcome
By action of the OSMA House of Delegates, April
23, 1953, and follow-up action of The Council,
January 10, 1954, the Committee on Maternal Health
operates a continuous Maternal Mortality Study 1
throughout the 88 counties of Ohio. Essentially des-
ignated to study maternal deaths, the mission of the
committee has not been altered.
However, when the IBM Data Processing System
was developed for the study in 1958, a small segment
of the code sheet was designated to collect a modest
amount of information concerning the child, or "fetal
outcome.”
In this project a search was made for the number
of maternal deaths and their primary causes, during
*Dr. Ruppersberg, Columbus, is Chairman, Committee on Maternal
Health, Ohio State Medical Association.
Submitted January 17, 1966.
an eight year period, 1955-1962 (see Tables 1 and 2).
As stated previously in this column, "hemorrhage”
holds a questionable honor as the leading primary
cause of maternal deaths in Ohio.2
Table 1. Category of IBM Cards, 8 Years, 1955-1962,
Ohio Maternal Mortality Study
Rejects (No Case) 21
Cases Incomplete 57
Nonmaternal Deaths 177
Maternal Deaths 643
Undetermined 2
Total 900
Table 2. Classification of Cause of Death, 643 Maternal
Deaths, 8 Years, 1955-1962, Ohio Maternal Mortality
Study
Hemorrhage 165
Infection 120
Toxemia 75
Other Causes 283
Total 643
Further studying the 643 maternal deaths, it was
found that 280 babies were born alive; of these, two
died a neonatal death (Table 3). While 123 mothers
died undelivered, postmortem cesarean sections de-
livered fifteen living babies (included in the 280).
Eleven stillborn babies occurred in this series. The
ectopic pregnancies, abortions, etc., are omitted from
comment.
Table 3. Child Outcome, 643 Maternal Deaths, 8 Years,
1955-1962, Ohio Maternal Mortality Study
Not Recorded 5
Pt. died undelivered 123
Live Births 280
(Neonatal Deaths 2)
Stillborn 11
Excluded 224
Total 643
In this study, terminology and classification of ges-
tational age as stated are based upon fetal weights,
in accordance with modern accepted standards.
The majority of the mothers, 352 (54.7 per cent)
reached term or near term in their gestation at the
for March, 1966
247
time of delivery or death. On the other hand, 135 of
the 643 women (20.9 per cent) carried a "premature”
gestation at the time of death or delivery (Table 4).
Table 4. Classification of Gestation, 643 Maternal Deaths,
8 Years, 1933-1962, Ohio Maternal Mortality Study.
Not Recorded 2
Immature (500-1000) Gm. ) 21
Premature (1001-2500 Gm. ) 135
Term (2501 Gm., or more) 352
Ecoptic, Abortion, Mole, etc 133
Total 643
Prenatal Care
Currently the medical profession is having attention
drawn more and more towards the importance of
good prenatal care. This especially pertains to the
segment which provides obstetric care for the preg-
nant or puerperal patient. Since its incipience, the Com-
mittee on Maternal Health has placed emphasis on this
phase of obstetric care. "Adequate prenatal care” has
been described in "Guiding Principles for Obstetric
Care”3; developed by the Committee, the precepts pro-
vide a yardstick upon which variations in care are meas-
ured. Emphasis has been directed not only toward
the prevention of maternal deaths, but in support of
"Maternal Health in Ohio,” to the happy end that all
mothers might lead a normal life, fulfilling the pleas-
ant duties of a mother raising a family.
To summarize a few facts from data available, the
cases were examined for certain information relative
to prenatal care received by the patient before her
death. Our data indicate 305 patients received
adequate prenatal care in this series (Table 5). Of
these 123 died undelivered. One hundred eighty-two
living babies were delivered from the 305 mothers;
this figure, in comparison, is at least three times the
number represented by patients who received either
no prenatal care or inadequate care.
Table 5. Prenatal Care and Child Outcome, 643 Maternal
Deaths, 8 Years, 1933-1962, Ohio Maternal Mortality Study.
No. Patient
Prenatal Care from
Available Information
of
Cases
Died Un-
delivered
Live
Births
Care Not Reported
62
22
14
No Prenatal Care
63
9
27
Adequate Prenatal Care
305
44
182
Inadequate Prenatal Care
122
22
57
Excluded
91
26
0
Total
643
123
280
Discussion
It is obvious to the author, as well as to the reader,
that although the statistics presented above are not
conclusive, we may glean certain valid impressions
from a study of the figures. (1) Omitting the "ex-
cluded group,” of 552 mothers who died, 280 babies
(50.7 per cent) were salvaged, either antepartum,
intrapartum or postpartum. (2) The incidence of
"premature” gestation (135 among the 510) is
relatively higher than might be expected. (3) Facts
and figures concerning prenatal care of any patient
in this series are fraught with a certain amount of error
due principally to omission of statement or inaccurate
estimation of "adequacy” as recorded on available
documents.
Johnston4 studied 23,717 deliveries occurring in
Jefferson Davis Hospital during five years, 1957-1961.
Forty per cent of the mothers delivered were reg-
istered in the prenatal clinic, with adequate prenatal
care, while approximately 50 per cent of the mothers
delivered had inadequate care or sought no profes-
sional advice during pregnancy. He found that in
all three groups, immature, premature and term preg-
nancies, the perinatal mortality rate was consistently
higher for the non-clinic patient (inadequate prenatal
care) . Over the five-year period, one woman in five
had a hemoglobin of 10 grams or less and among 635
cases of syphilis, due to lack of prenatal care more
than half of the patients received no antisyphilitic
treatment during their pregnancies.
Some fascinating discoveries related to prenatal
care in the Philadelphia area were published by Kane.5
Data from 144 eastern hospitals were received and
processed on computer facilities; 409,766 case rec-
ords were reviewed covering two years, 1961-1962.
Mortality was used as a yardstick rather than diag-
nostic entities; terminology was the same as that listed
in Table 4 (above). Kane found that progressive
increase in the number of pregnancies is related to an
increase in mortality of the newborn infant, in opposi-
tion to older beliefs; previous pregnancy experience
is a major factor in infant survival. Quantitative in-
crease in prenatal care, above certain basic levels, does
not materially influence the end result for the infant,
except during the first pregnancy. There is a great
need for epidemiologic studies to evaluate the prob-
lems of "bad- risk mothers.”
Conclusion
1. A survey of records in the Ohio Maternal Mor-
tality Study, relative to "Child Outcome” in the face
of maternal death, is presented.
2. Two hundred eighty babies were born alive
among 643 mothers who died. Fifteen of the live-
born survived postmortem cesarean section.
3. The incidence of live births among mothers
who received adequate prenatal care is markedly
higher than among mothers who received inadequate
prenatal care, or none at all in this study.
4. This fact alone supports general aims of the
Committee on Maternal Health to improve prenatal
care among pregnant patients, in order to insure both
maternal and fetal health.
"Be good to Mother, before Baby is Born.”
References
1. Maternal Mortality Study, Statewide Basis. Ohio State M. }..
51:886-888, (September) 1955.
2. Committee on Maternal Health: Maternal Mortality Report for
Ohio — 1962. Ohio State M. ]., 61:1103-1105 (December) 1965.
3. Guiding Principles for Obstetric Care. Ohio State M. ]., 53:
1328-1329, 1957. (Revised 1963.)
4. Johnston, Robert A., et ah: Prenatal Care. Southern Med.
57:399-402 (April) 1964.
5. Kane, Sydney H.: Significance of Prenatal Care. Obstet. &
Gynec., 24:66-72 (July) 1964.
248
The Ohio State Medical Journal
Utilization Review Under Medicare . . .
Under Conditions for Participation. Hospital Approved by the
Joint Commission Must also Meet Utilization Review Criteria
IN ORDER to participate as a hospital under the
Medicare law, an institution currently accredited
by the Joint Commission on Accreditation of Hos-
pitals will be deemed to meet all of the conditions of
participation, except the requirement for utilization re-
view and, in the case of tuberculosis and psychiatric
hospitals, the additional staffing and medical records
requirements considered necessary for the provision of
intensive care. Consequently, a JCAH-approved gen-
eral hospital will be able to establish eligibility to
participate by furnishing adequate evidence that it has
an effective utilization review plan.
For hospitals which are not accredited, the condi-
tions of participation are modeled after, and are no
higher than, the requirements for accreditation of
the JCAH. The JCAH and its sponsors, the Ameri-
can College of Physicians, the American College of
Surgeons, the American Hospital Association, and
the American Medical Association, have for many
years been engaged in a program directed toward
the attainment of hospital care meeting professional
standards.
UTILIZATION REVIEW PLAN
As a condition of participation the hospital is
required to have in effect a plan for utilization
review which applies at least to the services fur-
nished by the hospital to inpatients who are en-
titled to benefits under the law. An acceptable
utilization review plan provides for: (1) the re-
view, on a sample or other basis, of admissions,
duration of stays, and professional services fur-
nished; and (2) review of each case of continuous
extended duration.
Introduction
There are many types of plans which can fulfill the
requirements of the law. Hospitals wishing to estab-
lish their eligibility to participate should submit a
written description of their utilization review plan and
a certification that it is currently in effect or that it
will be in effect on July 1, 1966. Ordinarily this will
constitute sufficient evidence to support a finding that
the utilization review plan of the hospital is or is not
in conformity with the statutory requirements. Inter-
mediaries will be relied upon heavily to participate
with the medical profession and the hospital admin-
istrative staff in long-run measures to assure that
utilization review operates effectively.
The review plan of a hospital should have as its
overall objective the maintenance of high quality pa-
tient care, and an increase in effective utilization of
hospital sendees to be achieved through an educational
approach involving study of patterns of care, and the
encouragement of appropriate utilization. It is con-
templated that a review of the medical necessity of
admissions and durations of stay, for example, would
take into account alternative use and availability of
out-of-hospital facilities and sendees. The review of
professional sendees furnished might include study of
such conditions as overuse or underuse of sendees,
logical substantiation of diagnoses, proper use of con-
sultation, and whether required diagnostic workup
and treatment are initiated and carried out promptly.
Review of lengths of stay might consider not only
medical necessity, but the effect that hospital staffing
may have on duration of stay, whether assistance is
available to the physician in arranging for discharge
planning, and the availability of out-of-hospital faci-
lities and sendees which will assure continuity of care.
Costs incurred in connection with the implementa-
tion of the utilization review plan are includable in
reasonable costs and are reimbursable to the hospital
to the extent that such costs relate to health insurance
program beneficiaries. For example, costs may in-
for March , 1966
2 49
elude expenses incurred for the purchase of data from
organizations outside the hospital which compile sta-
tistics, profiles, and study results on utilization of hos-
pital facilities and services.
Standard A
The operation of the utilization review plan is
a responsibility of the medical profession. The
plan in the hospital has the approval of the medi-
cal staff as well as that of the governing body.
Standard B
The hospital has a currently applicable, written
description of its utilization review plan. Such
description includes:
• The organization and composition of the com-
mittee (s) which will be responsible for the utili-
zation review function;
• Frequency of meetings;
• The type of records to be kept;
• The method to be used in selecting cases on a
sample or other basis;
• The definition of what constitutes the period
or periods of extended duration;
• The relationship of the utilization review
plan to claims administration by a third party;
• Arrangements for committee reports and
their dissemination;
• Responsibilities of the hospital’s administra-
tive staff.
Standard C
The utilization review function is conducted by
one or a combination of the following:
• By a staff committee or committees of the
hospital, each of which is composed of two or more
physicians, with or without the inclusion of other
professional personnel; or
• By a committee(s) or group (s) outside the
hospital composed as above which is established by
the local medical society and some or all of the
hospitals and extended care facilities in the locality;
or
• Where a committee (s) or group (s) as de-
scribed in the first or second paragraph of this
standard has not been established to carry out all
the utilization review functions prescribed by the
Act, by a committee (s) or group (s) composed as
in the first paragraph above, and sponsored and
organized in such manner as approved by the
Secretary of Health, Education, and Welfare.
Factor 1. The medical care appraisal and educa-
tional aspects of review on a sample or other basis,
and the review of long-stay cases need not be done
by the same committee or group.
Factor 2. Existing staff committees may assume
the review responsibility stipulated in the plan. In
The accompanying article is presented by The
Journal as factual information, without editorial
comment, in the interest of keeping physicians
abreast of regulations under the Medicare Law.
The introductory paragraphs are excerpted from
the pamphlet "Conditions of Participation for
Hospitals,” issued by the U. S. Department of
Health Education, and Welfare, Social Security
Administration. The standards under "Utiliza-
tion Review Plan” are quoted bodily from the
same pamphlet.
smaller hospitals, all of these functions may be carried
out by a committee of the whole or a medical care ap-
praisal committee.
Factor 3. The committee(s) is broadly represen-
tative of the medical staff and at least one member
does not have a direct financial interest in the hospital.
Standard D
Reviews are made, on a sample or other basis,
of admissions, duration of stays, and professional
services furnished, with respect to the medical
necessity of the services, and for the purpose of
promoting the most efficient use of available health
facilities and services. Such reviews emphasize
identification and analysis of patterns of patient
care in order to maintain consistent high quality.
The review is accomplished by considering data
obtained by any one or any combination of the
following:
• By use of services and facilities of external
organizations which compile statistics, design pro-
files, and produce other comparative data; or
• By cooperative endeavor with the fiscal inter-
mediary (ies) in the locality; or
• By internal studies of medical records.
Factor 1. Reviews of cases, based on diagnostic
categories, include diagnoses of special relevance to
the aged group.
Factor 2. Some review functions are carried out
on a continuing basis.
Factor 3. Reviews include a sample of recertifica-
tions of medical necessity, as made for purposes of
the Health Insurance for the Aged Program.
Standard E
Reviews are made of each beneficiary case of
continuous extended duration. The hospital uti-
lization review plan specifies the number of con-
tinuous days of hospital stay following which a
review is made to determine whether further in-
patient hospital services are medically necessary.
The plan may specify a different number of days
for different classes of cases. Reviews for such
250
The Ohio State Medical journal
purpose are made no later than the seventh day
following the last day of the period of extended
duration specified in the plan. No physician has
review responsibility’ for any extended stay cases
in which he was professionally involved. If physi-
cian members of the committee decide, after op-
portunity for consultation is given the attending
physician by the committee, and considering the
availability and appropriateness of out-of-hospital
facilities and sendees, that further inpatient stay is
not medically necessary7, there is notification in
writing within 48 hours to the institution, the at-
tending physician and the patient or his represen-
tative.
Factor 1. Because there are significant diver-
gences in opinion among individual physicians in
respect to evaluation of medical necessity for inpatient
hospital sendees, the judgment of the attending physi-
cian in an extended stay case is given great weight,
and is not rejected except under unusual circumstances.
Standard F
Records are kept of the activities of the com-
mittee; and reports are regularly made by the
committee to the executive committee of the medi-
cal staff and relevant information and recom-
mendations are reported through usual channels
to the entire medical staff and the governing body
of the hospital.
Factor 1. The hospital administration studies and
acts upon administrative recommendations made by
the committee.
Factor 2. A summary of the number and types
of cases reviewed, and the findings, are part of the
records.
Factor 3. Minutes of each committee meeting are
maintained.
Factor 4. Committee action in extended stay cases
is recorded, with cases identified only by hospital case
number.
Standard G
The committee (s) having responsibility for
utilization review7 functions have the support and
assistance of the hospital’s administrative staff in
assembling information, facilitating chart reviews,
conducting studies, exploring ways to improve
procedures, maintaining committee records, and
promoting the most efficient use of available health
services and facilities.
Factor 1. With respect to each of these activities,
an individual or department is designated as being
responsible for the particular sendee.
Factor 2. In order to encourage the most efficient
use of available health sendees and facilities, assist-
ance to the physician in timely planning for post-
hospital care is initiated as promptly as possible,
either by hospital staff, or by arrangement with other
agencies. For this purpose, the hospital makes avail-
able to the attending physician current information
on resources available for continued out-of-hospital
care of patients and arranges for prompt transfer of
appropriate medical and nursing information in or-
der to assure continuity of care upon discharge of
a patient.
^ ritten Prescription Required
For Class A Narcotic Drugs
Numerous inquiries have been made by physicians
as to the law’ in regard to telephone prescriptions for
narcotic dmgs. The following communication is the
text of a letter addressed to a physician by Rupert
Salisbury, Ph. D., executive secretary’ of the State
Board of Pharmacy’ of Ohio, and explains the law
on this subject:
”1 have been asked by a pharmacist to explain to
you the Narcotic Laws, both Federal and State under
which you and the pharmacists in this state must
operate. This is with specific reference to Class A
narcotic drugs. Such drugs require an original writ-
ten and signed prescription to be in the receipt of
the pharmacist prior to delivery of such dmgs.
The operative section of the law here is Sec-
tion 151.397 of the Federal Narcotic regulations.
This has to do w’ith telephone orders and it states '(a)
where w*ritten prescriptions signed by the practitioner
are required, the furnishing of narcotics pursuant to
telephone advice of practitioners is prohibited, whether
signed prescriptions covering such orders are subse-
quently received or not, but in an emergency’, a drug-
gist may deliver or have delivered through his respon-
sible employee or agent, narcotics pursuant to a
telephone order, provided a properly prepared signed
prescription is supplied before delivery is made which
shall be filed by the dmggist as required by law.’
"This section is quite clear and in the event that
you w’ish a Class A narcotic dispensed to one of your
patients, the pharmacist must be furnished with a
signed original prescription prior to such delivery.
Such dmgs as Demerol, morphine, alone or in com-
bination, constitute Class A narcotics.
"Codeine when in admixture with other dmgs such
that the narcotic effect is masked by the therapeutic
effect of the other dmgs, falls into the Class B nar-
cotic category and here an oral prescription over a
telephone is sufficient and no written prescription is
required. However, this holds tme only for codeine
in admixture, codeine alone, in any strength, is a
Class A narcotic dmg.
" Should you have any questions about these laws
and their interpretation, the Board of Pharmacy
would be most happy to answer them."’
for March , 1966
251
associated with
Gastroenteritis
Spastic bowel
Infiuenza-like
Infections
Antibiotic
administration
1
israiasii
normal activity
promptly...
252
The Ohio State Medical Journal
In children with diarrhea prompt symptomatic control is usually
urgently indicated to relieve cramping and to prevent dehydration.
Lomotil halts precipitous progress through the intestines and
controls diarrhea with notable promptness, safety and effectiveness.
Experimental evidence1 has shown that Lomotil is more efficient
in this regard than morphine without the latter’s manifest disad-
vantages. In roentgenographic study2 Lomotil slowed gastrointesti-
nal propulsion within two hours.
At the same time, by diminishing overstimulation of the intestines,
Lomotil relieves the abdominal cramps and discomfort so distress-
ing to youngsters.
Lomotil gets children off toast and tea and back to normal diets
and normal activity with gratifying celerity.
with
LOMOTIL liquid/tablets
Each tablet and each 5 cc. of liquid contains:
diphenoxylate hydrochloride
(Warning: may be habit forming)
atropine sulfate
2.5 mg.
0.025 mg.
Dosage: For full therapeutic effect— Rx full
therapeutic dosage. The recommended ini-
tial daily dosages, given in divided doses,
until diarrhea is controlled, are:
Children :
3 to 6 months— 3 mg.
(V2 tsp* t.i.d.)
6 to 12 months— 4 mg.
(V2 tsp. q.i.d.)
1 to 2 years— 5 mg.
m/2 tsp. 5 times daily)
2 to 5 years— 6 mg.
(1 tsp. t.i.d.)
5 to 8 years— 8 mg.
(1 tsp. q.i.d.)
8 to 12 years— 10 mg.
(1 tsp. 5 times daily)
Adults: 20 mg. (2 tsp. 5 times daily or 2
tablets 4 times daily)
*Based on 4 cc. per teaspoonful.
Maintenance dosage may be as low as one
fourth the therapeutic dose.
Precautions: Lomotil, brand of diphenoxy-
late hydrochloride with atropine sulfate,
is an exempt narcotic preparation of very
low addictive potential. Recommended
dosages should not be exceeded. Lomotil
should be used with caution in patients
with impaired liver function and in pa-
tients taking addicting drugs or barbitu-
rates. The subtherapeutic amount of
atropine is added to discourage deliberate
overdosage.
Side Effects: Side effects are relatively un-
common but among those reported are
gastrointestinal irritation, sedation, dizzi-
ness, cutaneous manifestations, restlessness
and insomnia.
1. Janssen, P. A. J., and Jageneau, A. H.: A
New Series of Potent Analgesics: Dextro
2:2-Diphenyl-3-Methyl-4-Morpholinobutyryl-
pyrrolidine and Related Amides. Part 1:
Chemical Structure and Pharmacological
Activity, J. Pharm. Pharmacol. 9:381-400
(June) 1957.
2. Demeulenaere, L.: Action du R 1132 sur
le transit gastro-intestinal, Acta Gastroent.
Belg. 27:674-680 (Sept.-Oct.) 1958.
SEARLE
Research in the Service of Medicine
for March, 1966
2 53
Medicare Intermediaries in Ohio . . .
Two Companies Will Administer Payment of Physicians’
Bills in This State Under Part B of the Medicare Law
7\ MONG 48 organizations in the health insurance
Z-j\ field named to serve as contractors under
-4- Part B of the Medicare Law, two have been
designated in Ohio.
Medical Mutual of Cleveland, Inc., is being offered
the contract as intermediary for the counties of Ash-
tabula, Cuyahoga, Geauga, Lake, and Lorain, accord-
ing to information issued from the Social Security
Administration in mid-February.
Nationwide Mutual Insurance Company, with head-
quarters in Columbus, is being offered the contract
for the other counties in the state.
Among the 48 organizations selected are 32 Blue
Shield plans, 15 insurance companies, and one inde-
pendent health insurer. The selected Blue Shield
plans will serve 59 per cent of the Nation’s Medicare
beneficiaries, according to the Social Security Admin-
istration; the insurance companies, 38 per cent; and
the independent insurer, 1 per cent.
The contractors will receive and pay physicians’
bills of older people signed up for the voluntary
medical insurance, or Part B of the Medicare Law,
under one-year contracts, subject to renewal upon
satisfactory performance. Selection of contractors is
tentative, subject to agreement as to contract condi-
tions between the individual organizations and the
government.
In making these announcements, Robert M. Ball,
Commissioner of Social Security, included the fol-
lowing information in his statement:
"The medicare beneficiaries who are members of
certain group practice prepayment plans will nor-
mally not be served by the area contractor, but by
their own plan under special contractual arrange-
ments with the Government. Plans like the Kaiser
Foundation Health Plan on the West Coast, Health
Insurance Plan of New York, Group Health Associa-
tion in Washington, D. C.; Group Health Coopera-
tive of Puget Sound in the State of Washington and
the Community Health Association of Detroit will
fall in this category.
Possible State Agencies
' Where a State enters into an agreement with the
Secretary to pay the supplementary medical insurance
program premiums on behalf of its aged welfare
recipients, the agreement may provide for a desig-
nated State agency to serve as a contractor, but only
on behalf of its welfare recipients. In that case, the
State agency, rather than the area contractor, will
serve these beneficiaries. A number of State welfare
agencies have indicated that they may want this
arrangement.
"Under their contracts with the Government, the
individual contractor’s primary responsibility will be
to pay the reasonable charges for physician and other
health services. In determining reasonable charges
the contractors will consider the usual and customary
charges made by physicians, as well as the prevailing
rates in the area for similar services.
"In paying for physicians’ services, the contractor
must assure that the charges it pays are no higher
for medicare patients than for comparable services
and under comparable circumstances for its own pol-
icyholders or subscribers.
Safeguards
"Contractors will also be concerned with safe-
guards against unnecessary utilization of covered serv-
ices and will be required to maintain such records
and furnish such information as the Government
finds necessary.
"All organizations were evaluated carefully for their
ability to maintain good professional relations with
physicians, medical societies, and other professional
groups. Under terms of its contract, a contractor
will be required to work closely with medical so-
cieties and their medical review committees in the
area in which it operates to carry out its respon-
sibility for determining the rates and amounts of
payments to physicians and for providing safeguards
against unnecessary or improper utilization of services.
It will also work closely with other professional
groups whose services are covered under the program.”
Diagnostic Radiology
On Saturday and Sunday, April 16 and 17, Dr.
Edward B. Singleton, director of radiology, St. Luke’s
and Texas Children’s Hospital, Houston, Texas, will
deliver the eighteenth annual Joseph and Samuel
Freedman Lectures in Diagnostic Radiology at the
University of Cincinnati College of Medicine. Radi-
ologists desiring to attend are requested to write for
further details to Dr. Benjamin Felson, Department
of Radiology, Cincinnati General Hospital.
254
The Ohio State Medical Journal
Preview of Practice
• •
Medical Students of Two Ohio Schools Receive Pointers
On the Practical Side of Practice as Guests of the OSMA
THE OSMA Committee on Rural Health pre-
sented its annual program, "When You Begin
Practice,” at the Ohio State University and the
University of Cincinnati on February 5 and 6.
This special series of talks for junior medical stu-
dents and their wives or girl friends was greeted at
both universities with much enthusiasm, both in
numbers and interest.
The programs consisted of an afternoon of prac-
tical pointers on the economical, legal and family
aspects of setting up practice, some sound ideas on
the "art” of medicine and an indication of what the
future practice might be like under some of the
existing governmental programs.
The afternoon programs were followed with social
hours which permitted members of the Committee
on Rural Health and the speakers to discuss, in-
formally, many questions raised by the students.
Following the dinners, the wives and girl friends
were given a general idea what it is like to be a
doctor’s wife. The program concluded with talks
which pointed out responsibilities of the physician to
his community and to his medical society.
A fourth speaker at the OSU program was Assist-
ant Dean of the Medical College, Dr. J. Hutchison
Williams.
This series of special talks, sponsored by the Com-
mittee on Rural Health in cooperation with the Col-
leges of Medicine and the campus chapters of the
Student American Medical Association, is primarily
designed to acquaint junior medical students with
the practice of medicine in smaller cities and towns
and in rural areas.
This year’s program for the Ohio State Univer-
sity students marked the 15th time these lectures
have been held at this school. This year’s was the
14th lecture series program conducted for the Cin-
cinnati medical students.
The Ohio State Medical Association, in recognizing
the importance of the Student AMA, presented
checks of $100, each, to the local chapters of this
organization.
This stipend is designated to be used to help defray
some of the expenses of a representative from each
chapter to attend the national meeting of the Student
AMA.
Hugh M. MacDonald, president of OSU chapter,
and John W. Robinson, president of the Cincinnati
chapter, received the checks on behalf of their or-
ganizations.
Richard L. Fulton, M. D., Columbus, Tenth Dis-
trict Councilor, presided at the OSU program and
Robert E. Howard, M. D., Cincinnati, First District
Councilor, presided at Cincinnati.
The program and speakers were as follows: "The
Family Physician: His Practice,” by Victor R. Fred-
erick, M. D., Urbana; "The Economics of Medical
Practice,” by Charles H. McMullen, M. D., Foudon-
ville, (at OSU), by John R. Polsley, M. D., North
Fewisburg, (at U. of C. ) ; "The Art of Medicine,”
by Harold C. Smith, M. D., Van Wert; "Medicare
and the Future Practice of Medicine,” by Jasper M.
Hedges, M. D., Circleville.
"The Physician’s Wife,” by Mrs. Victor R. Fred-
erick, Urbana; "The Physician and His Community,”
by Robert E. Reiheld, M. D., Orrville; and "The
Physician and His Medical Society,” presented by
Henry A. Crawford, M. D., Cleveland, president of
OSMA.
Dr. Reiheld Dr. Polsley Dr. Smith
for March, 1966
255
ill;,, ™ ,
Dr. Crawford
S'n.eahen.'i in the.
wWhen Y ou Begin Practice”
Series
(See also facing page )
Mrs. Frederick
Dr. Howard
Dr. Hedges
Dr. Frederick Dr. Fulton Dr. McMullen
Medical student group at the Cincinnati meeting.
256
The Ohio State Medical Journal
'CARE of tin© PATi EA/T7 1 9 6 6 ’
SHERATON-CLEVELAND
HOTEL
See THE NEW LOOK
COMPLETE. .DETAILED
t fj PROGRAM
ii APRIL ISSUE i
OHIO STATE
MEDICAL
JOURNAL
Come ... to Cleveland
o
State Medical Board Resolution
Pays Tribute to Dr. Platter
The following resolution was forwarded to The
Journal by Dr. Donald I7. Bowers, Columbus, interim
secretary of the State Medical Board:
RESOLUTION
"WHEREAS, Herbert Morris Platter, M. D., has
faithfully and devotedly performed his duties as
Secretary of the State Medical Board of Ohio for the
past forty-eight years, and
"WHEREAS, Dr. Platter has been a physician for
seventy-three years, during which he has served not
only the State Medical Board and the State of Ohio,
but also his patients, and has further been recognized
locally and nationally for his services and pioneer
efforts in postgraduate medical education, public
health measures, organization of the Federation of
State Medical Boards, and participation in the origi-
nal Medical Practice Act for the State of Ohio, and
"WHEREAS, The State Medical Board of Ohio
is aware of the exceptionally long and faithful serv-
ice, devotion, dedication, and interest to the Board,
to the State of Ohio, to the nation, as well as to the
medical profession, and
"WHEREAS, Dr. Platter has now signified his
desire to be relieved from his historic duties, and
"WHEREAS, The State Medical Board of Ohio
desires to express its gratitude to Dr. Platter for his
outstanding and remarkable contributions,
"NOW, THEREFORE BE IT RESOLVED by the
State Medical Board of Ohio that the Board on be-
half of itself and the State of Ohio extend its ap-
preciation and sincere gratitude to Dr. Platter for his
forty-eight years of faithful service to the Board, and
for his seventy-three years of continuous service to
the public, and
"BE IT FURTHER RESOLVED, That copies of
this Resolution be made available to the Governor of
the State of Ohio, the Ohio State University, the
American Medical Association, The Ohio State Medi-
cal Association, and the Federation of State Medical
Boards of the United States.
"Columbus, Ohio, this 17th day of December,
1965."
The resolution bears the signature of members of
the Board and is stamped with the Board’s official
Seal.
Dr. Platter, who retired at the age of 96, Decem-
ber 31, is making his residence in the Lutheran
Senior City, Columbus.
The Illinois State Medical Society is inviting physi-
cians from other states to attend its Spring conference
on narcotic addiction to be held March 24-25 at the
Sherman House in Chicago. Persons wishing details
may write the society at 360 N. Michigan Avenue,
Chicago, Illinois 60601.
New Provisions in OSMA Bylaws
Pertaining to Nomination
Of President-Elect
Attention is called to new provisions in the
Bylaws of the Ohio State Medical Association
pertaining to the nomination and election of the
President-Elect at the OSMA Annual Meeting.
The President-Elect and other officers are elected
by the House of Delegates, meetings of which
will be held during the Annual Meeting in
Cleveland, May 24 - 28.
Nominations of the President-Elect are to be
made 60 days in advance of the meeting at
which election takes place and information on
nominations published in The Journal, unless
these provisions are waived by a two-thirds vote
of the House of Delegates. The 60-day dead-
line is March 28.
The revised section in the OSMA Bylaws
pertaining to the procedure reads as follows :
Section 1 (a). Nomination of President-
Elect. Nominations for the office of Presi-
dent-Elect shall be made from the floor of the
House of Delegates, provided however that only
those candidates may be nominated whose names
have been filed with the Executive Secretary at
the time and in the manner hereinafter provid-
ed, unless compliance with such requirements
shall be waived as hereinafter provided. The
name of a candidate for the office of President-
Elect shall be filed with the Executive Secretary
of the Association at least sixty (60) days prior
to the meeting of the House of Delegates at
which the election is to take place. Promptly
upon filing of such candidate’s name, the Execu-
tive Secretary, if such candidate is eligible for
election, shall prepare and transmit this infor-
mation to each member of the House of Dele-
gates. No candidate may be presented at any
meeting of the House unless the foregoing re-
quirements of filing and transmittal have been
complied with or unless such compliance shall
have been waived or dispensed with by a vote
of at least two-thirds (%) of the Delegates
present at the opening session of such meeting.
The Executive Secretary shall cause to be pub-
lished in The Journal in advance of such meet-
ing of the House of Delegates biographical
information on all eligible candidates meeting
the requirements of filing and transmittal.
258
The Ohio State Medical Journal
• • •
OMPAC Membership Now 2,228
Substantial Gain Shown in Past Month; No Members Recorded
In 20 Counties; Aims and Potentials of OMPAC Summarized
PHYSICIANS from 68 counties had affiliated
with the Ohio Medical Political Action Com-
mittee up to February 17. Membership on that
date totaled 2,228, a gain of approximately 1,000
members in the past month.
OMPAC officials credit this good showing to the
excellent work being done by County Medical Society
secretaries in most counties, in collecting OMPAC
dues at the same time Medical Society dues are being
collected. Some county groups apparently are not
following this procedure which was recommended
by The Council of the Ohio State Medical Associa-
tion. Those are the counties which show few, if
any, OMPAC memberships.
May Join Direct
Individual physicians who may reside in a county
where the County Medical Society secretary is not
collecting OMPAC dues may join direct by sending
their $ 25.00 membership dues to OMPAC, P. O.
Box 5617, Columbus, Ohio 43221.
Membership cards have been mailed to approxi-
mately 1,200 members. Membership cards will be
mailed within the next few weeks to the balance of
the membership and, periodically, to additional mem-
bers as dues are received.
A contribution of $10.00 per member is made
by OMPAC to the American Medical Political Action
Committee, Chicago. This qualifies each Ohio mem-
ber for AMPAC membership. Membership cards
in AMPAC are mailed from Chicago.
OMPAC’s Aims and Potentials
OMPAC has the following primary aims and po-
tentials which need financial backing in order to get
off the ground:
• Become the spearhead of the fight in Ohio to
help in the nationwide battle to keep medicine’s
friends in the Congress and retire its opponents.
• Become the strong right arm of the medical
profession of Ohio in political activities. (Medical
societies can’t engage in political activities because of
legal barriers.)
• Be of assistance to the medical profession of
Ohio in its legislative battles . . . state and national.
• Provide financial assistance to a greater number
of Ohio candidates for public office.
• Help in financing educational campaigns by the
medical profession to acquaint the public with the
medical profession’s views on social, economic and
legislation questions affecting public health and the
practice of medicine.
• Assist Ohio physicians, and others, locally and
on a regional basis to organize effective political ac-
tion groups.
• Organize public education campaigns, to pro-
mote the improvement of government ... to en-
courage and stimulate physicians . . . citizens gen-
erally ... to take a more active part in governmental
affairs . . . join with other substantial groups in such
activities.
• Issue newsletters and informative material pe-
riodically to Ohio physicians in order to keep them
acquainted and up-to-date with political happenings
and trends throughout the nation.
• Help to organize and finance regional and state
conferences of Ohio physicians and their wives, and
others . . . workshops . . . where political, legis-
lative and governmental subjects and information
can be discussed and plans for action developed.
• Help to bring about increased liaison with other
Ohio professions, business and industrial groups, etc.,
in order to develop concerted action on political and
legislative matters.
• Assist the medical profession of Ohio in its
pre-election activities.
• Cooperate with AMPAC in helping to elect
qualified candidates in other states and support
AMPAC’s nationwide campaign for better govern-
ment.
Membership by Counties
Following is a breakdown of OMPAC member-
ship by counties as of February 17:
Adams 1
Fairfield 1
Licking 1
Portage 26
Allen 68
Fayette 12
Logan 0
Preble 0
Ashland 6
Franklin 215
Lorain 55
Putnam 0
Ashtabula 14
Fulton 3
Lucas 4
Richland 1
Athens 12
Gallia 2
Madison 2
Ross 2 1
Auglaize 2
Geauga 10
Mahoning 85
Sandusky 1 1
Belmont 18
Greene 19
Marion 1 1
Scioto 33
Brown 6
Guernsey 3
Medina 17
Seneca 20
Butler 66
Hamilton 382
Meigs 0
Shelby 15
Carroll 6
Hancock 3
Mercer 2
Stark 164
Champaign 0
Hardin 0
Miami 37
Summit 0
Clark 54
Harrison 6
Monroe 0
Trumbull 52
Clermont 4
Henry 7
Montgomery 217 Tuscarawas 26
Clinton 5
Highland 0
Morgan 0
Union 2
Columbiana 0 Hocking 1
Morrow 2
Van Wert 0
Coshocton 0
Holmes 6
Muskingum 25
Vinton 0
Crawford 35
Huron 13
Noble 1
Warren 0
Cuyahoga 253 Jackson 0
Ottawa 6
Washington 0
Darke 7
Jefferson 2
Paulding 1
Wayne 27
Defiance 4
Knox 25
Perry 3
Williams 0
Delaware 7
Lake 57
Pickaway 6
Wood 2
Erie 0
Lawrence 15
Pike 0
Wyandot 3
Total 2228
for March, 1966
259
Weil Memorial Lectureship
Scheduled in Akron
The third annual Alven M. Weil Memorial Lec-
tureship has been scheduled for Akron, on Wednes-
day, March 9. The program will begin at 4:00 p. m.
in the Akron City Club with a three-man panel
presentation on "Dysfunctional Labor.’’ The follow-
ing panelists will participate:
Dr. D. Anthony D’Esopo, professor emeritus, Co-
lumbia University College of Physicians and Surgeons,
and consultant obstetrician and gynecologist, Pres-
byterian Hospital.
Dr. Charles Henning Hendricks, professor of ob-
stetrics and gynecology at Western Reserve University
School of Medicine.
Dr. Louis M. Heilman, professor and chairman
of the Department of Obstetrics and Gynecology,
State University of New York, Downstate Medical
Center.
Cocktails and dinner will follow the presentation.
Reservations may be made by writing : Summit County
Medical Service Bureau, Inc.; Attn., Akron Obstetri-
cal and Gynecological Society, 211 Second National
Building, Akron 44308.
After dinner speaker will be Dr. Heilman whose
topic will be "The Use of Electronics in Obstetrics
and Gynecology.”
The Obstetrical and Gynecological group is spon-
soring the lectureship under the direction of Richard
J. Yoder, M. D., president, and Ronald B. Mitchell,
M. D., secretary.
Western Reserve Dental School
Tests Self -Teaching Method
Using workbooks, film slides, and school equip-
ment, but without the traditional lecturer to guide
them, freshmen students at the Western Reserve
University School of Dentistry are teaching them-
selves. An instructor is available, but only to an-
swer questions.
The workbook and slides, developed in a three-
year research project by Henry G. Vanek, D. D. S.,
assistant professor of operative dentistry, and his
associates at the School, were presented to 30 students
— half of the second-semester freshman class. The
other half is learning this part of the dental course
from the usual lecture and laboratory instruction.
All 60 are thereby contributing to a demonstra-
tion that is expected to lead to more extensive teacher-
less instruction at this dental school and elsewhere
— an educational trend made necessary by the short-
age of instructors and the increasing body of scientific
knowledge that must be taught to future dentists in
a relatively short time.
Convincing evidence that self-instructed groups
can learn the same amount of knowledge and achieve
the same grade averages in less time than those taught
by the usual methods has already been gathered by
testing students who tried out the workbook in
earlier versions during the past two years, school of-
ficials report.
American College of Surgeons
Joint Cleveland Meeting
More than 2,500 surgeons and graduate nurses are
expected to attend the annual four-day Sectional
meeting of the American College of Surgeons in
Cleveland, March 14-17. (Refer to January issue
of The Journal, page 6l.)
Purpose of this 12th annual joint meeting for doc-
tors and nurses, which pioneered in Cleveland in
1955, is the exchange of information between medical
and nursing services to improve care of the surgical
patient.
Registration is open to all doctors of medicine and
graduate nurses. Headquarters hotels will be the
Sheraton- Cleveland and Statler-Hilton.
"Doctors and nurses from all over Canada and the
United States will attend this intensive scientific
meeting to learn significant advances in surgery,” ac-
cording to Dr. John H. Davis, associate professor of
surgery, Western Reserve University School of Medi-
cine, and chairman of the local advisory committee on
arrangements for the doctors’ sessions.
"Some 300 doctors and nurses on the program will
act as teachers, focusing attention on newer ways of
handling surgical procedures and supervising nursing
care of patients,” Dr. Davis explained.
Dr. Warren Wendell Green, Toledo, president,
Ohio Chapter of the College, will be chairman at
this Chapter’s luncheon on the opening day.
Also on the first day Dr. Howard A. Patterson,
New York, president of the College, will preside over
sessions at which Dr. Robert M. Zollinger, Colum-
bus, a regent of the College, will moderate a panel
on breast cancer. A panel on evaluation of the poor
risk patient for operation will follow, moderated by
Dr. William D. Holden, Cleveland.
The opening day’s surgery program will also in-
clude a report on what’s new in burns, by Dr. Bruce
G. MacMillan, Cincinnati. In the specialty of orth-
opedic surgery Dr. Walter A. Hoyt, Jr., Akron, will
moderate a panel on injuries of the spine, and Dr.
Charles H. Herndon, Cleveland, one on bunion
treatment.
In ear-nose-throat discussions Dr. Hollie E. Mc-
Hugh, Montreal, and Dr. William J. Loeb, Cleveland,
will preside. In plastic surgery meetings Monday,
Dr. Clifford L. Kiehn and Darrel T. Shaw, Cleveland,
will guide the program, and in urology Dr. William
E. Forsythe, Jr., Cleveland, and Dr. Justin E. Cordon-
nier, St. Louis.
"My Experiences with Project Hope in Africa”
is the title of an address by Dr. Harvey J. Mendel-
sohn, Cleveland, guest speaker at the nurses’ lunch-
eon March 16.
260
The Ohio State Medical Journal
Deadline for Submission of Resolutions to Columbus
Office of the Association Is March 25
DELEGATES to the Ohio State Medical Association and County Medical Societies
planning to have resolutions submitted for consideration by the House of Dele-
gates at the 1966 Annual Meeting should be guided by the following Constitutional
requirements:
1. Resolutions, regardless of whether they have been submitted in advance and pub-
lished in The journal, must be introduced at the first session of the House of Delegates,
Tuesday evening, May 24, at the Sheraton-Cleveland Hotel, Cleveland.
2. When the resolution is introduced, copies in triplicate should be presented.
3. To be eligible for presentation, a resolution must have been filed with the Executive
Secretary of the Ohio State Medical Association, Columbus, at least 60 days prior to the
first session of the House of Delegates, namely, not later than March 25. This requirement
may be waived by a two-thirds majority of the House of Delegates.
4. Resolutions received will be published in The Journal prior to the meeting. Also
copies of resolutions will be distributed to members of the House of Delegates to give them
an opportunity to discuss issues with their constituents and possibly receive voting intruc-
tions from their County Medical Societies.
OSU Medical College Gets Grant
For Basic Science Building
The Ohio State University" College of Medicine
moved a step closer to its goal of admitting 200 stu-
dents per entering class with recent awarding of an
extensive construction grant.
The College has been awarded a construction grant
of 56,013,546 by the U. S. Public Health Service to
assist in construction of a new' basic science building.
The project will cost approximately $12 million
for a five-story building. Balance of the construction
funds will come from the 1963 bond issue which
was passed by Ohio voters.
Dr. Richard L. Meiling, dean of the College,
predicted that when the new' basic science building is
completed 50 students w ill be added to the entering
class in medicine. Present enrollment in the first year
class is 150.
Dr. Meiling said that the first two floors of the
new' basic science building will provide multi-dis-
cipline laboratories for first and second year medical
students. Third, fourth and fifth floors will house
departmental offices and teaching laboratories for
pathology, pharmacology, microbiolog)', anatomy,
physiology, and physiological chemistry.
Plans call for a two-story annexed w'ing, which
w’ill contain two auditorium-type classrooms, each
seating 275 persons. Also included in the w'ing w’ill
be administrative offices of the College of Medicine,
a student lounge, a staff lounge and closed-circuit
television teaching facilities.
The building w'ill be located adjacent to the Medi-
cal Center between Ninth and Tenth Avenues in
Columbus. Construction is expected to begin late in
1966 wflth occupancy anticipated in 1968.
Pediatric Lectureship Presented on
Neonatal Hyperbilirubinemia
The thirteenth Benjamin Know' Rachford Lec-
tureship, presented under direction of the University
of Cincinnati College of Medicine, w?as in the form
of a "Symposium on Neonatal Hyperbilirubinemia."
The following speakers presented the topic material
indicated:
Dr. Rudolf Schmid, professor of medicine, Uni-
versity' of Chicago, "Experimental Studies on Bili-
rubin Metabolism.”
Dr. Louis K. Diamond, professor of pediatrics,
Harvard University, "Neonatal Hyperbilirubinemia
Due to Increased Red Cell Destruction.”
Dr. Gerald R. Odell, associate professor of pedi-
atrics, Johns Hopkins University, "Non Hematologic
Neonatal Hyperbilirubinemia.”
Dr. Benjamin H. Landing, professor of pathology
and pediatrics. University of Southern California,
"Neonatal Hepatitis.”
for March, 1 966
261
Obituaries
Ad Astra
C. Lloyd Beatty, M. D., Akron; University of
Western Ontario Faculty of Medicine, 1923; aged
67; died January 2; member of the Ohio State Medi-
cal Association, the American Medical Association,
and the American Academy of General Practice. Dr.
Beatty’s practice in Akron extended over some 28
years. Among affiliations, he was a member of sev-
eral Masonic bodies. Surviving are two sons, a daugh-
ter and a brother.
Sam Crawford Clark, M. D., Cherry Fork; Uni-
versity of Cincinnati College of Medicine, 1915;
aged 77; died January 13; member of the Ohio State
Medical Association and the American Medical As-
sociation. A practicing physician in Adams County
for more than 50 years, Dr. Clark was active in
numerous community affairs. He was a member of
the county board of health, a member of the board
of directors of the Adams County Hospital, and
former county coroner. He served as delegate to a
number of National Democractic Conventions and
was former mayor of Cherry Fork. Surviving are his
widow and a daughter.
Laurence Starr Cutter, M. D., Clemson, S. C.;
University of Cincinnati College of Medicine, 1925;
aged 68; died January 12. A practicing physician
of long standing in Cleveland, Dr. Cutter retired
about a year ago and moved to South Carolina. His
widow and a daughter survive.
Thomas W. Durbin, M. D., Toledo; University of
Michigan Medical School, 1921; aged 71; died Janu-
ary 15; former member of the Ohio State Medical
Association and the American Medical Association.
A practicing physician of long standing in Toledo,
Dr. Durbin had been retired for some years for health
reasons. He is survived by his widow and three
daughters.
John Rudolph Finley, M. D., Cleveland; Ohio
State University College of Medicine, 1916; aged 74;
died January 9; member of the Ohio State Medical
Association and the American Medical Association.
A former resident of Cleveland, Dr. Finley moved to
California for a short time and then returned to
Cleveland to resume his practice. His specialty was
obstetrics and gynecology. A member of the Epi-
scopal Church and a veteran of World War I, he is
survived by his widow, and two sisters.
Justin J. Haberer, M. D., Oakland, Calif.; St.
Louis University School of Medicine, 1939; aged 51;
died January 4. A former practitioner in Dayton
and in New Lebanon, Dr. Haberer held a State
appointment in Columbus before he left to practice
in California about five years ago. He was a mem-
ber of several Masonic bodies and a veteran of World
War II. Surviving are his widow, a daughter, a son,
his parents and three sisters.
Charles H. Leatherman, M. D., Cleveland; Me-
harry Medical College, 1926; aged 67; died January
19; former member of the Ohio State Medical As-
sociation and the American Medical Association;
member of the National Medical Association. A
general practitioner of long standing in Cleveland,
Dr. Leatherman was associated with the YMCA and
the AME Church. His widow survives.
Frank Adolph Oldenburg, M. D., Cuyahoga Falls;
Marquette University School of Medicine, 1940; aged
51; died December 1; member of the Ohio State
Medical Association, the American Medical Associa-
tion, American Society of Anesthesiology, and the
International Anesthesia Research Society. A native
of Milwaukee, Wisconsin, Dr. Oldenburg had been
a practicing physician in the Summit County area since
about 1944.
Joseph O. Porter, Sr., M. D., Cincinnati; Univer-
sity of Virginia School of Medicine, 1921; aged 69;
died January 15 in an airplane accident; member of
the Ohio State Medical Association and the Ameri-
can Medical Association. A practitioner of long
standing in Cincinnati, Dr. Porter was a veteran of
World War I. He is survived by his widow, three
daughters and a son, Dr. Joseph O. Porter, Jr., of
Cincinnati; also five sisters and a brother survive.
Wilmer Howell Rogers, M. D., Amsterdam; Tu-
lane University School of Medicine, 1928; aged 59;
died January 28; member of the Ohio State Medical
Association, the American Medical Association, and
the American Academy of General Practice. A gen-
eral practitioner in the Amsterdam area for about 30
years, Dr. Rogers was former Jefferson County cor-
oner and was mayor of his community at one time.
Affiliations included memberships in the Moose Lodge,
the Elks Lodge, and the Catholic Church. Surviving
are his widow, three daughters, a son, his mother,
two sisters, and a brother.
Donald Mason Rothrock, M. D., Youngstown;
University of Pennsylvania School of Medicine, 1917;
aged 70; died January 28; member of the Ohio State
Medical Association, the American Medical Associa-
tion, and the American Academy of General Practice.
A former resident of Pennsylvania, Dr. Rothrock
served most of his professional career in Youngstown.
He was a veteran of World War I. Affiliations in-
262
The Ohio State Medical Journal
eluded memberships in the Elks Club and the Meth-
odist Church. His widow survives.
Salvatore M. Sancetta, M. D., Cleveland; Western
Reserve University School of Medicine, 1941; aged
48; died January 11; member of the Ohio State
Medical Association, the American Medical Asso-
ciation, Central Society for Clinical Research, Ameri-
can College of Physicians, and the International
Academy of Pathology; diplomate of the American
Board of Internal Medicine. A specialist in cardi-
ology, Dr. Sancetta was associated with Metropolitan
General Hospital, and was on the faculty of Western
Reserve University School of Medicine. Last May he
was elected president of the Northeastern Ohio Heart
Association. A veteran of World War II, he is
survived by his widow, a son, two daughters and a
brother.
Robert E. Shapiro, M. D., Syracuse, N. Y.; State
University of New York Upstate Medical Center, 1951;
aged 47; died January 1. Dr. Shapiro formerly took
residency work at Children’s Hospital in Columbus.
Frederick Agenstein Smith, M. D., Akron; Uni-
versity of Kansas School of Medicine, 1926; aged 66;
died January 25; member of the Ohio State Medical
Association, the American Medical Association, Amer-
ican Diabetes Association, and the American Rheu-
matism Association. A practitioner in Akron since
1927, specializing in internal medicine, Dr. Smith
served in the Pacific Theater during World War II.
He was a member of the Church of the Latter Day
Saints. Survivors include his widow, a daughter, two
brothers, and a sister.
Charles O. Reynolds, M. D., St. Petersburg, Fla.;
University of Cincinnati College of Medicine, 1912;
aged 78; died January 24. A practitioner of long
standing in Huntington, W. Va., Dr. Reynolds was
Swell known in Southern Ohio. His widow survives.
Willard A. Van Nest, M. D., New Smyrna Beach,
Fla.; Stritch School of Medicine of Loyola University,
1936; aged 63; died January 25. Dr. Van Nest prac-
ticed for a short time in Toledo before moving to
Florida about 20 years ago, His widow is among
survivors.
. . ;
Cases of infectious hepatitis in 1965 were about
10 per cent below the number reported in 1964, the
fourth successive year to show a reduction. Even so,
the number of cases reported in 1965 totaled nearly
33,650, compared with the all-time high of nearly
73,000 cases reported in 1961. — Metropolitan Life.
Mortality in the United States was at about the
same level in 1965 as in the preceding year. The
statisticians estimate the national death rate for
1965 to be 9-4 per 1,000 population, the 18th suc-
cessive year to register a death rate below 10 per
1,000. — Metropolitan Life.
Hospital Orderly ^ anted by FBI
Believed to Be in Ohio
The Federal Bureau of Investigation has reason to
believe a fugitive may be employed or seeking em-
ployment as a hospital orderly or male aide in Ohio.
He is Richard Dale Bartloff, also known as Richard
Elmore Bartloff, Dale Bartloff, and "Richie.”
Bartloff is being sought by the FBI for allegedly
violating probation on a charge of theft of mail.
A bench warrant for his arrest was issued on October
20, 1964, in Detroit, Michigan.
He has had employment in the past as a hospital
orderly or male aide. Bartloff is described as male;
race, white; born, July 27, 1937, Berrien Springs,
Michigan; height, 5'10"; 155 pounds; hair, blonde;
eyes, hazel. Scars and marks: mole on left leg, scar
on right forefinger, cut scar on palm of right hand,
cut scar on right index finger.
Any person having information concerning this
individual, is requested to notify the nearest office of
the FBI, the telephone number of which may be lo-
cated on the first page of the telephone director)'.
The eighth annual Refresher Course in Diagnostic
Roentgenology will be held by the Radiology Depart-
ment of the University of Cincinnati College of
Medicine under the direction of Dr. Benjamin Felson
from May 31 through June 4.
underachievers
A residential facility for Junior and Senior
High School males who need psychiatric
help with: ■ Problems of academic under-
achievement and attendance . . . ■ Diffi-
culties in family-school-social adjustments.
Complete academic and therapy program for
grades 7 through 12.
For information contact: Rita Burgett, Secretary
The Readjustment Center
Box 373, Ann Arbor, Mich.
Phone: (AC 313) 663-5522
for March, 1966
263
Activities of County Societies . . .
First District
(COUNCILOR: ROBERT E. HOWARD, M. D„ CINCINATI)
CLINTON
Clinton County Medical Society held its January
meeting at Clinton Memorial Hospital Tuesday night
(Jan. 25) and heard Dr. William Schubert, director
of the clinical research center at Cincinnati Children’s
Hospital, speak on children’s digestive ailments. —
Wilmington News- Journal.
Second District
(COUNCILOR: THEODORE L. LIGHT, M. D., DAYTON)
MONTGOMERY
The Montgomery County Medical Society approved
a proposed program through which researchers from
the Department of Preventive Medicine at Ohio State
University College of Medicine will conduct a major
study of coronary heart disease in the Dayton area.
(Part of the study will be made in the Columbus
area.) The team hopes to examine some 10,000
persons in the Dayton area, with a follow-up of se-
lected numbers from this group.
Third District
(COUNCILOR: FREDERICK T. MERCHANT, M. D., MARION)
ALLEN
Dr. Richard Bing, professor of medicine at Wayne
State University, Detroit, was guest speaker for the
January 11 meeting of the Academy of Medicine of
Lima and Allen County. His topic was "The Recog-
nition of Coronary Artery Disease.”
HARDIN
Dr. H. Curtis Wood, medical field consultant for
the Association for Voluntary Sterilization, was guest
speaker for the Hardin County Medical Society at its
January meeting in Hardin Memorial Hospital, Kenton.
Fourth District
(COUNCILOR: ROBERT N. SMITH, M. D., TOLEDO)
LUCAS
Among programs presented in Toledo during
February was the Postgraduate Lecture Series given
at the Academy of Medicine building, on February
17 and 18. Dr. Robert J. Marshall, West Virginia
University School of Medicine, discussed the various
phases of cardiovascular disease.
Fifth District
(COUNCILOR: P. JOHN ROBECHEK, M. D., CLEVELAND)
ASHTABULA
The public press of the area reported a full list of
committees of the Ashtabula County Medical Society
as presented to the press by Dr. J. Richard Nolan, of
Ashtabula, the 1966 president of the Society.
CUYAHOGA
The Academy of Medicine of Cleveland building
is a busy place, where numerous meetings are held
throughout the month. During February the fol-
lowing meetings were scheduled in the building:
Combined meeting of the Cleveland Society of
SUCCESSOR TO
NONE OF ITS DISADVANTAGES
V (CHLORAL GLYCINE MIXTURE)
> DRICLOR
f ALL OF ITS ADVANTAGES
insures full sedative action
• LESS TOXIC • NON IRRITATING • STABLE
AVAILABLE THROUGH YOUR WHOLESALER
BLESSINGS, INC.
Cleveland 3, Ohio
References on request
Chloral — the “old reliable” — for more than 100 years
is dramatically improved in DriClor (5 grains chloral
hydrate with the amino acid glycene). DriClor is less
toxic . . . more stable . . . non-irritating to the stomach
. . . and more effective grain for grain.
The effective sedative, hypnotic and anti-convulsant
form of Chloral Hydrate.
Also Chlorasec for quick, even sleep. DriClor inner core
(equivalent to 3.75 Grs. of Chloral Hydrate). Seco-
barbital acid outer coat (.75 Grs.)
264
The Ohio State Medical Journal
Indications: ‘Miltown’ (meprobamate) is ef-
fective in relief of anxiety and tension states.
Also as adjunctive therapy when anxiety
may be a causative or otherwise disturbing
factor. Although not a hypnotic, ‘Miltown’
fosters normal sleep through both its anti-
anxiety and muscle-relaxant properties.
Contraindications: Previous allergic or idio-
syncratic reactions to meprobamate or
meprobamate-containing drugs.
Precautions: Careful supervision of dose
and amounts prescribed is advised. Consider
possibility of dependence, particularly in pa-
tients with history of drug or alcohol addic-
tion; withdraw gradually after use for weeks
or months at excessive dosage. Abrupt with-
drawal may precipitate recurrence of pre-
existing symptoms, or withdrawal reactions
including, rarely, epileptiform seizures.
Should meprobamate cause drowsiness or
visual disturbances, the dose should be re-
duced and operation of motor vehicles or
machinery or other activity requiring alert-
ness should be avoided if these symptoms
are present. Effects of excessive alcohol may
An eminent role in
medical practice
• Clinicians throughout the world con-
sider meprobamate a therapeutic
standard in the management of anxi-
ety and tension.
• The high safety-efficacy ratio of
‘Miltown’ has been demonstrated by
more than a decade of clinical use.
Miltown*
(meprobamate)
possibly be increased by meprobamate.
Grand mal seizures may be precipitated in
persons suffering from both grand and petit
mal. Prescribe cautiously and in small quan-
tities to patients with suicidal tendencies.
Side effects: Drowsiness may occur and,
rarely, ataxia, usually controlled by decreas-
ing the dose. Allergic or idiosyncratic re-
actions are rare, generally developing after
one to four doses. Mild reactions are char-
acterized by an urticarial or erythematous,
maculopapular rash. Acute nonthrombocy-
topenic purpura with peripheral edema and
fever, transient leukopenia, and a single
case of fatal bullous dermatitis after admin-
istration of meprobamate and prednisolone
have been reported. More severe and very
rare cases of hypersensitivity may produce
fever, chills, fainting spells, angioneurotic
edema, bronchial spasms, hypotensive crises
(1 fatal case), anuria, anaphylaxis, stoma-
titis and proctitis. Treatment should be
symptomatic in such cases, and the drug
should not be reinstituted. Isolated cases of
agranulocytosis, thrombocytopenic purpura,
and a single fatal instance of aplastic ane-
mia have been reported, but only when other
drugs known to elicit these conditions were
given concomitantly. Fast EEG activity has
been reported, usually after excessive me-
probamate dosage. Suicidal attempts may
produce lethargy, stupor, ataxia, coma,
shock, vasomotor and respiratory collapse.
Usual adult dosage: One or two 400 mg.
tablets three times daily. Doses above 2400
mg. daily are not recommended.
Supplied: In two strengths: 400 mg. scored
tablets and 200 mg. coated tablets.
Before prescribing, consult package circular,
^.WALLACE LABORATORIES
W/ sCr anbury , N.J.
Pathologists and the Cleveland Chest Society, Acad-
emy of General Practice, Cleveland Rheumatism So-
ciety, Cleveland Gastroenterology Club, weekly Psy-
chiatric Courses; weekly Neurology Seminars, Heart
Association Scientific Council, Medical Assistants,
Cleveland Society of Internal Medicine, and the
Cleveland Radiological Society.
The Academy of Medicine of Cleveland is spon-
soring a series of broadcasts over Station WGAR in
Cleveland on Sunday evenings beginning at 7 : 00 p. m.
During February the following topics were discussed
on the dates indicated:
February 6 — "Medicine and the Great Society.’’
February 13 — "Family Life Education.”
February 20 — "Cancer Research.”
February 27 — "Cancer Therapy.”
Sixth District
(COUNCILOR: EDWIN R. WESTBROOK, M. D., WARREN)
MAHONING
Installation ceremonies for new officers of the
Mahoning County Medical Society were held at the
January 28 dinner - dance meeting of the society at
the Mural Room, Youngstown. Members of the local
dental society and their wives were guests for the
occasion.
Dr. F. A. Resch, as incoming president, received
the gavel from Dr. John J. McDonough.
Special honors were paid to Dr. W. K. Allsop, who
received the 50- Year Button and certificate of the
Ohio State Medical Association from Dr. Edwin R.
Westbrook, Warren, Councilor of the Sixth District.
SUMMIT
Members of the Summit County Medical Society
participated in a program on February 1 at which
the topics of discussion were "State University
Status?” and "A Medical School for Akron?”
TRUMBULL
The Trumbull County Medical Society held its first
meeting of 1966 recently at the Trumbull Country
Club with Dr. John McGreevey, president, presiding.
Several socio-economic problems were discussed and
clarified for the group. Dr. Allan Schaffer, president-
elect and program chairman, outlined plans for next
year.
(This report from the Warren Tribune Chronicle
was followed by a roster of new officers and commit-
tee members.)
The regular meeting of the Trumbull County Medi-
cal Society was held on February 16 at the Trumbull
County Club, where a social hour, dinner, and pro-
gram were held. Robert A. Lang, executive secretary
of the Academy of Medicine of Cleveland, was the
program speaker for a discussion on the new Medi-
care regulations.
eruice
mark ot
Professional Protection Exclusive
'fM&sM
NORTHERN OHIO OFFICE: J. R. Ticknor, A. C. Spath, Jr., R. A. Zimmerman, Reps.
11955 Shaker Boulevard Cleveland 44120 Tel. 216-795-3200
CENTRAL OHIO OFFICE: J. E. Hansel and R. E. Stallter, Representatives
Room 201, 1818 West Lane Ave., P. O. Box 5684, Columbus 43221 Tel. 614-486-3939
SOUTHERN OHIO OFFICE: D. M. Routt, III, Representative
Medical Specialties Building, Room 704
3333 Vine Street, P. O. Box 20084 Cincinnati 45220 Tel. 513-751-0657
266
The Ohio State Medical Journal
In anxiety
states:
B and C
vitamins
are therapy
Stress formula vitamins are an important supportive measure in main-
taining the nutritional status of the emotionally disturbed patient. With
STRESSCAPS, B and C vitamins are present in therapeutic amounts to meet
increased metabolic demands. Patients with anxiety, and many others under-
going physiologic stress, may benefit from vitamin therapy with STRESSCAPS.
Stress Formula Vitamins Lederle
Each capsule contains:
Vitamin B i (asThiamine Mononitrate) 10 mg. I
Vitamin B2 (Riboflavin)
10
mg.
Niacinamide
100
mg.
Vitamin C (Ascorbic Acid)
300
mg.
Vitamin B6 (Pyridoxine HCI)
2
mg. 1
Vitamin B12 Crystalline
4 me
Calcium Pantothenate
Recommended intake: Adults
1 caps
mg. I
daily, for the treatment of v
tamin d
ciencies. Supplied in deco
minder” jars of 30 and 100; bo
a t i v e
LEDERLE LABORATORIES, A Division of AMERICAN CYANAMID COMPANY, P
arl River, N. Y.
' 8241-4
Seventh District
(COUNCILOR: BENJAMIN C. DIEFENBACH, M. D„
MARTINS FERRY)
BELMONT
The Belmont County Medical Society with the
Auxiliary met on February 17 at the Holiday Inn
for an afternoon program and dinner. Speaker for
the occasion was Robert C. Green, staff assistant in
the regional bureau of health office at Charlottesville,
Virginia. The topic of discussion was "Current As-
pects of Medicare.”
TUSCARAWAS
Dr. Thomas Meney, director of the radiology serv-
ice at the Cleveland Clinic, spoke on "The Role of
the Kidney in Hypertension,” at the January 12 meet-
ing of the Tuscarawas County Medical Society.
Ray Waggoner, president of the Tuscarawas County
Pharmaceutical Association, also spoke at the meet-
ing, where he outlined areas of cooperation between
pharmacists and physicians.
Eighth District
(COUNCILOR: ROBERT C. BEARDSLEY, M. D.,
ZANESVILLE)
WASHINGTON
Dr. Mary Whitacre Owen was elected president of
Washington County Medical Society at a meeting last
night (Jan. 12) in Lafayette Motor Hotel, becoming
the first woman physician to be so honored in the
county.
Named to serve with her were Dr. A. M. Jones Jr.,
vice-president, and Dr. George E. Huston, secretary-
treasurer.
A clinical presentation accompanied by slides was
presented for the program by Dr. Charles W.
Thacker, pathologist at Camden-Clark Hospital in
Parkersburg. — Marietta Daily Times.
Ninth District
(COUNCILOR: GEORGE NEWTON SPEARS, IRONTON)
JACKSON
The Jackson County Medical Society held its an-
nual meeting and ladies’ night dinner in Jackson.
The Society went on record as endorsing the pro-
posed Jackson General Hospital, for which the people
of Jackson voted a $470,000 bond issue at last No-
vember’s election.
Tenth District
(COUNCILOR: RICHARD L. FULTON, M. D., COLUMBUS)
FRANKLIN
A combined specialty society meeting and meeting
of the Academy of Medicine of Columbus and Frank-
lin County was held in the Neil House Hotel, Co-
lumbus, on February 15. A social hour and dinner
preceded the programs.
The Neuropsychiatric Society of Central Ohio
presented Dr. Jack F. Wilder, New York City, who
discussed "Psychosocial Rehabilitation Programs in
Community Mental Health Centers.”
For the Academy meeting, a panel discussion was
conducted on the topic, "Blood Banking, or, Why
Do We Have Trouble Getting Enough Blood in
Central Ohio?” Dr. Wesley L. Furste, was moder-
ator, with Dr. Ralph D. Lausa as co-moderator. Par-
ticipating were Dr. Brooks H. Hurd, Dr. Colin R.
Macpherson; also Alfred L. Baron, executive direc-
tor of the Central Ohio American Red Cross unit,
and Dr. Sergio L. Cruz, medical director of the
Central Ohio American Red Cross Blood Program.
Eleventh District
(COUNCILOR: WILLIAM R. SCHULTZ, M. D„ WOOSTER)
LORAIN
A total attendance of 71 marked the February 8
meeting of Lorain County Medical Society, in a joint
meeting with members of the Lorain County Bar
Association. President Joseph A. Cicerrella, M. D.,
introduced the featured speaker, The Honorable
James L. McCrystal, Common Pleas Judge of Erie
County. Active in community affairs, Judge McCry-
stal has served on the Board of Providence Hospital,
Sandusky, for 15 years.
His topic encompassed several areas in the liaison
between the two professions and their mutual respon-
sibility towards the patient-client.
During the business session, Richard C. Zbornik,
M. D., Lorain, was elected into Active Membership
in the Society.
Members’ attention was directed to communications
from Ohio State Medical Association concerning the
deadline for submission of Resolutions, and nomina-
tions for President-Elect to House of Delegates.
A. Clair Siddall, M. D., chairman of the Cancer
Committee, reported on his Committee’s activities. A
Resolution relative to Reimbursement under Medicare
for Services of Hospital-Based Physicians was read
and unamimously approved for transmittal to Ohio
State Medical Association.
AMA Environmental Health Program,
Chicago, April 4 and 5
"Impact of Environment on Accidental Injuries
and Fatalities” has been announced as the theme for
the Third AMA Congress on Environmental Health
Problems, scheduled at the Drake Hotel, Chicago,
Monday and Tuesday, April 4 and 5.
This program is acceptable for 12 accredited hours
by the American Academy of General Practice. A
fee of $10 is payable at time of registration, but
advance registration may be made with the Depart-
ment of Environmental Health of the AMA. Per-
sons planning to attend should make their own hotel
reservations.
Women are going into medicine in increasing
numbers, according to a report of the Association of
American Medical Colleges. Women accounted for
7.3 per cent of medical school graduates in 1965,
compared to 4.5 per cent in 1930. Women students
accounted for 9-1 per cent of those accepted for
medical schools for the 1964-1965 academic year.
268
The Ohio State Medical Journal
<Appakdtran |fall
Established 1916
Asheville, North Carolina
An institution for the diagnosis and treatment of psychiatric and neurological illnesses,
rest, convalescence, drug and alcohol habituation. There are ample facilities for classification
of patients
Insulin coma, electroshock, psychotherapy, occupational and recreational therapy are employed. The
hospital is equipped with complete laboratory facilities, including electroencephalography and x-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town in the beautiful Smoky
Mountain Range, an ideal location for rehabilitation.
WM. RAY GRIFFIN, Jr., M. D. MARK A. GRIFFIN, Sr., M. D.
ROBERT A. GRIFFIN, M. D. MARK A. GRIFFIN, Jr., M. D.
For rates and further information write APPALACHIAN HALL, Asheville, N. C.
For prompt, emphatic diuresis
IS!
HEM
(BENZTHIAZIDE)
NEW FROM TUTAG for prompt, comfortable
diuretic action with a balanced excretion
of sodium chloride and a lower potassium
loss under normal dosage and diet regimen
DIURETIC ACTION: Clinically, the oral administration of AQUATAG (benzthi-
azide) results in diuretic activity within two hours with maximal natriuretic,
chloruretic, and diuretic effects occurring during the fourth, fifth and sixth hours.
Maintenance of response continues for approximately 12 to 18 hours. Acidosis
is an unlikely complication since therapeutic doses of AQUATAG (benzthi-
azide) do not appreciably increase bicarbonate excretion. Edematous patients
receiving 50 mg. of AQUATAG (benzthiazide) daily for five days developed a
maximal increase in the rate of sodium excretion on the first day, and main-
tained this high rate until depletion of excessive body stores of sodium.
In congestive heart-failure patients, AQUATAG (benzthiazide) produced the
same weight loss, during a 48-hour treatment period as did a maximally effec-
tive dose of hydrochlorothiazide.
DOSAGE: Diuresis, initially 50 to 200 mg.; maintenance 25 to 150 mg., daily.
Hypertension 50 to 100 mg. initially, adjusted to 50 mg. t.i.d. or downward to
minimal effective dosage level.
PRECAUTIONS AND SIDE EFFECTS: Electrolyte imbalance with hypoka-
lemia, hypochloremic alkalosis and hyponatremia may occur. Other reactions
may include blood dyscrasias. hyperuricemia and gout, nausea, jaundice,
anorexia, vomiting, diarrhea, dizziness, paresthesia, photosensitivity and head-
ache. Insulin requirements may be altered in diabetes.
WARNINGS: Dosage of coadministered antihypertensive agents should be
reduced by at least 50%. Use with caution in edema due to renal disease;
advanced hepatic disease or suspected presence of electrolyte imbalance.
Stenosis or ulcer of small intestine have been reported with coated potassium
formulas and should be administered only when indicated. Until further clinical
experience is obtained, the use of the drug in pregnant patients should be
carefully weighed against possible hazards to the fetus.
CONTRAINDICATIONS: AQUATAG (benzthiazide)
is contraindicated in progressive renal disease or
disfunction including increasing oliguria and azo-
temia. Continued administration of this drug is
contraindicated in patients who show no response
to its diuretic or antihypertensive properties.
Before prescribing or administering, read the package
insert or file card available on request.
Available as 25 or 50 mg. scored tablets.
Request clinical samples and literature on your
letterhead.
S.J.TUTAG
& COMPANY
Detroit. Michigan 48234
for March, 1966
269
W Oman’s Auxiliary Highlights . . .
By MRS. S. L. MELTZER, Publicity Committee
Chairman, 2442 Dorman Dr., Portsmouth
WHAT I am about to relate happened more
than ten years ago. But the incident is
warm and touching and can easily stand the
retelling. The doctor’s wife had had a bad day. One
of the children had been ill and the other two had
been into every possible form of devilment. The
telephone had jangled constantly. (The doctor’s of-
fice adjoined his home and the office nurse was away
ill.) Even the weather had added to the harassment
of the day. The rain had plummeted down stormily
for hours and the roof over the children’s playroom
in the back had sprung a leak. Worst of all, the
doctor had been called out on an emergency and
there had been a never-ending (or so it seemed)
line of petulant patients seeking him out. And
angry because he wasn’t there at the office to keep
his appointments. One had argued unpleasantly
about his bill.
Now it was nearing dinner time and the frustrated
woman of the house was trying to get a meal to-
gether. She had had it, she told herself. This
business of being a doctor’s wife was for the birds.
She had to share him with everyone else — and she
seemed to come up inevitably with the short end of
the stick. Did anyone ever appreciate the doctor or
his family or have the slightest awareness of their
problems? she asked herself bitterly. No, the doc-
tor’s wife decided, nobody did. Nobody cared.
And then came the knock at the door. It was
dusk outside. The little old lady who stood on
the porch, hat askew, held something very carefully
in her hands. It was a birthday cake, she explained,
for doctor.
The very tired doctor’s wife, annoyance riding her
voice, explained that it was not her husband’s birth-
day. "Oh, I know that’’ the little old lady said
breathlessly. "It’s my birthday. But it really belongs
to doctor. I wouldn’t be having a birthday today if
it weren’t for him. He saved my life last winter.
He never failed me when I needed him. Not even
the night of the blizzard.” She smiled a warm, beau-
tiful smile. "Please give him this very special cake
with all my love.” She paused — and then added
softly: "You are a very lucky woman to have the
privilege of being his wife.”
A thoroughly ashamed -of -herself young woman
carefully took hold of the cake plate and its precious
cargo. I am a very lucky woman, she thought con-
tritely. She murmured "doctor’s wife” and she felt
herself grow tall. (Corny? I don’t think so. I know
that doctor’s wife and I know what one grateful little
old lady did for her.)
Around the State
Since 1951, the Allen County auxiliary has "moth-
ered” the Best Years Club at the YWCA. Meeting
once a month, this group of Lima women, past 65
years of age, enjoy fellowship, knitting, sewing,
quilting and crafts plus a dessert luncheon served by
auxiliary members. Twice each year, a covered-dish
dinner for these women is on the auxiliary agenda,
with the doctors’ wives furnishing the food. Mrs.
David Barr, Allen County’s AMA-ERF chairman,
was the recipient recently of two honors. She was
Erst prize winner in Lima’s city flag contest and
second prize winner in the city’s motto contest.
Her winning flag design was in red, white and blue
with the borders in red and blue "L’s.” A dozen
yellow stars at the top of the crest represented the
12 original townships of the county. The center
Accredited by The Joint Commission on Accreditation of Hospitals.
WINDSOR HOSPITAL
A NONPROFIT CORPORATION
— ESTABLISHED 1 8 9 8 —
Chagrin Falls, Ohio 44022
247-5300 (Area Code 216)
A hospital for the treatment
of Psychiatric Disorders
Booklet available on request.
JOHN H. NICHOLS, M. D., Medical Director G. PAULINE WELLS, R. N., Admin. Director HERBERT A. SIHLER, Jr., Pres.
MEMBER: American Hospital Association — National Association of Private Psychiatric Hospitals — Ohio Hospital Association
270
The Ohio State Medical Journal
was symbolic of the oil boom and industrial rise
of the city. Her second-place motto was "Growth,
Education and Opportunity for All.”
The Butler County group had a busy January meet-
ing. The women packed drug samples for World
Medical Relief at the home of Mrs. Clifford Fening,
assisted by Girl Scout Troop 136. Mrs. Louis Skim-
ming, local international health chairman, reported
that nine barrels of drugs were packed. A week
earlier, the members had observed International
Health Day with an all-out campaign to collect as
many drug samples as possible.
The Knox County auxiliary held its January meet-
ing at the home of Mrs. Robert Sooy. Mrs. Clinton
Trott was assistant hostess. Mrs. James Kennedy,
vice-president, presided at the business session.
Named delegate to the state convention in May was
Mrs. William Perle, with Mrs. Richard Smythe de-
signated as alternate. Plans were completed at that
meeting for the party that was given later in the
month for the Golden Age Club. Mrs. Julius Sham-
ansky headed that committee. Films on Health Ca-
reers are being shown at the junior and senior high
schools. Following each showing, mimeographed
answers to the many student questions asked are dis-
tributed by the auxiliary. The Knox County mem-
bers realized a profit of $200 from their sale of
Christmas cards for AMA-ERF. Mrs. Sooy was chair-
man of that project. Medical samples, journals and
THE WENDT-BRISTOL COMPANY
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Drive-in Prescription & Retail Store
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Hospital Beds (Rental or Sale)
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Surgical Garments fitted by
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for March, 1966
271
text books are again being collected for World Medi-
cal Relief.
A James Bond Theme!
Not Ben Casey or Dr. Kildare but James Bond (no
less!) provided the theme for the Lucas County
auxiliary’s dinner dance in February. The formal
”007 party” was held at the Inverness Club, with
Johnny Knorr’s orchestra providing the music. Mrs.
Robert Walker was chairman of the dinner dance,
assisted by Mrs. Henry D. Cook, Mrs. Charles Mc-
Gaff, Mrs. Jerry Draheim, Mrs. Wilbur Taylor, Jr.,
and Mrs. Everett Kasher. The regular February
luncheon meeting featured the Rev. C. Umhau Wolf,
pastor of St. Paul’s Lutheran Church in Toledo,
who spoke on "This is Jordan.” Luncheon chairmen
were Mrs. Cook and Mrs. Robert Barrett. New Study
Groups getting under way include gardening (four
sessions, Mrs. Miller Hallauer, chairman) and tennis
(ten weeks of lessons arranged by Mrs. Joseph Roshe) .
The Stark County auxiliary was honored recently
by being awarded a "Gold Key” for outstanding
1965 volunteer work for the United Fund and its
agencies. The presentation was made at Mergus
Restaurant during the annual joint report meeting of
the United Fund, its Health Foundation and the Can-
ton Welfare Federation. Mrs. William A. McCrea,
auxiliary president, accepted the Gold Key on behalf
of her organization. The Washington County aux-
iliary honored its doctors recently with a Doctors’
Day dinner at the Hotel Lafayette. Mrs. George
Huston and Mrs. Ford Eddy were in charge of ar-
rangements. The January meeting was a "guest
day” with Carlos Germani, exchange student from
Brazil, as the speaker.
Coming Up
Believe it or not, it’s only about two and a half
months to State Convention! Just doesn’t seem pos-
sible. Be sure to see the April issue of The Journal
for full details. Begin making your plans NOW to
attend. Cleveland is the place. May is the month.
And we’re all looking forward to seeing YOU.
Carroll County Medical Society
Announces Seminar Program
The Carroll County Medical Society has announced
a complete program for its Second Annual Postgrad-
uate Medical Seminar to be held at the Atwood Yacht
Club, Atwood Lake, Route 1, Dellroy, across from
the new Atwood Lodge, on Wednesday, April 13.
Sessions begin at 9:30 a. m.
The program will be conducted by a team from the
University of Cincinnati College of Medicine, with
topics and speakers as follows:
The Diagnosis of Diabetes Mellitus — Dr. Har-
vey C. Knowles, professor of medicine.
Pericarditis — Dr. N. O. Fowler, professor of
medicine and director of the Cardiac Research Lab-
oratory of the University of Cincinnati.
Indications for Surgical Intervention of Duo-
denal Ulcer — Dr. John Wulsin, associate professor
of surgery.
Problems of Teenagers — Dr. Norton Dock, as-
sistant professor of psychiatry and associate professor
of pediatrics.
Two half-hour round table discussion periods will
also be a part of the program.
Reservations for the luncheon should be made
with Dr. Thomas J. Atchison, 292 East Main Street,
Carrollton, Secretary of the Society.
A complete day’s program for the ladies is plan-
ned, including a visit to the House of Baskets, New
Philadelphia, luncheon at the new Atwood Lodge,
card playing, etc. A nominal registration fee will
include cost of the luncheon.
Dr. Manuel E. Lichtenstein, Chicago, was guest
speaker for the February 8 dinner meeting of the
Fort Steuben Academy of Medicine in the Fort Steu-
ben Hotel, Steubenville. His topic was "The Clinical
Differences Between the Two Halves of the Colon.”
GROUP LIFE INSURANCE
Initiated and Sponsored by
Your OHIO STATE MEDICAL ASSOCIATION
For Information, Call Or Write
TURNER & SHEPARD, inc,
20 SOUTH THIRD STREET COLUMBUS, OHIO 43215 PHONE 228-6115 CODE 614
272
The Ohio State Medical Journal
HOTEL RESERVATIONS -NOW
FOR THE
1966 OSMA ANNUAL MEETING
CLEVELAND MAY 24-28
Leading Downtown Cleveland Hotels
and Prevailing Rates
SHERATON-CLEVELAND HOTEL
(Headquarters)
Public Square
Singles to $12.50
Doubles $14.50-16.50
Twins 17.00-22.50
AUDITORIUM HOTEL
1315 East 6th Street
Singles $ 6.00 - 10.50
Doubles 8.50-12.50
Twins 12.50-13.50
STATLER HILTON HOTEL
Euclid & East 12th Street
Singles $ 8.00-15.50
Doubles 14.00-17.50
Twins 16.00-30.00
All of the above rates
are subject to change
If you plan to share a room, please indicate name
of roommate so the hotel may avoid duplicate
reservations.
HOTEL RESERVATION BLANK
(Mail to Hotel of Choice)
(NAME OF HOTEL)
Cleveland, Ohio
(ADDRESS)
Please reserve the following accommoda-
tions during the period of the Ohio State
Medical Association Annual Meeting,
May 24 - 28 (or for period indicated)
| | Single Room
| | Double Room
J Twin Room
Other accommodations
Price range
Arriving May at A.M P.M.
PLEASE VERIFY MY RESERVATION
Name
Add ress
for March, 1966
273
Hyperbaric Symposium Sponsored
By Maumee Valley Hospital
Maumee Valley Hospital, 2025 Arlington Avenue,
Toledo, will sponsor a one-day symposium on Hyper-
baric Therapy, Thursday, March 31. The program,
beginning at 9:00 a. m. at the hospital, will include
lectures by internationally known physicians who have
made outstanding contributions to the field of Hyper-
baric Oxygenation.
The symposium has been planned to acquaint
physicians with the recent advancements in this field.
There is no registration fee. This program is ac-
ceptable for Continuation Study Credit by the Ameri-
can Academy of General Practice.
Program Director of the symposium is C. Robert
Tittle, M. D., director of internal medicine and medi-
cal education at Maumee Valley Hospital. He will
be assisted by Gilbert B. Stansell, M. D., director of
laboratories at the hospital.
Speakers for the morning sessions will include
Herbert A. Saltzman, M. D., Department of Medi-
cine, Duke University Medical Center, Durham,
North Carolina, discussing "Physiology and Current
Medical Application of Hyperbaric Oxygenation.”
He will be followed by Orliss Wildermuth, M. D.,
Department of Radiation Therapy, Tumor Institute
of the Swedish Hospital, Seattle, Washington, dis-
cussing "Radiologic Application of Hyperbaric Oxy-
genation.” These lectures will be followed by a
question and discussion period.
Following luncheon at the hospital, Claude Hitch-
cock, M. D., Department of Surgery, Minneapolis
General Hospital, Minneapolis, will discuss recent
"Surgical Applications of Hyperbaric Oxygenation.”
"Clinical Research in Hyperbaric Oxygenation,” of
current interest, will be discussed by Julius Jacobson,
M. D., Department of Surgery, Mt. Sinai Hospital,
New York, New York.
The afternoon session will conclude with the four
lecturing doctors and Dr. Stansell holding a panel
question and discussion period. Following the ad-
journment, the doctors will have an opportunity to
inspect the Maumee Valley Hospital Hyperbaric Unit.
For further information contact C. Robert Tittle,
M. D., director of internal medicine and medical
education, Maumee Valley Hospital, 2025 Arlington
Avenue, Toledo, Ohio 43609.
New Members . . .
Following are names of new members of the Ohio
State Medical Association certified to the Headquar-
ters Office during January. List shows name of physi-
cian, county and city in which he is practicing or
temporary addresses for those taking graduate work.
Athens
Philip D. Kinnard, Athens
Auglaize
Barbara Cummins,
Wapakoneta
Butler
Russell L. Malcolm Jr.,
Middletown
Clark
John S. Hopping, Springfield
Columbiana
Laszlo J. Bujdoso, Lisbon
Crawford
Stephen I. C. Kim, Galion
Erie
Allen B. Easton, Sandusky
Greene
Clayton E. Culbertson,
Yellow Springs
Enrique Martinez, Xenia
Hancock
Oscar M. Weaver Jr.,
Findlay
Knox
Malcolm J. Jones,
Mt. Vernon
Zolton Kontz, Mt Vernon
Lake
Frederick C. Kluth,
Painesville
Logan
Glen E. Miller, West Liberty
Mahoning
Benjamin P. Brucoli,
Youngstown
William Roy Johnson,
Youngstown
Loren J. Zehr, Youngstown
Marion
Ralph E. Beck, Marion
Miami
Alfred R. Davies, Troy
Peter E. Nims, Troy
Kenneth E. Smith, Troy
Montgomery
Bernard J. Liddy,
Niagara Falls, New York
Muskingum
Paul E. Hartenstein, Zanesville
Richland
Nabil G. Fahmy, Mansfield
Joel E. Kaye, Mansfield
Stark
Charles A. Belisle, Canton
Francisco J. Martija, Alliance
Summit
Eduardo Garcia-Rubio, Akron
Tuscarawas
Emmanuel J. Cassiano,
New Philadelphia
Protect Your Family — Now — With the OSMA- PLAN
of comprehensive group major medical insurance sponsored by the
Ohio State Medical Association for its members and their families
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(All three at low group rates)
Call or write : DANIELS-HEAD & ASSOCIATES, INC.
Daniels-Head Building, Portsmouth, Ohio 45662 Tel. 353-3124
274
The Ohio State Medical Journal
State Association Officers and Committeemen
Headquarters Office : Room 1005, 79 East State Street, Columbus 43215. Telephone 221-7715
Henry A. Crawford, President Lawrence C. Meredith, President-Elect Robert E. Tschantz, Past-President
1058 Hanna Bldg., Cleveland 44115 205 Elyria Block, Elyria 44035 515 Third Street, N. W., Canton 44703
Philip B. Hardymon, Treasurer
350 East Broad St., Columbus 43215
Mr. Hart F. Page, Executive Secretary
Mr. W. Michael Traphagan, Administrative Assistant
Perry R. Ayres, Editor
Mr. Charles W. Edgar, Director of Public Relations
and Assistant Executive Secretary
Mr. Herbert E. Gillen, Administrative Assistant
Mr. R. Gordon Moore, Executive Editor
THE COUNCIL
First District, Robert E. Howard, 2600 Union Central Bldg., Cincinnati 45202 ; Second District, Theodore L. Light, 2670 Salem Ave.,
Dayton 45406 ; Third District, Frederick T. Merchant, 1051 Harding Memorial Pky., Marion 43305 ; Fourth District, Robert N. Smith,
3939 Monroe St., Toledo 43606 ; Fifth District, P. John Robechek, 10525 Carnegie Ave., Cleveland 44106 ; Sixth District, Edwin R.
Westbrook, 438 North Park Ave., Warren; Seventh District, Benj. C. Diefenbach, 30 S. 4th St., Martins Ferry; Eighth District, Robert
C. Beardsley, 2236 Maple Ave., Zanesville ; Ninth District, George N. Spears, 2213 So. Ninth St., Ironton ; Tenth District, Richard
L. Fulton, 1211 Dublin Rd., Columbus 43212 ; Eleventh District, William R. Schultz, 1749 Cleveland Rd., Wooster 44691.
COMMITTEES
Committee on Education — Thomas E. Rardin, Columbus, Chair-
man (1966) ; Clyde W. Muter, Warren (1970) ; Thomas S. Brow-
nell, Akron (1969) ; John G. Sholl, Cleveland (1968) ; Elmer R.
Maurer, Cincinnati (1967).
Judicial and Professional Relations Committee — Frank F. A.
Rawling, Toledo, Chairman (1968) ; Homer A. Anderson, Colum-
bus (1970) ; Chester H. Allen, Portsmouth (1969) ; David Fish-
man, Cleveland (1967) ; Paul A. Mielcarek, Cleveland (1966).
Committee on Public Relations and Economics — Frederick P.
Osgood, Toledo, Chairman (1969) ; Luther W. High, Millers-
burgh (1970) ; John H. Budd, Cleveland (1968) ; John J. Cranley,
Cincinnati (1967) ; Horace B. Davidson, Columbus (1966).
Committee on Scientific Work — Samuel Saslaw, Columbus,
Chairman (1968) ; Jack Schreiber, Canfield (1970) ; Walter J.
Zeiter, Cleveland (1970) ; John D. Battle, Jr., (1969) ; Harold
J. Schneider, Cincinnati (1969) ; Isador Miller, Urbana (1968) ;
William Hamelberg, Columbus (1967) ; F. A. Simeone, Cleveland
(1967) ; Ralph K. Ramsayer, Canton (1966) ; G. Douglas Talbott,
Dayton (1966).
Committee on Care of the Aging — Charles W. Stertzbach,
Youngstown, Chairman; James O. Barr, Chagrin Falls; Dwight
L. Becker, Lima ; Robert A. Borden, Fremont ; Edwin W.
Burnes, Van Wert ; Philip T. Doughten, New Philadelphia ;
Robert B. Elliott, Ada ; George T. Harding, Sr., Worthington ;
Roger E. Heering, Columbus; M. Robert Huston, Millersburg ;
John S. Kozy, Toledo; Francis M. Lenhart, Defiance; Harold
E. McDonald, Elyria ; H. W. Porterfield, Columbus ; Elliot W.
Schilke, Springfield ; Bernard A. Schwartz, Cincinnati ; Clar-
ence V. Smith, Canton; Joseph B. Stocklen, Cleveland; Don P.
VanDyke, Kent; William M. Wells, Newark; Roger Williams,
Columbus.
Committee on Cancer — Arthur G. James, Columbus, Chairman ;
Thomas D. Allison, Lima ; Andrew M. Barone, Lima ; William
F. Boukalik, Cleveland; William J. Flynn, Youngstown; Douglas
P. Graf, Cincinnati; Stanley O. Hoerr, Cleveland; William A.
Newton, Jr., Columbus ; W. D. Nusbaum, Lancaster ; Arthur E.
Rappoport, Youngstown ; Carl A. Wilzbach, Cincinnati.
Committee on Eye Care — Arthur D. Collins, Cleveland, Chair-
man ; Martin J. Cook, Springfield ; Thomas L. Edwards, Lima ;
Robert H. Magnuson, Columbus ; Russell J. Nicholl, Cleveland ;
Claude S. Perry, Columbus ; Norman W. Pinschmidt, Gallipolis ;
Barnet R. Sakler, Cincinnati ; Robert L. Willard, Toledo.
Committee on Hospital Relations — William R. Schultz, Woo-
ster, Chairman ; L. A. Black, Kenton ; L. Fred Bissell, Aurora ;
Oscar W. Clarke, Gallipolis; Robert M. Craig, Dayton; John
V. Emery, Willard ; Harvey C. Gunderson, Toledo ; Philip B.
Hardymon, Columbus ; Middleton H. Lambright, Cleveland ;
Lloyd E. Larrick, Cincinnati ; Joseph S. Lichty, Akron ; James
C. McLarnan, Mt. Vernon ; Ben V. Myers, Elyria ; Robert A.
Tennant, Middletown ; V. William Wagner, Port Clinton ; Wil-
liam A. White, Canton.
Committee on Insurance — David A. Chambers, Cleveland,
Chairman ; William F. Bradley, Columbus ; Walter A. Daniel,
Tiffin; Chester R. Jablonoski, Cleveland; William A. Knapp,
Zanesville; Marvin R. McClellan, Cincinnati; William Neal,
Archbold ; Oliver Todd, Toledo ; Robert E. Tschantz, Canton ;
Allan L. Wasserman, Dayton ; John W. Wherry, Elyria ; Wil-
liam A. White, Canton.
Committee on Laboratory Medicine — Horace B. Davidson, Co-
lumbus, Chairman; William H. Benham, Columbus; John B.
Hazard, Cleveland ; Melvin Oosting, Dayton ; Arthur E. Rap-
poport, Youngstown; William Sinclair, Cleveland; Gilbert B.
Stansell, Toledo; Philip B. Wasserman, Cincinnati.
Committee on Legislation — James T. Stephens, Oberlin, Chair-
man ; Donald R. Brumley, Findlay ; George D. J. Griffin, Cin-
cinnati; Jack L. Kraker, Lancaster; Maurice F. Lieber, Canton;
Ralph F. Massie, Ironton ; James C. McLarnan, Mt. Vernon ;
Robert E. Rinderknecht, Dover; John H. Sanders, Cleveland;
Carl R. Swanbeck, Sandusky; William W. Trostel, Piqua.
Committee on Maternal Health — Anthony Ruppersberg, Co-
lumbus, Chairman ; Otis G. Austin, Medina ; Raymond E. Bar-
ker, Columbus ; William D. Beasley, Springfield ; Keith R.
Brandeberry, Gallipolis ; Thomas E. Byrne, Mentor ; C. Ray-
mond Crawley, Dover ; Mel A. Davis, Columbus ; Marion F.
Detrick, Jr., Findlay; John P. Garvin, Columbus; Richard P.
Glove, Cleveland; Robert A. Heilman, Columbus; John F. Hil-
labrand, Toledo; Robert E. Johnstone, Cincinnati; Albert A.
Kunnen, Dayton; James F. Morton, Zanesville; Ralph K. Ram-
sayer, Canton; Robert E. Swank, Chillicothe ; Densmore Thomas,
Warren; Robert S. VanDervort, Elyria.
Committee on Medicine and Religion — George W. Petznick,
Cleveland, Chairman ; John D. Albertson, Lima ; Eugene F.
Damstra, Dayton ; Francis M. Lenhart, Defiance ; Ralph W.
Lewis, Portsmouth; J. Kenneth Potter, Cleveland; Charles A.
Sebastian, Cincinnati ; John R. Seesholtz, Canton ; William B.
Smith, Zanesville; James T. Stephens, Oberlin; Donald J. Vin-
cent, Columbus ; Don G. Warren, West Lafayette.
Committee on Mental Health — Wendell A. Butcher, Columbus,
Chairman ; Homer A. Anderson, Columbus ; Max D. Graves,
Springfield; Charles W. Harding, Worthington; Warren G.
Harding, II, Columbus ; Henry L. Hartman, Toledo ; J. Robert
Hawkins, Cincinnati ; William H. Holloway, Akron ; Nathan
B. Kalb, Lima ; Thomas E. Rardin, Columbus ; Philip C. Rond,
Columbus ; Victor M. Victoroff, Cleveland ; John A. Whieldon,
Columbus.
Committee on Disaster Medical Care — Thomas D. Allison,
Lima, Chairman ; Thomas P. Bowlus, Toledo ; Nino M. Cam-
ardese, Norwalk; Drew L. Davies, Columbus; John H. Davis,
Cleveland ; Gregory G. Floridis, Dayton ; Robert D. Gillette,
Huron; Robert S. Heidt, Cincinnati; N. J. M. Klotz, Wads-
worth ; Thomas W. Morgan, Gallipolis : Sterling W. Obenour,
Jr., Zanesville ; Vol K. Philips, Columbus ; Elden C. Weckesser,
Cleveland; (Liaison with the American Medical Association)
Wendell A. Butcher, Columbus.
Military Advisory Committee — Drew L. Davies, Columbus,
Chairman; A. A. Brindley, Maumee; Ralph G. Carothers, Cin-
cinnati; Homer D. Cassel, Dayton; Henry A. Crawford, Cleve-
land; Walter L. Cruise, Zanesville; Charles R. Keller, Mans-
field ; Ralph W. Lewis, Portsmouth ; Edward L. Montgomery,
Circleville ; Frank T. Moore, Akron; Earl Rosenblum, Steuben-
ville.
Committee on Occupational Health — Rex H. Wilson, Akron,
Chairman; Drew J. Arnold, Columbus; William W. Davis, Co-
lumbus; Winfred M. Dowlin, Canton; Harold M. James, Day-
ton ; H. W. Lawrence, Middletown ; Daniel M. Murphy, Marion ;
Anthony M. Puleo, Cleveland ; George W. Wright, Cleveland ;
H. P. Worstell, Columbus.
Committee on Poison Control — John A. Norman, Akron,
Chairman ; William G. Gilger, Cleveland ; Mason S. Jones, Day-
ton ; James H. Bahrenburg, Canton ; Edward V. Turner, Co-
lumbus; William M. Wallace, Cleveland; Hugh Wellmeier,
Piqua ; John A. Williams, Cincinnati.
Committee on Radiation — Charles M. Barrett, Cincinnati,
Chairman ; Eldred B. Heisel, Columbus : George F. Jones, Lan-
caster; Carey B. Paul, Jr., Columbus; Thomas C. Pomeroy, Co-
lumbus; Denis A. Radefeld, Lorain; Eugene L. Saenger, Cin-
cinnati; Robert E. Schulz, Wooster; John P. Storaasli, Cleve-
land; Robert P. Ulrich, Troy; Robert L. Wall, Columbus; John
Robert Yoder, Toledo: James G. Kereiakes, Ph. D. (Advisory
Member, Special Consultant), Cincinnati.
for March, 1966
275
State Association Officers and Committeemen (Continued)
Committee on Rural Health — Robert E. Reiheld, Orrville,
Chairman ; Chester J. Brian, Eaton ; J. Martin Byers, Green-
field : Walter A. Campbell, Coshocton ; E. Joel Davis, East Can-
ton ; Victor R. Frederick, Urbana ; Benjamin W. Gilliotte, Zanes-
ville; Jerry L. Hammon, West Milton; Jasper M. Hedges, Circle-
ville ; Luther W. High, Millersburg ; E. D. Mattmiller, Athens;
John R. Polsley, North Lewisburg ; Leonard S. Pritchard, Co-
lumbiana; Harold C. Smith, Van Wert; Kenneth W. Taylor,
Pickerington ; Edmond K. Yantes, Wilmington.
Committee on Scientific and Educational Exhibit — Charles V.
Meckstroth, Columbus, Chairman ; Harvey C. Knowles, Jr., Cin-
cinnati ; W. Arnold McAlpine, Toledo ; Arthur E. Rappoport,
Youngstown; Arnold M. Weissler, Columbus; Walter J. Zeiter,
Cleveland ; Robert E. Zipf, Dayton.
Committee on School Health — Charles H. McMullen, Loudon-
v i lie. Chairman; Walter Felson, Greenfield; Paul D. Hahn, New
Philadelphia; Howard H. Hopwood, Cleveland; Dale A. Hudson,
Piqua ; Howard J. Ickes, Canton ; Charles L. Kagay, Dayton ;
Lawrence L. Maggiano, Warren ; Robert C. Markey, Bowling
Green; Robert J. Murphy, Columbus; Carey B. Paul, Jr., Colum-
bus; Carl L. Petersilge, Newark; William H. Rower, Ashland;
Thomas E. Shaffer, Columbus; Aubrey L. Sparks, Warren;
Albert E. Thielen, Cincinnati; Homer B. Thomas, Gallipolis.
Committee on Traffic Safety — N. J. Giannestras, Cincinnati,
Chairman; Howard W. Brettell, Steubenville; Drew L. Davies,
Columbus; Clark M. Dougherty, New Philadelphia: Wesley L.
Furste, Columbus ; Thomas W. Morgan, Gallipolis ; Lester G.
Parker, Sandusky; Thomas N. Quilter, Marion; Stewart M.
Rose, Columbus; John F. Tillotson, Lima; Robert C. Waltz,
Cleveland; Paul L. Weygandt, Akron; Robert E. Zipf, Dayton.
Committee on Workmen’s Compensation — H. P. Worstell, Co-
lumbus, Chairman; A. L. Berndt, Portsmouth; Thomas H.
Brown, Jr., Toledo; Charles A. Browning, Jr., Bellefontaine ;
Oscar W. Clarke, Gallipolis ; Frederick A. Flory, Columbus ;
Lawrence T. Hadbavny, Cleveland; Clyde O. Hurst, Portsmouth;
Edmund F. Ley, Tiffin ; Joseph Lindner, Sr., Cincinnati : John
D. Osmond, Jr., Cleveland ; James G. Roberts, Akron ; George
L. Sackett, Sr., Painesville ; Joseph H. Shepard, Columbus;
William V. Trowbridge, Cleveland; Rex H. Wilson, Akron;
Frederick A. Wolf, Cincinnati ; James N. Wychgel, Cleveland.
OSMA Members of the Joint Advisory Committee on Athletic
Injuries — Robert J. Murphy, Columbus; John R. Jones, Toledo;
Sol Maggied, West Jefferson; Charles H. McMullen, Loudonville :
Carey B. Paul, Jr., Columbus ; Thomas E. Shaffer, Columbus ;
Don A. Kelly, Cleveland ; Marvin R. McClellan, Cincinnati ;
Walter A. Hoyt, Jr., Akron.
OSMA Members of the Joint Committee on School Bus Driver
Examinations — Carey B. Paul, Jr., Columbus; Thomas N. Quil-
ter, Marion ; Stewart M. Rose, Columbus.
DELEGATES AND ALTERNATES
Delegates and Alternates to the American Medical Association
— George W. Petznick, Cleveland; H. T. Pease, Wadsworth, alter-
nate; Carl A. Lincke, Carrollton; Robert S. Martin, Zanesville,
alternate; Theodore L. Light, Dayton; Kenneth D. Arn, Dayton,
alternate; Edmond K. Yantes, Wilmington; Harry K. Hines,
Cincinnati, alternate; John H. Budd, Cleveland; P. John Robe-
chek, Cleveland, alternate ; Richard L. Meiling, Columbus ; Rob-
ert E. Tschantz, Canton, alternate ; Frederick F. Osgood, Toledo ;
Robert N. Smith, Toledo, alternate ; Charles A. Sebastian, Cin-
cinnati ; J. Robert Hudson, Cincinnati, alternate ; Edwin H.
Artman, Chillicothe ; Philip B. Hardymon, Columbus, alternate.
County Societies’ Officers and Meeting Dates
First District
Councilor: Robert E. Howard, Cincinnati 45202
2600 Union Central Bldg.
ADAMS — Gary J. Greenlee, President, Manchester 45144 ; Stan-
ley H. Title, Secretary, Manchester 45144.
BROWN — Charles H. Maly, President, Sardinia 45171 ; Charles
W. Hannah, Secretary, Sardinia 45171. 1st Monday monthly.
BUTLER — Robert Johnson, President, 500 S. Breiel Boulevard,
Middletown 45042 ; Mr. Charles G. Greig, Executive Secretary,
110 North Third Street, Hamilton 45011. 4th Wednesday
monthly.
CLERMONT — Cecil F. Barber, President, State Route 133, Feli-
city 45120 ; Phillips F. Greene, Secretary, Route 1, Box 509,
New Richmond 45157. 3rd Wednesday monthly, except July
and August.
CLINTON — Richard R. Buchanan, President, 115 West Main,
Wilmington 45177 ; Mary Ranz Boyd, Secretary, Box 629,
Wilmington 45177. 4th Tuesday monthly.
HAMILTON — Robert M. Woolford, President, 320 Broadway,
Cincinnati 45202 ; Mr. Edward F. Willenborg, Executive
Secretary, 320 Broadway, Cincinnati 45202. Monthly meet-
ing dates, 1st Tuesday; Academy, 3rd Tuesday, except June,
July and August.
HIGHLAND — Thomas L. Jones, President, 528 South St., Green-
field 45123 ; Walter Felson, Secretary, 357 South St., Greenfield
45123. 3rd Tuesday bimonthly.
WARREN — O. Williard Hoffman, President, 20 East Fourth
Street, Franklin 45005 ; Ray E. Simendinger, Secretary, 901
North Broadway Street, Lebanon 45036. 2nd Tuesday monthly.
Second District
Councilor: Theodore L. Light, Dayton 45406
2670 Salem Ave.
CHAMPAIGN— Myron J. Towle, President, 848 Scioto Street,
Urbana 43078 ; Fred R. Denkewalter, Secretary, 848 Scioto
Street, Urbana 43078. 2nd Wednesday monthly.
CLARK — Henry M. Tardif, President, 2608 E. High Street,
Springfield 45505 ; Mrs. Marion L. Wilcoxson, Executive
Secretary, Hotel Shawnee, Room 207, Springfield 44501. 3rd
Monday monthly, except June, July and August.
DARKEN- William A. Browne, President, 722 Sweitzer St.,
Greenville 45331 ; Delbert D. Blickenstaff, Secretary, 552 S.
West St., Versailles 45380. 3rd Tuesday monthly.
GREENE— Clement G. Austria, President, 1142 North Monroe
Drive, Xenia 45385 ; Mrs. C. K. Elliott, Executive Secretary,
225 Pleasant Street, Xenia 45385. 2nd Thursday monthly
except July and August.
MIAMI — David Brown, President, 1060 North Market Street,
Troy 45373 ; Jack P. Steinhilber, Secretary, 145 Sunset Drive,
Piqua 45356. 1st Tuesday monthly.
MONTGOMERY— Charles E. O’Brien, President, 600 Fidelity
Building, Dayton 45402 ; Mr. Robert F. Freeman, Executive
Secretary, 280 Fidelity Medical Building, Dayton 45402. 1st
Friday monthly October through May — -1st Wednesday June.
PREBLE — John D. Darrow, President, 228 N. Barron St., Eaton
45320 ; Willard C. Clark, Jr., Secretary, 228 N. Barron, Eaton
45320. Irregular meetings.
SHELBY — George J. Schroer, President, 322 Second Ave., Sidney
45365 ; Alfonsas Kisielius, Secretary, Ohio Bldg., Sidney 45365.
Third District
Council : Frederick T. Merchant, Marion 43305
1051 Harding Memorial Pky.
ALLEN — Carl H. Zinsmeister, President, 729 W. Market Street,
Lima 45801 ; Thomas D. Allison, Secretary, 401 Metropolitan
Bank Building, Lima 45801. 3rd Tuesday monthly.
AUGLAIZE — Robert Sobocinski, President, 75 Blackhoof Street,
Wapakoneta 45895 ; J. F. Bowling, Secretary, 319 West Spring
Street, St. Marys 45885. 1st Thursday monthly except July.
CRAWFORD — Don E. Ingham, President, 201 N. Market Street,
Galion 44833 ; Johnson H. Chow, Secretary, 1040 Devonwood
Drive, Galion 44833. Called meetings.
HANCOCK — Raymond J. Tille, President, 801 S. Main St., Find-
lay 45840 ; Herbert L. Queen, Secretary, 828 Woodworth Dr.,
Findlay 45840.
HARDIN — William D. Dewar, President, 405 North Main Street,
Kenton 43326 ; John J. Roget, Secretary, Belle Center 43310.
2nd Tuesday monthly.
LOGAN — Thomas Seitz, President, 223 E. Columbus Street,
Bellefontaine 43311 ; Glen Miller, Secretary, R. D. 2, West
Liberty 43357. 1st Friday monthly.
MARION — Ransome Williams, President, 1035 Harding Me-
morial Parkway, Marion 43302 ; Alice Fisher, Secretary, 1040
Delaware Avenue, Marion 43302. 1st Tuesday monthly.
MERCER — R. Duane Bradrick, President, Rockford 45882 ; R. L.
Dobbins, Secretary, 5402 State Route 29 East, Celina. 3rd
Thursday, monthly.
SENECA — Olgierd C. Garlo, President, 53 Clay Street, Tiffin
44883 ; Leonard M. Gaydos, Secretary, 233 South Monroe
Street, Tiffin 44883. 3rd Tuesday monthly.
VAN WERT — Norman L. Marxen, President, Medical Arts Bldg.,
Fox Road, Van Wert 45891 ; W. L. Her, Secretary, Medical
Arts Bldg., Fox Road, Van Wert 45891. 4th Friday monthly.
WYANDOT- — Herschel A. Rhodes, President, 777 N. Sandusky
Ave., Upper Sandusky 43351 ; J. J. Browne, Secretary, 777 N.
Sandusky Ave., Upper Sandusky 43351. 2nd Tuesday monthly.
Fourth District
Councilor: Robert N. Smith, Toledo 43606
3939 Monroe St.
DEFIANCE — L. F. Berry, Jr., President, 1400 East Second
Street, Defiance 43512 ; W. S. Busteed, Secretary, Box 218,
Defiance 43512.
FULTON — B. H. Reed, Jr., President, Delta 43515 ; R. L. Davis,
Secretary, Wauseon 43567. 2nd Tuesday quarterly March,
June, September, December.
HENRY — J. J. Harrison, President, 113 East Clinton Street,
Napoleon 43545 ; Gamble S- Hall, Secretary, 834 Strong
Street, Napoleon 43545. 1st Tuesday monthly.
LUCAS — E. L. Doermann, President, 2001 Collingwood Blvd.,
Toledo 43620 ; Mr. Robert W. Elwell, Executive Secretary, 3101
Collingwood Blvd., Toledo 43610. 3rd Tuesday monthly except
July and August.
OTTAWA — V. Wm. Wagner, President, 122 East Perry, Port
Clinton 43452 ; William Coon, Secretary, 120 East Perry, Port
Clinton 43452. 2nd Thursday monthly.
PAULDING — Roy R. Miller, President, 220 W. Perry, Paulding
45879 ; D. Paul Ward, Secretary, Box 416, Oakwood 45873.
Meetings called.
PUTNAM — Arthur P. Daniel, President, 144 N. Walnut, Ottawa
45875 ; Oliver N. Lugibihl, Secretary, Pandora 45.877. 1st
Tuesday monthly.
27 6
The Ohio State Medical Journal
SANDUSKY — J. L. Zimmerman, President, Memorial Hospital
of Sandusky County, Fremont 43420 ; Mrs. Patsy J. Askins,
Executive Secretary, Memorial Hospital of Sandusky County,
Fremont 43420. 3rd Wednesday monthly.
WILLIAMS — John E. Moats, President, Central Drive, Bryan
43506 ; Neil T. Levenson, Secretary, 907 Noble Drive, Bryan
43506. 2nd Tuesday monthly.
WOOD- — Roger A. Peatee, President, 140 S. Prospect Street,
Bowling Green 43402 ; William B. Elderbrock, Secretary,
Health Service, Bowling Green State University, Bowling
Green 43402. 3rd Thursday monthly.
Fifth District
Councilor: P. John Robechek, Cleveland 44106
10525 Carnegie Ave.
ASHTABULA — J. R. Nolan, President, 2736 Lake Avenue, Ash-
tabula 44004 ; Richard Millberg, Secretary, 430 West 25th
Street, Ashtabula 44004. 2nd Tuesday monthly.
CUYAHOGA — William F. Boukalik, President, 20030 Scottsdale
Boulevard, Cleveland 44122 ; Mr. Robert A. Lang, Executive
Secretary, 10525 Carnegie Avenue, Cleveland 44106.
GEAUGA — Bruce F. Andreas, President, 400 Downing Drive,
Chardon 44024 ; Arturo J. Dimaculangan, Secretary, 8400 May-
field Road, P. O. Box 277, Chesterland 44026. 2nd Friday
monthly.
LAKE — Robert W. Colopy, President, 89 E. High Street, Paines-
ville 44077 ; Mrs. Owen A. McLaren, Executive Secretary,
7408 Cadle Avenue, Mentor 44060. 4th Wednesday evening-
monthly, January, May, March, September and November
unless otherwise ordered by Council.
Sixth District
Councilor: Edwin R. Westbrook, Warren 44481
438 North Park Ave.
COLUMBIANA — Edith S. Gilmore, President, 432 W. 5th St.,
E. Liverpool 43920 ; Fraser Jackson, Secretary, 205 W. 6th
St. 3rd Tuesday monthly.
MAHONING - — F. A. Resch, President, Doctors Park, Canfield
44406 ; Mr. Howard C. Rempes, Jr., Executive Secretary, 245
Bel-Park Building, 1005 Belmont Avenue, Youngstown 44504.
3rd Tuesday monthly except July and August.
PORTAGE — David Palmstrom, President, 124 North Prospect
Street, Ravenna 44266 ; William R. Brinker, Secretary, 141
East Main Street, Kent 44240. 3rd Tuesday monthly.
STARK — A. R. Furnas, Jr., President, 420 Lake Avenue, N. E.,
Massillon 44646 ; Mr. John H. Austin, Executive Secretary,
405 4th Street, N. W., Canton 44702. 2nd Thursday monthly.
SUMMIT — James G. Roberts, President, 655 West Market Street,
Akron 44303 ; Mr. Sidney H. Mountcastle, Executive Secretary,
437 Second National Building, 159 South Main Street, Akron
44308. 1st Tuesday monthly.
TRUMBULL — John F. McGreevey, President, 297 Hawthorne
Lane N. E., Warren 44484 ; Mrs. Kay Ticknor, Executive
Secretary, 280 North Park Avenue, Warren 44481. 3rd
Wednesday monthly September through May.
Seventh District
Councilor: Benj. C. Diefenbach, Martins Ferry 43935
30 S. 4th St.
BELMONT — James Sutherland, President, 9 North 4th Street,
Martins Ferry 43935 ; Bertha M. Joseph, Secretary, 100 South
4th Street, Martins Ferry 43935. 3rd Thursday of February,
March, April, June, September, October, November and
December.
CARROLL— Glen C. Dowell, President, 207 West Main, Car-
rollton 44615 ; Thomas J. Atchison, Secretary, 292 East
Main, Carrollton 44615. 1st Thursday monthly.
COSHOCTON — Don Warren, President, 600 East Main Street,
West Lafayette 43845 ; Harold Lear, Secretary, 133 South
Fourth Street, Coshocton 43812. 2nd Tuesday monthly.
HARRISON — Charles D. Evans, President, 159 South Main
Street, Cadiz 43907 ; G. E. Vorhies, Secretary, Scio 43988,
Quarterly.
JEFFERSON — Jacob R. Cohen, President, 341 Market Street,
Steubenville 43952 ; Irving Dreyer, Secretary, Ohio Valley
Hospital, Steubenville 43952. 4th Tuesday monthly except
December, January, February.
MONROE — Byron Gillespie, Secretary, Woodsfield 43793.
TUSCARAWAS — Robert J. Kuba, President, 319 Grant St., Den-
nison 44621 ; Thomas E. Ogden, Secretary, 138 E. Main St.,
Gnadenhutten. 2nd Thursday monthly.
Eighth District
Councilor: Robert C. Beardsley, Zanesville 43705
2236 Maple Ave.
ATHENS — D. R. Johnson, President, 52 West Washington
Street, Nelsonville 45764 ; L. A. Hamilton, Secretary, 400 East
State Street, Athens 45701. 2nd Tuesday monthly except July
and August.
FAIRFIELD — George W. LeSar, President, 216 Harmon Avenue,
Lancaster 43130 ; Stephen R. Hodsden, Secretary, 1423 West
Market Street, Baltimore 43105. 2nd Tuesday monthly.
GUERNSEY— A. C. Smith, President, 1115 Clark Street, Cam-
bridge 43725 ; Dayle O. Snyder, Secretary, 840 Wheeling
Avenue, Cambridge 43725. 1st Tuesday monthly.
LICKING- — Carl L. Petersilge, President, 104 Hudson Avenue,
Newark 43055 ; Robert P. Raker, Secretary, 317 N. Granger
Street, Granville 43023. 4th Tuesday monthly.
MORGAN — A. H. Whitacre, President, Chesterhill 43728; Henry
Bachman, Secretary, Box 199, Malta 43758.
MUSKINGUM — Paul A. Jones, President, 838 Market Street,
Zanesville 43701 ; Myron Powelson, Secretary, 2825 Maple
Avenue, Zanesville 43705. 2nd Tuesday monthly.
NOBLE — Frederick M. Cox, President, Caldwell 43724 ; Edward
G. Ditch, Secretary, 415 Main Street, Caldwell 43724. 1st
Tuesday monthly.
PERRY — Charles B. McDougal, President, 319 High St., New
Lexington 43764 ; Michael P. Clouse, Secretary, West Main St.,
Somerset 43783.
WASHINGTON — Mary L. Whitacre, President, Rt. 6, Marietta
45750 ; G. E. Huston, Secretary, 328 Fourth St., Marietta
45750. 2nd Wednesday monthly.
Ninth District
Councilor: George N. Spears, Ironton 45638
2213 S. 9th St.
GALLIA — Quentin Korfhage, President, Gallipolis Clinic, Gal-
lipolis 45631 ; John Groth, Secretary, Holzer Clinic, Gallipolis
45631. Monthly meetings at called times.
HOCKING — Jan S. Matthews, President, 9 East Second Street,
Logan 43138 ; H. M. Boocks, Secretary, Route 3, Logan 43138.
2nd Tuesday monthly.
JACKSON — John M. Cook, President, Box 316, Oak Hill 45656 ;
Earl J. Levine, Secretary, 120 N. Ohio Ave., Wellston 45692.
LAWRENCE — Frank W. Crowe, President, 2110 South 9th
Street, Ironton 45638 ; George Newton Spears, Secretary, 2213
South Ninth Street, Ironton 45638. Quarterly at called times.
MEIGS — Charles J. Mullen, President, 210% E. Main St., Pome-
roy 45769 ; Edmund Butrimas, Secretary, 204 E. Main St.,
Pomeroy 45769.
PIKE — Robert T. Leever, President, 100 East Third St., Waverly
45690 ; Albert M. Shrader, Secretary, East Water St., Waverly
45690. 1st Tuesday monthly.
SCIOTO — Chester H. Allen, President, 1405 Offnere Street,
Portsmouth 45662 ; Erich Spiro, Secretary, 1735 Waller Street,
Portsmouth 45662. 2nd Monday in February, April and Octo-
ber ; December meeting and summer meeting decided by the
Council and members notified one month in advance.
VINTON — Richard E. Bullock, President, 203 South Market St.,
McArthur 45651.
Tenth District
Councilor: Richard L. Fulton, Columbus 43212
1211 Dublin Rd.
DELAWARE — Don K. Michel, President, 98 W. William, Dela-
ware 43015 ; Tennyson Williams, Secretary, Box 265, Delaware
43015. 3rd Tuesday monthly.
FAYETTE — R. D. Woodmansee, President, 403 East Market
Street, Washington C. H. 43160 ; M. H. Roszmann, Secretary,
1005 East Temple Street, Washington C. H. 43160. 2nd
Friday monthly
FRANKLIN — Joseph A. Bonta, President, 3100 Olentangy River
Road, Columbus 43202 ; Mr. W. “Bill” Webb, Jr., Executive
Secretary, 79 East State Street, Room 601, Columbus 43215.
3rd Tuesday monthly.
KNOX — Richard L. Smythe, President, 812 Coshocton Road,
Mt. Vernon 43050 ; Robert E. Sooy, Secretary, Box 470, Mt.
Vernon 43050. 1st Wednesday evening monthly.
MADISON — Sol Maggied, President, 15 East Pearl Street, West
Jefferson 43162 ; Michael Meftah, Secretary, 11 East 2nd
Street, London 43140. 1st Wednesday monthly.
MORROW — Francis W. Kubb, President, 140 North Main, Mt.
Gilead 43338 ; William S. Deffinger, Secretary, Box 8, Marengo
43334. 1st Tuesday monthly.
PICKAWAY — V. D. Kerns, President, 143 E. Main Street,
Circleville 43113 ; Carlos Alvarez, Secretary, 147 Pinckney
Street, Circleville 43113. 1st Friday evening monthly, except
months of July and August.
ROSS — Joseph McKell, President, 174 W. Main Street, Chilli-
cothe 45601 ; Lowell O. Smith, Secretary, 217 Delano Avenue,
Chillicothe 45602. 1st Thursday evening monthly.
UNION — Malcolm Maclvor, President, 110 N. Court St., Marys-
ville 43040 ; May B. Zaugg, Secretary, 130 N. Maple St.,
Marysville 43040. 1st Tuesday, February, April, October,
December.
Eleventh District
Councilor: William R. Schultz, Wooster 44691
1749 Cleveland Road
ASHLAND — Henry C. Chalfant, President, 309 Arthur Street,
Ashland 44805 ; H. W. Smith, Secretary, 414 Samaritan Ave-
nue, Ashland 44805. 1st Thursday monthly.
ERIE — Clinton F. Lavender, President, 1218 Cleveland Road,
Sandusky 44870 ; R. D. Gillette, Secretary, P. O. Box 127,
Huron 44839. Alternate Tuesday and Thursday monthly.
HOLMES — Charles H. Hart, President, 109 South Clay Street,
Millersburg 44654 ; William A. Powell, Secretary, 8 West
Adams Street, Millersburg 44654. Monthly meeting date to
be determined later.
HURON — W. R. Graham, President, 15 Main Street, Wakeman
44889 ; E. R. McLoney, Secretary, 257 Benedict Avenue, Nor-
walk 44857. 2nd Wednesday of February, April, June, Au-
gust, October, and December.
LORAIN — Joseph A. Cicerrella, President, 209 6th Street, Lorain
44052 ; Mrs. Gladys Davidson, Executive Secretary, 428 West
Avenue, Elyria 44035. 2nd Tuesday monthly except June,
July and August.
MEDINA- — Myrl A. Nafziger, President, Albrecht Building,
Wadsworth 44281 ; Mr. A. Dana Whipple, Executive Secretary,
320 East Liberty Street, Medina, Ohio 44256. 3rd Thursday
monthly.
RICHLAND — C. J. Shamess, President, 74 Wood Street, Mans-
field 44903 ; Harold F. Mills, Secretary, 70 Madison Road,
Mansfield 44905. 3rd Thursday monthly except June, July and
August.
WAYNE — Howard MacMillan, President, 1740 Cleveland Road,
Wooster 44691 ; R. J. Watkins, Secretary, 1736 Beall Avenue,
Wooster 44691. 2nd Wednesday monthly, January, February,
April, September, November and December.
for March, 1966
277
Table of Contents
(Continued From Page 195)
Page
203 Medical Executive of Long Standing in
Columbus Area Dies
203 State Medical Board of Ohio Issues Annual
Report
210 M. D.’s in the News
221 "Death to Measles’’ Article Poses Lesson in
Latin
221 Do You Know?
246 Instructions to Contributors of Scientific Papers
251 Written Prescription Required for Class A
Narcotic Drugs
254 Diagnostic Radiology Lecture in Cincinnati
258 State Medical Board Resolution, Tribute to
Dr. Platter
258 New Provisions in OSMA Bylaws Pertaining
to Nomination of President-Elect
260 Weil Memorial Lecture Scheduled in Akron
260 Western Reserve Dental School Tests Self-
Teaching Methods
260 American College of Surgeons Joint Cleveland
Meeting
261 OSU Medical College Gets Grant for Basic
Science Building
261 Pediatric Lectureship Presented on Neonatal
Hyperbilirubinemia
262 Obituaries
263 Hospital Orderly Wanted by LBI Believed to
Be in Ohio
264 Activities of County Medical Societies
268 AMA Environmental Health Program
270 Woman’s Auxiliary Highlights
272 Carroll County Medical Society Announces
Seminar Program
274 Hyperbaric Symposium Sponsored by Toledo
Hospital
274 New Members of the Association
275 Roster of OSMA Officers and Committeemen
276 Roster of County Medical Society Officers and
Meeting Dates
278 The Journal’s Advertisers in This Issue
279 Classified Advertisements
JOURNAL ADVERTISERS
Advertisers in The Journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The Journal.
and help make it a quality publication. In return we
place their messages on the desks of Ohio's physicians.
Please familiarize yourself with their services and pro-
ducts, and let them know that you see their advertising
in The Journal.
In This Issue :
Abbott Laboratories 217-218-219-220
Allergy Laboratories of Ohio, Inc 197, 271
Ames Company, Inc Inside Back Cover
Appalachian Hall 269
Blessings, Inc 264
The Brown Pharmaceutical Co 208
Burroughs Wellcome & Co. (USA) Inc 215
Cameron-Miller Surgical Instruments Co 216
Daniels-Head & Associates, Inc 274
Elder, Paul B., Company 199
Geigy Pharmaceuticals, Division of
Geigy Chemical Corporation 198
Harding Hospital 208
Hynson, Westcott & Dunning, Inc 193
The Kendall Company 213
Lederle Laboratories, A Division of American
Cyanamid Company 206-207, 267, 280
Lilly, Eli, and Company 224
The Medical Protective Company 266
North, The Emerson A., Hospital Inc 222
Parke, Davis & Company Inside Front Cover
The Readjustment Center 263
Roche Laboratories, Division of
Hoffmann-La Roche Inc Back Cover
Searle, G. D., & Company 252-253
Smith Kline & French Laboratories 202
Squibb, E. R., & Sons 196
Turner & Shepard, Inc 272
Tutag, S. J., & Co 269
The Vale Chemical Company, Inc 209
Wallace Laboratories 210-211, 223, 265
Warner-Chilcott Laboratories, Division of
Warner-Lambert Pharmaceuticacl Co. .. 200-201
Warren-Teed Pharmaceuticals Inc 204-205
The Wendt-Bristol Company 271
Windsor Hospital 270
Winthrop Laboratories 194
278
The Ohio State Medical Journal
CTi
vwe
OHIO STATE MEDICAL
journal
VOL. 62 APRIL, 1966 NO. 4 g
OSMA OFFICERS m
President -
Henry A. Crawford, M. D. g
1058 Hanna Bldg., Cleveland 44115 g
President-Elect H
Lawrence C. Meredith, M. D. g
205 Elyria Block, Elyria 44035 g
Past-President Hi
Robert E. Tschantz, M. D. g
515 Third St., N. W., Canton 44703 jH
T reasurer
I’m it. u' B. Hardymon, M. D. g
350 E. Broad St., Columbus 43215
liDITO R I A L STAFF
Editor HE
Perry R. Ayres, M. D. g
Managing Editor and g
Business Manager g
Hart F. Page g
Executive Editor and g
Executive Business Manager HI
R. Gordon Moore g§
OSMA EXECUTIVE STAFF H
Executive Secretary |
Hart F. Page jj
Director of Public Relations and g
Assistant Executive Secretary 11
Charles W. Edgar g
Administrative Assistants §
W. Michael Traphagan g
Herbert E. Gillen g
Address All Correspondence: g
The Ohio State Medical Journal g
79 E. State Street g
Columbus, Ohio 43215 Hi
Published monthly under the direction of The |H
Council for and by members of The Ohio State
Medical Association, 79 E. State Street, Columbus, =
Ohio 43215, a scientific society, nonprofit organi-
zation, with a definite membership for scientific ^
and educational purposes. =H
Subscription, $6.00 per year to non-members;
single copy, 50 cents (outside Continental U.S.,
$7.50 and 75 cents). 1|=
Entered as second class matter July 5, 1905, at =j
the Postoffice at Columbus, Ohio, under the Act
of Congress of March 3, 1879; Acceptance for 1
mailing at special rate of postage provided for in Hi
Section 1103, Act of Oct. 3, 1917. Authority HI
July 10, 1918. m
The Journal does not assume responsibility for ===
opinions expressed by the essayists. Advertisers -
must conform to policies and regulations estab-
lished by The Council of the Ohio State Medical =
Association. =
Table of Contents
Page Scientific Section
321 The Family Physician and Psychiatry. A Discussion of
a New Method of Instruction. Warren G. Harding
II, M. D., and Wendell A. Butcher, M. D., Columbus.
323 Medical Travelogue. About Artificial Organs, Kidney
Transplantation, and Unrelated Medical Experiences
in Europe, Fall, 1964. W. J. Kolff, M. D., Cleveland.
329 Treatment of Septic Shock. A Progress Report. Frank
W. Ames, M. D., Bellevue, and Martin J. Fischer,
M. D., Akron.
332 Adverse Reactions to Drugs. Report Them to AMA!
333 Demethylchlortetracycline Overdosage. A Case Report
of Toxic Effects in a Patient with Impaired Renal
Function. Armand Mandel, M. D., Parma, Ohio.
336 Apnea Due To Intramuscular Colistin Therapy. Report
of a Case. Michael A. Anthony, M. D., and David
L. Louis, M. D., Columbus.
339 A Clinicopathological Conference from The Ohio State
University Hospital, Columbus, Ohio.
288 The Historian’s Notebook: Levi Rogers. Frontier
Doctor, Pastor, and Statesman. (Part III.) Phillips
F. Greene, M. D., New Richmond.
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
News and Organization Section
347- 379 The Official Program for the 1966 OSMA Annual
Meeting
348- 349 Highlights
330-333 Daily Schedule of Events in Summary
354-370 Chronological Program, Names of Speakers,
Topics, etc.
354 First Session of the House of Delegates
354-355 Roster of Delegates and Alternates
357 OMPAC Luncheon
369 The President’s Reception
371 Ohio Health Commissioners’ Institute
373 Annual Convention of the Woman’s Auxiliary to
OSMA
373-37 4 Scientific and Health Education Exhibit
375 Technical Exhibitors
376-377 Things To Do in Cleveland
378-379 Special Events of Special Groups During Annual
Meeting Week
( Continued on Page 402 )
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\ The Ohio State Medical Journal
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for April, 1966
285
Right there
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Improvement of mental alertness and aware-
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requires a comforting environment, a stimulating
dietary regimen and concomitant drug therapy.
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Side Effects: overdosage may produce tremor, convulsions
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Caution should be taken when treating patients with a low
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Write for detailed literature and
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Cincinnati Surgery Team Pioneers in
Clinical Use of Argon Laser
University of Cincinnati Medical Center surgeons
in the Laser Laboratory at Children’s Hospital re-
ported the successful first use of an argon laser to
remove a melanoma and to treat a tattoo, both on hu-
man patients.
The January 24 operation was on a 45-year old
man, who was sent to the Cincinnati laboratory for
treatment by the National Cancer Institute, Bethesda,
Maryland.
Dr. Leon Goldman, director of the Laser Lab-
oratory and head of the University’s Department
of Dermatology, reports these first operations were
successful.
The argon laser sends a continuous beam of light
which can be more easily regulated and controlled
than the burst of light from other types of laser.
The University of Cincinnati surgeons used a curved
mirror to aid in manipulating the laser beam. For
comparison the surgeons also treated other tumors
on the man with a mby laser beam and with elec-
trosurgery. A second patient had a portion of tat-
tooing removed by the argon laser.
Developed by Bell Telephone Laboratories in
Murray Hill, N. J., the argon laser was sent to the
Cincinnati laboratory with Bell technicians for this
research.
Dr. Goldman further announced that an argon
laser is being donated to the Cincinnati laboratory by
the John A. Hartford Foundation, New York City,
which supports the entire work of the Laser Labora-
tory. Since the University of Cincinnati also does
research toward protection of laser personnel, the
staff will continue these studies in regard to the argon
laser. The surgeon now must focus the beam, work-
ing from behind an amber plastic screen.
The operation was performed by Dr. Thomas E.
Brown, head of the laboratory’s neurosurgical work
(under Dr. Robert L. McLaurin, University of Cin-
cinnati professor of surgery) ; Dr. Goldman, and Dr.
Bruce Henderson, fellow in pediatric surgery (under
Dr. Lester Martin, Cincinnati associate professor of
surgery) and in laser surgery (under Dr. Vinton E.
Siler, Cincinnati professor of surgery).
Dr. William A. Altemeier, head of Cincinnati
university’s department of surgery, had appointed
Dr. Siler to direct laser surgery at the laboratory.
This is the first department of surgery in the nation
which has a division of laser surgery. Dr. Goldman
opened the nation’s first Medical Laser Laboratory at
the University of Cincinnati three years ago.
A consumer survey by the Pharmaceutical Manufac-
turers Association showed that while most people
think prescription drugs cost too much, 82 per cent
of those interviewed said their last prescription did
a good job and 70 per cent said it was worth the cost.
28(5
The Ohio State Medical Journal
at Merck Sharp & Dohme...
understanding. . . precedes development
The development of chlorothiazide and probene-
cid were events of major importance, but perhaps
even more important for the future was the Renal
Research Program by which they were developed.
When Merck Sharp & Dohme organized this pro-
gram in 1943, it was expressing in action some of
its basic beliefs about research:
• Many problems connected with renal structure
and function were still undefined or unsolved. The
Renal Research Program would begin its basic
research in some of these problem areas.
• From knowledge thus acquired might come clues
to the development of new therapeutic agents of
significant value to the physician.
For example, the Renal Research Program put
fifteen years into this search before chlorothiazide
became available. But because these years had
first led to a greater understanding of basic
problems, the desired criteria for chlorothiazide
existed before the drug was developed.
Along with other research teams at Merck Sharp
& Dohme, the Renal Research Program continues
to add new understanding of basic problems —
understanding which will lead to important new
therapeutic agents.
©MERCK sharp & dohme Division of Merck & Co., I nc., West Point, Pa.
where today’s theory is tomorrow’s therapy
for April, 1966
287
The Historian’s Notebook
Levi Rogers
Frontier Doctor, Pastor and Statesman
PHILLIPS F. GREENE, M. D.*
PART III
( Concluded from March Issue )
A BOUT JUNE 1st Levi rejoined the 19th Infan-
try at Camp Bull, Chillicothe. He reported
A- -A- to John B. Campbell, Col. by brevet, then in
charge. Dr. Rogers had by now accumulated quite a
number of bills for travel expenses, etc. He was told
he must present them to the paymaster in Cincinnati.
Finding none of his charges were ill, Dr. Rogers ob-
tained a ten day leave from Col. Campbell and ar-
ranged for Dr. Spurch, surgeon’s mate of the 26th In-
fantry to cover for him. He did not actually intro-
duce Spurch to Campbell.
Upon his return to Chillicothe June 14th all
seemed well. But soon a train of events started that
ended in Surgeon Rogers’ dismissal from the army.
A newly arrived Kentucky volunteer had died while
Rogers was on leave. His first word of this was a
note from Col. Campbell dated June 17th, inform-
ing Rogers that Campbell had not considered Spurch
competent for serious cases and had called in Dr.
Monet of Chillicothe. Campbell instructed Rogers to
pay Dr. Monet. Levi at once contacted Monet, whom
he knew well and learned that the recmit had died
of jaundice in Dr. Monet’s home. Dr. Monet of
course declined to accept money from Dr. Rogers for
his services.
But Dr. Rogers felt Dr. Spurch had been unfairly
treated, especially as Col. Campbell had made some
slighting remarks in public concerning Spurch’s
abilities medically. Rogers wrote a very careful note
to Col. Campbell raising this point. The Colonel re-
plied that he himself, not the medical profession
was responsible for the health of his troops and he
would use his own judgment. (For over a hundred
years this view was commonly held in our army. Not
till the medical corps was finally organized under its
own medical superior officers was it laid to rest.) But
back in 1813, Levi Rogers felt he must press the issue.
There followed an exchange of letters, each getting
more irate. In his last letter to Col. Campbell dated
*Dr. Greene, New Richmond, is a member of the staff. Brown
County Hospital at Georgetown; Yale in China, emeritus Professor
of Surgery.
Submitted February 3, 1965.
June 21, Rogers practically ordered his superior officer
to reply at once. Col. Campbell did not reply at all.
On June 23rd Rogers sent a full report of the whole
affair to the Hon. John Armstrong, Secretary of War.
He seems never to have had a reply from that either.
Early in July 1813 the British forces were again
preparing to take Ft. Meigs. Surgeon Rogers was
sent back with a contingent of the 19th Infantry.
He was the surgeon in charge during the second siege,
July 26-31. This also ended by the British with-
drawing.
During the following weeks the Fort was under
no enemy threat. The main American military ac-
tivity was building a navy for Lake Erie. Apparently
Col. Campbell chose this time to get rid of Rogers.
Early in September Rogers was arrested for "crimes
and misdemeanors.’’8 He was tried by a military
court of inferior ranking personnel, his own wit-
nesses were refused permission to testify, were not
even sworn in. While the trial was in progress the
news of Perry’s victory over the British fleet ar-
rived and the camp went wild in celebration. The
court hastily found Surgeon Rogers guilty, set Sep-
tember 30th as his dismissal date, and rushed out
to join in the celebration.
Early in October the army moved away leaving only
a skeleton staff and the sick and wounded at Fort
Meigs; Dr. Rogers was requested to remain to care
for these. He felt he should stay and did so. An
eloquent bit of paper on file in Washington is a
testimonial from the three ranking officers at Ft.
Meigs at this time.
To the Hon. John Armstrong, Secretary of War:
We certify that when the Army moved from this place
all the sick which were numerous, were left here. Dr.
Rogers was requested to attend them which has been done
with great attention and success by which he has the con-
fidence and thanks of the officers and men at this garrison.
Capt. Daniel Corner, commandant
Lt. Thomas Dunn
Ens. Ophraim
There is another document in Washington, — a
memorial by Dr. Rogers written at Ft. Meigs, Nov.
288
The Ohio State Medical Journal
2, 1813, to the Secretary of War, begging for a re-
view of his court-martial. After describing the whole
proceeding and asserting his innocence he concludes:
This is worse than death to a man whose whole life has
borne marks of public esteem and confidence. Your memo-
rialist hopes that the whole proceedings may be viewed by
the President of the United States and justice done.9
I have been unable to find any record that this
memorial was ever acted upon. This court-martial is
missing from the official records of courts-martial
held during the War of 1812. Maybe it was never
officially reported to Washington. Levi Rogers was
obviously still serving at Ft. Meigs weeks after the
date officially recorded for his dismissal. He con-
sidered trying to contact both Gen. Harrison and
Gen. McArthur to ask for their backing but decided
against it, because it was so difficult to locate them
and because "in time of this war they were giving
their whole effort to the struggle.”10
Rogers’ original appointment had been for one
year. Early in 1814 he was back home in Bethel,
Clermont County, Ohio. Medicine became his chief
occupation, though he was also elected a trustee of
Tate Township where Bethel is located, and was
serving in that capacity when he so suddenly died.
He left his widow, two sons and five daughters. Many
were the tributes paid him. "A great loss to our
community. A man of singularly good judgment, ”11
said one of his legal colleagues and near neighbor,
Thomas Morris, later U. S. Senator from Ohio.
During his last months of life, Levi had given
special attention to training his second son John
George Rogers in medicine. After his death, the
Rev. George C. Light was able to persuade Dr. Wil-
liam Wayland of Circleville to come to Bethel, take
over Levi’s practice and continue the medical educa-
tion of John George.
Anyone who has read this account cannot have
missed the fact that Levi Rogers was a man of keen
intellect and unbounded energy. He lived a life of
great service and devotion to the country and the
people of this state. His sudden death must have
been widely noted. I fully expected to find an ap-
propriate obituary somewhere. So far no obituary
has come to light, either in the press of his day or in
the Ohio records of the Methodist Episcopal Church.
Although he was well qualified in the three fields
of religion, medicine, and law, and was involved in
all three throughout his adult life, medicine was
clearly his chief vocation. After the age of 27 when
he resigned as a regular pastor of the M. E. Church,
his preaching, performing of marriages and conduct-
ing funerals were all by way of aiding situations and
meeting needs as occasion arose, rather than as a full
time minister of the gospel.
Outside of his elected offices, his legal work was
largely acting as executor for estates of people who
had been his patients, and this usually without
changing their estates, in the case of poor people.
Medicine was his chief calling. Nothing to my
mind, shows more clearly his devotion to the ill than
his continuing to care for the sick at Fort Meigs
after he had been dismissed from the U. S. Army
by the decision of a vindictive, crooked court-martial.
His willingness to forego seeking the aid of power-
ful friends like Generals William H. Harrison and
Duncan McArthur because he did not want to trouble
them while they were making every effort to prosecute
the War of 1812, shows a degree of unselfishness
truly great. Finally his willingness to let the whole
matter drop and return to his medical practice in
Clermont County is indeed, "forgetting the things
that are behind and pressing on to the high calling,”
to which he had dedicated his life.
Acknowledgment: Special mention of help received
should be mentioned in the case of Lucile Hook, formerly
Librarian of the Cincinnati Historical Society and Dr. Frank
B. Rogers, Librarian of the Surgeon General’s Medical
Library, Washington, D. C., himself a descendent of Levi
Rogers.
References
8. U. S. Army Records, Washington, D. C.: Levi Rogers file.
9. Rogers, L. : Memorial to Hon. John Armstrong. Now in
Archives, Bureau of Special Services, Washington, D. C., Nov. 3,
1813, (Unpublished).
10. Levi Rogers file, same as Ref. No. 8.
11. Everts: p. 142.
CAMP ITCH. — Insufficient evidence remains to determine the exact nature of
camp itch. It may have been scabies as many Northern observers main-
tained. However, as true Southerners, we must stand with Guild and Claiborne
and conclude that camp itch was a distinct, noncontagious, pruriginous dermatitis
resulting in some way from the vicissitudes of combat and leading to disability
of great numbers of troops during the Civil War. — E. Randolph Trice, M. D.,
and R. Campbell Manson, M. D., Richmond, Va.: Southern Medical Journal,
59:10-14, January 1966.
for April, 1966
291
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The Ohio State Medical Journal
Mediatric
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Each MEDIATRIC Tablet or Capsule contains:
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Methyltestosterone 2.5 mg.
Ascorbic acid 100.0 mg.
Cyanocobalamin 2.5 meg.
Intrinsic factor concentrate 8.0 mg.
Thiamine mononitrate 10.0 mg.
Riboflavin 5.0 mg.
Niacinamide 50.0 mg.
Pyridoxine HC1 3.0 mg.
Calc, pantothenate 20.0 mg.
Ferrous sulfate exsic 30.0 mg.
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The Ten Commandments
For the Prevention of
Alcoholic Addiction
TO ENJOY ALCOHOL SAFELY:
1. NEVER take a drink when you "NEED” one.
2. SIP SLOWLY. Space drinks: The second
thirty minutes after the first; the third an hour after
the second; NEVER a fourth.
3. DILUTE drinks — never on the rocks.
4. Keep accurate record of amount and number
of drinks. Never drink every day.
5. Do not minimize the amount you drink. In-
stead, exaggerate it. If you say you drink twice as
much as you think you do, this will probably be
nearly accurate.
6. Do not drink on an empty stomach.
7. No signal drinking such as "luncheon,” "Left
office,” "on the way home,” "before dinner,” before
bed,” "meeting people,” "celebrating,” and "to get
me through.”
8. Tired or tense? Soak in a hot tub.
9. Never drink to escape discomfort.
10. Never drink in the morning.
By understanding this dangerous, pleasant drug and
observing precautions, many people may enjoy the use
of alcohol.
Alcoholism is a psychophysical addictive disease to
which all people are liable. It occurs in individuals
who are physically pre-disposed and emotionally con-
ditioned. The change from being non-alcoholic to
alcoholic occurs suddenly, is seldom recognized, and
is due to a breakdown in organic and psychological
protective mechanisms. Once it has occurred, it
cannot be reversed — then only total abstinence will
save the individual.
It is possible for those who have not become al-
coholic to enjoy the use of alcohol in this alcohol-
oriented culture. Only they can prevent their becom-
ing alcoholics, and to a large extent only they can
prevent their children becoming alcoholics.
These ten commandments have been prepared as a leaflet by Wil-
liam B. Terhune, M. D., Medical Director, The Silver Hill Foun-
dation, Box 1177, New Canaan, Connecticut. The author will supply
copies for distribution free of charge.
A new million-dollar shellfish research center for
the U. S. Public Health Service will be built in the
Pacific Northwest, on the lower Puget Sound. Its
45 -man staff of scientists and technicians will gather
information on the role of shellfish in the transmis-
sion of disease and the effect of commercial processes
on their sanitary quality.
Dr. James B. Overmier spoke on the topic, "The
Heart” at the guest night meeting of the Town and
Country Child Conservation League in Leipsic.
Current Comments in the Field
Of the Drug Manufacturers
The following excerpts of comments from various
sources are presented in behalf of the Pharmaceutical
Manufacturers Association and drug manufacturing
firms in general.
* * *
Ill-advised statements and actions since the thali-
domide phenomenon, aided by the unbalanced per-
spective given these statements in the lay press, have
contributed to the public’s apprehension — approach-
ing hysteria — concerning the side effects of drugs.
To the extent that this concern admonishes greater
caution and alertness in the use of dmgs, some good
may be salvaged from the thalidomide tragedy. But
to the extent that it deprives patients of useful new
drugs or frightens a physician into withholding
needed therapy from his patients, it is regrettable. We
must not forget that there is no progress without risk,
whether it be in the field of electricity, the motor
car, the airplane, atomic energy, space exploration,
or drugs. Even a bathtub can be perilous, as astro-
naut John Glenn discovered. — Theodore G. Klumpp,
M. D., in Massachusetts Physician, (28:207-208),
June-July 1965.
* * *
May I earnestly recommend, therefore, that general
practitioners assume as a professional responsibility
the obligation of recording their personal experiences
with individual drugs. It is my hope that they will
pass along their conclusions, based on collective ex-
periences, to the companies who develop and pro-
duce those drugs. It is also my hope that they will
pass along such data to the Food and Drug Admin-
istration when and if the occasion warrants. May I
reiterate that as members of a great profession gen-
eral practitioners have a responsibility not only to
their patients today, but the patients of tomorrow and
to the most important mission on earth, the discovery
of new agents to conquer the still unconquered dis-
eases that afflict mankind. — Theodore G. Klumpp,
M. D., in GP, (32:211), November 1965.
* * *
The samples you get from drug companies are
intended for one purpose: to be given to patients
as a trial. However, if no written prescription ac-
companies the sample, the transaction looks like the
dispensing of a home remedy; or looks as if the
patient is being used as a guinea pig. Common sense
suggests that the sample should be accompanied by
a written prescription for the same item. — Editorial
in the Journal of Medical Society of New Jersey,
(62:547), December 1965.
❖ ^ ^
Without protection of the U. S. patent laws, it is
doubtful if drug firms would have spent the money
which produced cortisone, tolbutamide, isoniazid,
chlorothiazide, broad spectrum antibiotics and many
other wonder drugs of today.
296
The Ohio State Medical Journal
Elastic Stockings so sheer they look
like support hose. Both Ultreer and
support hose are sheer, shapely, cool
and comfortable. But that's where
the similarities end. New Ultreer fits
firmly and evenly over the entire leg.
Gives true therapeutic compression
necessary to relieve varicose veins and
other leg disorders. They provide
the therapy you prescribe. The fashion
and economy she demands.
Ultreer stockings have a new low price.
So low, she can afford two pairs of
Ultreer instead of one pair of regular
elastic stockings. There'll be no
disagreements there. Ultreer stockings
are as comforting to her purse as
they are to her
legs. New Ultreer
are the elastic
stockings doctors
and women can
agree on.
KenDALL
BAUER S RtACK StiWWTS DfVtBKJN
for April, 1966
297
Work Days Restricted by Illness
In Billions, Report Shows
During the 12 months ending June 1964 the civil-
ian population of the United States, exclusive of per-
sons residing in institutions, experienced 3.0 billion
days of restricted activity due to illness or injury. The
average person cut down his usual activities for 16.2
days during the year. Included in the days of re-
stricted activity were 1.1 billion days spent in bed,
or a rate of 6.0 days of bed disability per person per
year.
Illness or injury caused 385.2 million days lost
from work, or 5.5 days per currently employed per-
son per year. (For the purposes of the Health In-
terview Survey, current employment is defined as
working at any time during the 2 -week period prior
to the week of the household interview, or having a
job or business during that period.)
Children aged 6-1 6 years missed 204.4 million days
of school because of illness or injury. The average
child lost 5.0 days from school.
As age increased, rates of disability days also in-
creased. In general, the age pattern was similar for
males and females, except that rates for females us-
ually exceeded those for males. However, among
males aged 45 years and over, the rate of time lost
from work exceeded that for currently employed
females.
Persons residing in nonmetropolitan areas had
higher rates of restricted- activity days, bed-disability
days, and time lost from work than did residents of
metropolitan areas. The rate of time lost from school
however, was higher for persons aged 6-1 6 years liv-
ing in metropolitan areas than elsewhere.
Among persons living in nonmetropolitan areas
the rates of reduced activity were about the same in
farm and nonfarm sectors. Nonfarm residents had
a higher rate of bed-days and of time lost from
school. Farm residents had a higher rate of time
lost from work than did nonfarm residents.
With increasing family income groups up to
$10,000, the rates of disability days due to illness
or injury declined for each type of disability except
time lost from school. In the income group $10,000
and over, the rates of disability were about the same
as those for persons of a $7,000-$9,999 family
income.
Persons who were unemployed had higher rates of
restricted activity and bed disability than did cur-
rently employed persons. — U. S. Public Health Serv-
ice "Disability Days.”
Dr. William A. Altemeier, professor and chair-
man of the Department of Surgery at the University
of Cincinnati College of Medicine, received an
$8,000 grant from the American Cancer Society to
further his research in the use of nitrogen mustard.
New Members . . .
Following are names of new members of the Ohio
State Medical Association certified to the Headquar-
ters Office during February. List shows name of
physician, county and city in which he is practicing or
temporary addresses for those taking graduate work.
Ashland Lucas
Emmert C. Lentz, Ashland
Ashtabula
Richard L. DeCato, Ashtabula
Morris Wasylenki, Ashtabula
Cuyahoga
Virgilio T. Collantes,
Cleveland
Max H. Kent, Cleveland
Seymour Liberman, Cleveland
Ronald J. Ross, Cleveland
Delaware
William N. Henderson,
Delaware
Franklin
Richard M. Ward, Columbus
Gallia
Gerald E. Vallee, Gallipolis
Hamilton
Emmit F. Ackdoe, Cincinnati
Zol E. Muskovitch,
Evansville, Indiana
Marjorie M. Porter, Cincinnati
Thomas D. Saurwein, Toledo
Robert E. Youngen, Toledo
Mahoning
Jose L. Solana, Youngstown
C. Conner White, Jr.,
Youngstown
Marion
Frank V. Apicella, Marion
Miami
Albert C. Howell, Tipp City
Richland
James W. Wiggin, Jr.,
Mansfield
Sandusky
Eugene F. Dierksheide,
Fremont
Stark
Christopher M. King, Alliance
Van Wert
Wilmer L. Iler, Van Wert
Lorain Williams
Charles G. Adams, Vermilion Neil T. Levenson, Bryan
Ohio State Pioneers in Network
Nursing Education Program
Faculty of Ohio State University School of Nurs-
ing and the nursing service department of University
Hospitals has launched a pilot continuing education
program for nurses over radio-telephone.
The program is heard from 2 to 3 P. M. on sched-
uled days and is heard in hospitals already participat-
ing in the Ohio Medical Education Network, which
originates from WOSU-FM. Nursing staffs of the
following hospitals hear the program: Miami Valley,
St. Elizabeth, Grandview and Wright-Patterson, all
in Dayton; Piqua Memorial, Piqua; Lancaster-Fair-
field, Lancaster; Marion General, Marion; Mercy and
Springfield City, both in Springfield; Mercy Me-
morial, Urbana; Newark City, Newark, and Grant,
Columbus.
Network for these programs permits nurses in
participating hospitals to ask questions of the speak-
ers. Sponsors believe the Ohio State venture is the
first two-way continuing education program for nurses
in the United States.
Each member hospital receives 35 mm, colored
slides in advance of the programs. Speakers indicate
which slide they want shown as they proceed with
their presentations.
Campus area nurses and students hear the pro-
grams at the scheduled hour in Room 100, Starling
Loving Hall. Two radio stations, WVUD-FM, Day-
ton, and WOSU-FM, Columbus, serve participating
hospitals.
298
The Ohio State Medical Journal
To All My Patients
"I did not write the medicare bill.
"I am not sure I understand it.
"I am not a government official.
"I was not trained in political economy.
"If you are not satisfied with your present,
(1) medical costs or sendees, (2) hospital
availabilities or cost, or (3) the cost of your
drugs there isn’t much reason to talk it over
with me — I am probably as dissatisfied as you
are and probably much more confused.
"There isn’t much point in discussing with
me the problems you have as a result of getting
a whole new system of laws (regarding your
medical care) to live by, because I don’t yet
understand what it is all about either.
"May I humbly suggest, if you have a prob-
lem (and I sincerely hope you do not) that you
write your representative or senator in the
United States Congress. Most of them knew
enough about the law to vote for it, and perhaps
since they knew so much about it when it was
voted on, they can give you answers to all
your questions now. I can’t.
"Since my profession ... is coming more
and more under the control of the elected and
appointed officials in Washington, D. C., please
do not expect me to become less and less a
doctor. I can’t. I won’t. Therefore, the eco-
nomic-legal-political questions that are troubling
you should be taken to the experts in those
fields for an appropriate answer.
"In the meantime, remember me as the one
who treats your arthritis, your blood pressure,
your aches and pains. The one who is con-
cerned with your long and comfortable physical
life and — I hope — your mental stability in
these trying hours.” — Original Source: St.
Louis County (Mo.) Medical Society Bulletin.
M. D.’s in the News
Dr. Donald M. Hosier, director of the cardiac
laboratory and clinic at Children’s Hospital in Co-
lumbus, spoke at the Heart Association workers’ tea
in Newark during the recent heart fund campaign.
^ ^
Dr. John C. Drake spoke at a meeting of the Inter-
Church Activities Committee at the Gay Street
Methodist Church in Mount Vernon, where he dis-
cussed ethical and moral considerations in areas of
medicine and religion.
5-: :«J ifc
Dr. Oscar W. Clarke, Gallipolis, addressed the Rio
Grande PTA group, where he discussed diseases of
the heart as part of the Heart Month program.
SK
Dr. John J. Grady, member of the board of direc-
tors of the Academy of Medicine of Cleveland, spoke
on "Alcoholism” at a meeting of the Ward 33 Repub-
lican Club, in the Cleveland area.
5*1 5H
Dr. Harriet E. Gillette, assistant director of physi-
cal medicine and rehabilitation at Cleveland Clinic,
discussed "Comprehensive Programs for the Handi-
capped” at the annual Lima and Allen County Cere-
bral Palsy Clinic dinner.
% % :jc
Dr. Norman S. Brandes, Columbus, has been
named president-elect of the Tri-State Group Psy-
chotherapy Society, an organization of group ther-
apists from Ohio, Kentucky, and Indiana.
Tuberculosis mortality, which established a new
low of about four per 100,000 population in 1964,
continued at that level in 1965. Two decades ago,
the mortality rate from this disease was ten times as
high. — Metropolitan Life.
SUCCESSOR TO
NONE OF ITS DISADVANTAGES
V (CHLORAL GLYCINE MIXTURE)
Vdriclor
f ALL OF ITS ADVANTAGES
insures full sedative action
• LESS TOXIC • NON IRRITATING • STABLE
AVAILABLE THROUGH YOUR WHOLESALER
BLESSINGS, INC.
Cleveland 3, Ohio
References on request
Chloral — the “old reliable’’ — for more than 100 years
is dramatically improved in DriClor (5 grains chloral
hydrate with the amino acid glycene). DriClor is less
toxic . . . more stable . . . non-irritating to the stomach
. . . and more effective grain for grain.
The effective sedative, hypnotic and anti-convulsant
form of Chloral Hydrate.
Also Chlorasec for quick, even sleep. DriClor inner core
(equivalent to 3.75 Grs. of Chloral Hydrate). Seco-
barbital acid outer coat (.75 Grs.)
for April , 1966
307
eruice
mark o,
Professional Protection
NORTHERN OHIO OFFICE: J. R. Ticknor, A. C. Spath, Jr., R. A. Zimmerman, Reps.
11955 Shaker Boulevard Cleveland 44120 Tel. 216-795-3200
CENTRAL OHIO OFFICE: J. E. Hansel and R. E. Stallter, Representatives
Room 201, 1818 West Lane Ave., P. O. Box 5684, Columbus 43221 Tel. 614-486-3939
SOUTHERN OHIO OFFICE: D. M. Routt, III, Representative
Medical Specialties Building, Room 704
3333 Vine Street, P. O. Box 20034 Cincinnati 45220 Tel. 513-751-0657
For prompt, emphatic diuresis
(BENZTHIAZIDE)
NEW FROM TUTAG for prompt, comfortable
diuretic action with a balanced excretion
of sodium chloride and a lower potassium
loss under normal dosage and diet regimen
DIURETIC ACTION: Clinically, the oral administration of AQUATAG (benzthi-
azide) results in diuretic activity within two hours with maximal natriuretic,
chloruretic, and diuretic effects occurring during the fourth, fifth and sixth hours.
Maintenance of response continues for approximately 12 to 18 hours. Acidosis
is an unlikely complication since therapeutic doses of AQUATAG (benzthi-
azide) do not appreciably increase bicarbonate excretion. Edematous patients
receiving 50 mg. of AQUATAG (benzthiazide) daily for five days developed a
maximal increase in the rate of sodium excretion on the first day, and main-
tained this high rate until depletion of excessive body stores of sodium.
In congestive heart-failure patients, AQUATAG (benzthiazide) produced the
same weight loss, during a 48-hour treatment period as did a maximally effec-
tive dose of hydrochlorothiazide.
DOSAGE: Diuresis, initially 50 to 200 mg.; maintenance 25 to 150 mg., daily.
Hypertension 50 to 100 mg. initially, adjusted to 50 mg. t.i.d. or downward to
minimal effective dosage level.
PRECAUTIONS AND SIDE EFFECTS: Electrolyte imbalance with hypoka-
lemia, hypochloremic alkalosis and hyponatremia may occur. Other reactions
may include blood dyscrasias, hyperuricemia and gout, nausea, jaundice,
anorexia, vomiting, diarrhea, dizziness, paresthesia, photosensitivity and head-
ache. Insulin requirements may be altered in diabetes.
WARNINGS: Dosage of coadministered antihypertensive agents should be
reduced by at least 50%. Use with caution in edema due to renal disease;
advanced hepatic disease or suspected presence of electrolyte imbalance.
Stenosis or ulcer of small intestine have been reported with coated potassium
formulas and should be administered only when indicated. Until further clinical
experience is obtained, the use of the drug in pregnant patients should be
carefully weighed against possible hazards to the fetus.
CONTRAINDICATIONS: AQUATAG (benzthiazide)
is contraindicated in progressive renal disease or
disfunction including increasing oliguria and azo-
temia. Continued administration of this drug is
contraindicated in patients who show no response
to its diuretic or antihypertensive properties.
Before prescribing or administering, read the package
insert or file card available on request.
Available as 25 or 50 mg. scored tablets.
Request clinical samples and literature on your
letterhead.
S.J.TUTAG
& COMPANY
Detroit. Michigan 48234
308
The Ohio State Medical Journal
Indications: ‘Miltown’ (meprobamate) is ef-
fective in relief of anxiety and tension states.
Also as adjunctive therapy when anxiety
may be a causative or otherwise disturbing
factor. Although not a hypnotic, ‘Miltown’
fosters normal sleep through both its anti-
anxiety and muscle-relaxant properties.
Contraindications: Previous allergic or idio-
syncratic reactions to meprobamate or
meprobamate-containing drugs.
Precautions: Careful supervision of dose
and amounts prescribed is advised. Consider
possibility of dependence, particularly in pa-
tients with history of drug or alcohol addic-
tion; withdraw gradually after use for weeks
or months at excessive dosage. Abrupt with-
drawal may precipitate recurrence of pre-
existing symptoms, or withdrawal reactions
including, rarely, epileptiform seizures.
Should meprobamate cause drowsiness or
visual disturbances, the dose should be re-
duced and operation of motor vehicles or
machinery or other activity requiring alert-
ness should be avoided if these symptoms
are present. Effects of excessive alcohol may
An eminent role in
medical practice
Clinicians throughout the world con-
sider meprobamate a therapeutic
standard in the management of anxi-
ety and tension.
The high safety-efficacy ratio of
‘Miltown’ has been demonstrated by
more than a decade of clinical use.
Miltown*
(meprobamate)
possibly be increased by meprobamate.
Grand mal seizures may be precipitated in
persons suffering from both grand and petit
mal. Prescribe cautiously and in small quan-
tities to patients with suicidal tendencies.
Side effects: Drowsiness may occur and,
rarely, ataxia, usually controlled by decreas-
ing the dose. Allergic or idiosyncratic re-
actions are rare, generally developing after
one to four doses. Mild reactions are char-
acterized by an urticarial or erythematous,
maculopapular rash. Acute nonthrombocy-
topenic purpura with peripheral edema and
fever, transient leukopenia, and a single
case of fatal bullous dermatitis after admin-
istration of meprobamate and prednisolone
have been reported. More severe and very
rare cases of hypersensitivity may produce
fever, chills, fainting spells, angioneurotic
edema, bronchial spasms, hypotensive crises
(1 fatal case), anuria, anaphylaxis, stoma-
titis and proctitis. Treatment should be
symptomatic in such cases, and the drug
should not be reinstituted. Isolated cases of
agranulocytosis, thrombocytopenic purpura,
and a single fatal instance of aplastic ane-
mia have been reported, but only when other
drugs known to elicit these conditions were
given concomitantly. Fast EEG activity has
been reported, usually after excessive me-
probamate dosage. Suicidal attempts may
produce lethargy, stupor, ataxia, coma,
shock, vasomotor and respiratory collapse.
Usual adult dosage: One or two 400 mg.
tablets three times daily. Doses above 2400
mg. daily are not recommended.
Supplied: In two strengths: 400 mg. scored
tablets and 200 mg. coated tablets.
Before prescribing, consult package circular.
WALLACE LABORATORIES
/sCranbury, N.J. Cm-s76i
Smoker Death Rate Tie Shown
Among GI Policyholders
Cigarette smokers among 250,000 U. S. Veterans
observed for more than eight years of a ten-year study
by the Public Health Service continued to have a
higher death rate than non-smokers. Among the
causes of death tabulated, only Parkinson’s disease
was associated with significantly lower mortality for
smokers.
Death rates for cigarette smokers were seen to re-
main fairly constant over the 8y2_year period, while
rates for non-smokers went down.
Findings of the nearly completed study show that,
in the same age group, 11 times as many cigarette
smokers as non-smokers died of lung cancer, and 12
times as many died of emphysema. Three or more
times as many cigarette smokers as non-smokers died
of cancer of the mouth, pharynx, esophagus or
larynx, and such diseases as bronchitis, asthma,
stomach ulcer, duodenal ulcer, and nonsyphilitic
aneurysm of the aorta.
Study results showed mortality risk related to the
amount smoked for each form of tobacco use. The
risks for cigarette smokers greatly exceeded those
for pipe or cigar smokers, and were lower for those
who stopped smoking than for those who continued.
Results to date from the study begun in 1954 in
cooperation with the Veterans Administration are
reported in a monograph, Epidemiological Studies
of Cancer and Other Chronic Diseases, just published
by the National Cancer Institute.
The group of veterans studied are policyholders of
U. S. Government Life Insurance. Nearly all are
white males mainly from the middle or upper socio-
economic levels.
USPHS Purchases Measles Vaccine
For Local Preschool Programs
The U. S. Public Health Service will buy at least
one and one-half million doses of vaccine during the
next year to protect preschool children against measles,
Surgeon General William H. Stewart announced.
The vaccine will be offered to health departments
receiving project grants under the national Vaccina-
tion Assistance Act. Gamma globulin will be used
in conjunction with the vaccine to minimize reactions.
The purchase was made in connection with the
Service’s cooperative effort with State and municipal
health departments to eradicate measles. Since the
licensing of the measles vaccine in 1963, some 12
million doses have been given in the United States,
and the number of cases of measles has dropped
from 385,000 cases reported in 1963 to 266,000
reported in 1965. It is estimated that reported cases
represent only one-tenth of the actual cases.
in the treatment of
IMPOTENCE
Android
(thyroid-androgen)
TABLETS
®
ANDROID
GOOD TO EXCELLENT 75%
U
PLACEBO
20%
SUMMARY
1. Forty cases reported.
2. Excellent to good results, 75% with Android, 20% with Placebo.
3. Cites synergism between androgen and thyroid.
4. No side effects in patients treated.
5. Alleviation of fatigue noted.
6. Case histories on 4 patients.
7. Although psychotherapy still needed, role of
chemotherapy cannot be disputed.
*“ Sexual impotence treatment with methyl testosterone • thyroid (ANDROID) a
double blind study” • Montesano, Evangelista: Clinical Medicine, April 1966.
ANDROID ANDROID-HP
CONTRAINDICATIONS - Methyl testosterone is
not to be used in malignancy of reproductive
organs in male, coronary heart disease, hyper-
thyroidism. Thyroid is not to be used in heart
diseac®, hypertension unless the metabolic
rate is low.
CAUTION: Federal law prohibits dispensing
without prescription.
ANDROID-X
ANDROID-PLUS
REFER TO
Each yellow tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. (1/6 gr.) 10 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
Each red tablet contains:
Methyl Testosterone 5.0 mg.
Thyroid Ext. (1/2 gr.) 30 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
Each orange tablet contains:
Methyl Testosterone 12.5 mg.
Thyroid Ext. (1 gr.) 64 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 or 2 tablets daily.
Available:
Bottles of 60, 500.
V
Write for literature and samples:
( BRolWfc THE BROWN PHARMACEUTICAL CO. 2500 W. 6th St., Los Angeles, Calif. 90057
Each white tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. <V4 gr.) 15 mg.
Ascorbic Acid
(Vit. 0 250 mg.
Glutamic Acid 100 mg.
Pyridoxine HCL 5 mg.
Niacinamide 75 mg.
Calcium Pantothenate 10 mg.
Vitamin B-12 2.5 meg.
Riboflavin 5 mg.
Dose: 1 tablet twice daily.
Available:
Bottles of 60, 500.
314
The Ohio State Medical Journal
The Family Physician and Psychiatry
A Discussion of a New Method of Instruction
WARREN G. HARDING II, M. D., and WENDELL A. BUTCHER, M. D.
THE family physician has long recognized that
a large proportion of his patients suffer from
symptoms for which he is unable to find organic
changes capable of explaining the disability of the
patient. The amount of time consumed by these pa-
tients far exceeds their proportionate number. Con-
servative estimates by many men in practice have in-
dicated that these psychiatrically oriented problems
have occupied from 50 to 70 per cent of their time.
The burden generated by the time factor is further
complicated by the frustration suffered by the doctor
as a result of his inability to understand the dynamics
involved in these disabling syndromes. Many com-
plain that so little training was given to them in their
formal education in this field. Indeed, in many
medical schools these diseases requiring a half of their
professional time were given less than 10 per cent
of the curricular time. Many of those who graduated
prior to 1950 received less than 3 per cent of their
instruction in psychiatric training. The purpose here
is not to indict medical education for a lack of in-
terest in this important field but to recognize that
even greater efforts need to be made to expand the
knowledge and insight of the young physician in this
challenging discipline.
The most encouraging aspect of the problem is
that a widespread recognition of the need is begin-
ning to appear. The AMA News of April 19, 1965,
pointed out that in the plans for the Board of Fam-
ily Practice approximately one fourth of the required
time would be devoted to Psychiatry. The Federal
Submitted July 29, 1965.
The Authors
• Dr. Harding, Columbus, is Administrator, and
Director of Medical Education, Grant Hospital;
Assistant Professor, Department of Surgery, The
Ohio State University College of Medicine.
• Dr. Butcher, Columbus, is Clinical Assistant
Professor of Psychiatry, The Ohio State University
College of Medicine.
Government is sponsoring a program designed to
establish Community Mental Health Centers in
strategic locations over the entire United States. In
Ohio, the Citizens Committee for Mental Health
Planning has received the enthusiastic support of civic
leaders throughout the state in a manner surprising to
its most ardent advocates. The problem that every-
body recognized but did nothing about is to be sub-
jected to a positive approach aimed at solving it.
It is foolish to hope that regardless of the support
of governmental agencies and an aroused citizenry
there will be enough trained psychiatrists in the fore-
seeable future to relieve the family physician of the
necessity of dealing with this type of patient. The
genuine need is for the family physician to recognize
the early symptoms pointing to emotional stress and,
by instituting active therapeutic measures at this stage,
to prevent the further development of mental illness.
The trained psychiatrist’s obligation is to be the con-
sultant and the therapist in those severe and compli-
321
cated cases that develop a need for prolonged therapy.
The revered family doctor, who has been replaced
by the specialist, recognized many of these develop-
ing symptoms. By counseling and supportive therapy,
he was able to contribute much to his patient, though
in most instances he neither gave the illness a name
nor formalized it into any psychiatric classification.
The mobility of the population and the changing
economic status of the people have abrogated the
relationship between doctor and patient so that the
modern family physician must be more alert and in-
cisive in order to recognize these early changes potent
for disaster. Armed with an encyclopedic knowledge
of the blood levels of rare chemical substances in
esoteric diseases, however, he often fails to recognize
the early symptoms of a depressive reaction, possibly
the most common psychiatric entity and the least
recognized. Do you realize how high suicide stands
in the statistics of death causes in the United States
and how many "accidental deaths’’ are actually pre-
meditated? Death is just as final whether it be from
suicide or from a blocked coronary artery.
The family physician, frustrated by the enormous
number of these difficult cases and cognizant of his
inept preparation to cope with them reacts in one of
three patterns. To some he gives a prescription for
some sedative or mood elevating medicament in the
hope that when they see him a miraculous improve-
ment will be apparent. To a second group he will
place a label of "crock” or some similar appellation
and attempt to close his eyes to their needs. The
remainder will involve him in their difficulties so
that he will feel that he must find out the mechanics
of their sickness and the most appropriate therapy to
return them to a useful and happy life.
The source to which he can turn for help varies.
Some go to a book and become lost in the minutiae
and trivia of the theories and discussions. Some go
to lectures, seminars, and postgraduate courses spon-
sored by the medical societies, universities and at
times by lay groups. In many of these sincere efforts
the family physician adds to his confusion by finding
that the explanations given are too theoretical or too
largely devoted to rare and unusual aspects of the
problems to be of much aid to him in his daily prac-
tice. The study is directed to the advanced clinical
picture rather than to its incipient manifestations
where his active therapy may result in clinical im-
provement and prevent the development of serious
incapacity. It is not the purpose here to indict any of
these methods but to offer a different approach which
is live, interesting, available and directed toward the
family physician and the community hospital house
staff.
The Case Forum
The hospital in which the following program has
developed in the past year is a 400 bed general hos-
pital. It does not have an organized psychiatric de-
partment, either as an inpatient or as an outpatient
service. Five practicing psychiatrists serve on the staff
in a consultative capacity. The hospital has a large
emergency room service which receives approximately
1500 visits each month. Contagious diseases are not
knowingly admitted.
A one hour psychiatric conference is scheduled bi-
monthly at one o’clock. All staff members are in-
vited to attend and participate but the family prac-
tice section members are especially concerned with
the material and presentations of the program. The
method gives them an opportunity to take an active
part in the educational program of the house staff
where their ability to contribute in a substantial man-
ner has long been neglected. The moderator of the
conference, a psychiatrist of recognized standing in
the community, invites a guest psychiatrist to share
the discussion with him. The family doctor or a
volunteer from any of the hospital services presents
a case from his private practice who may or may not
have been an inpatient in the hospital. The choice
of patient is left entirely to this physician, though for
purposes of organization, the general area of diag-
nosis such as depression, adolescent rebellion, eneure-
sis, and functional systemic symptoms is suggested.
The consulting psychiatrists are not aware of the case
prior to the conference.
The salient features of the history, physical exami-
nation, socio-economic background and the treatment
are presented. The moderator may then probe for
further information which may have been overlooked
or thought to be noncontributory to the illness. It
is not the purpose of the meeting to put the family
physician "on the pan” but to aid him by guiding
him into a method that will be of value in his future
investigation of such complaints. The psychiatrists
then discuss the various methods that may be used
to treat the patient and explain the recommended
treatment on the basis of the dynamics or organic
concept of its origin. In most cases, where at all
possible, one of them espouses one concept while the
other argues as vehemently for the other. During
this polemic, the staff may introduce questions in
order to clarify the meaning intended where the psy-
chiatrist has assumed too much understanding by the
staff. In the informal atmosphere of this discussion,
the engagement of the house staff in the discussion
has been most satisfying. Their reaction has been
that the subjects considered are those which they
see on the wards, emergency room and outpatient de-
partment each day of their work. The greatest recom-
mendation of the value of this session is the dif-
ficulty encountered in closing within the one-hour
time limit. Try it and you will be convinced.
322
The Ohio State Medical Journal
Medical Travelogue
About Artificial Organs, Kidney Transplantation, and Unrelated
Medical Experiences in Europe, Fall, 1964
W. J. KOLFF, M. D.
The Author
• Dr. Kolff, Cleveland, is Head of the De-
partment of Artificial Organs, Cleveland Clinic
Foundation.
ONE general lecture, "To Live Without Heart
and Kidneys,” and two more specific lectures,
one about "Hypertension and Kidney Trans-
plantation,” the other about the "Artificial Heart In-
side the Chest,” gave me an opportunity to visit
medical centers in Europe. The medical experiences
of these visits are related in the following pages.
London
Professor John McMichael made the arrangements
for our short visit in London. I gave three lectures;
two at the British Postgraduate Medical School and
one for the London University, preceded by a tea. The
most exciting thing I saw was the special heart care
room at Hammersmith; it is an intensive care unit
for patients with acute coronary attacks. Acute cor-
onaries that come to Hammersmith Hospital go to
this room while preference is given to bad cases.
The patient is immediately connected with extensive
recording equipment which can be followed in his
room and which is put on tape in a central recording
room, from where the patient can be observed via
closed circuit television.
Immediately upon admission a small polyethelene
catheter is inserted with Seldinger technique into the
superior vena cava. At frequent intervals small
amounts of dye are injected, and cardiac output is cal-
culated according to the dye dilution technique, using
an ear piece for recording. A needle is inserted in
the brachial artery for continuous recording of the
arterial pressure, and frequent recording of oxygen
saturation of the blood.
A continuous record is also made of two leads of
the EKG.
The Unit is in the department of Prof. McMichael,
under direct responsibility of Dr. Shillingsford.
The staff is divided into clinical and research
sections.
Since the special heart care room opened in De-
cember, 1963, twenty-nine patients with serious acute
From the Department of Artificial Organs of the Cleveland Clinic
Foundation, Cleveland, Ohio. The work of the Department is sup-
ported by the John A. Hartford Foundation and by NIH Grant HE
444 8, from the National Heart Institute.
coronary attacks had been admitted. Not a single
patient was lost, although a hospital mortality of 30
per cent should have been expected. Only one pa-
tient died later at home. Four patients were in ven-
tricular fibrillation. Immediate closed chest cardiac
massage and electroshock restored them. Two pa-
tients had malignant supraventricular tachycardia
and were electrically converted. Two patients showed
a syndrome described as being very ominous. Grad-
ual fall in arterial pressure, slowing of the heart rate
to 30, inversion of the P waves, and shortening of
P-QRS interval until the P wave disappears and the
QRS widens. The cardiac output fell to 2 liters
per minute. Prof. McMichael thought that this
might be a vagus effect, and atropine I. V. miracu-
lously reversed the entire syndrome.
The significance of this approach to the treatment
of acute coronaries is that the effect of therapy can be
evaluated objectively. The patients that I saw were
remarkably comfortable, although one had been re-
suscitated the night before.
Oxygen proved important for treatment, although
in most instances it lowered the cardiac output. Mor-
phine is deleterious. Some patients had low cardiac
output, lowest was 2 liters per minute, but some had
high cardiac output, 7.5 liters per minute.
Dr. McMichael took me to the technical work-
shop. Realizing the importance of a modern machine
shop for modern medicine Hammersmith has given
this first priority. The Alvarez heart valve, which
was given to me in Madrid, was developed here. A
later version, the Hammersmith valve, is also made
of polypropylene. It has good flow characteristics as
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323
compared to ball valves and the valve is being used
clinically.
Amsterdam
The First Congress of the European Dialysis and
Transplant Association was held in Amsterdam in
September, 1964.
There were 20 centers in Europe where patients in
chronic renal failure were maintained by repeated
dialysis. This was more than in the United States
at that time. Kidney transplantation is being done
in many countries.
The Congress was superbly organized and, since I
was a very early dialyzer, I was the guest of honor.
I gave an address and was Chairman of a session.
The most exciting paper that I heard was by a
Greek, Yatzidis. Whereas most of us discarded the
idea of removing retention products from the blood
with charcoal or resins because charcoal removes so
little urea, Yatzidis took the attitude "so what.”
Thus, with a very small, inexpensive column of ac-
tivated charcoal he removed large amounts of creati-
nine, uric acid, phenols, phosphates, and any other
conceivable retention product. Urea was removed
too, but only a few grams of it. This technique opens
numerous possibilities. First, we will be able to
differentiate the clinical effect of urea retention as
compared to that of other substances. Second, post-
dialysis oliguria might not occur with this type of
artificial kidney.
The Dutch minister of education, Mr. Th. Bot,
who has jurisdiction over all medical schools, was
invited to the banquet. Since I shared the same school
bench with him for one year and the same classroom
for six years, it was a great pleasure to see him
again. I had not seen him since 1930.
Stockholm
In Stockholm I met Clarence Crafoord, one of the
founders of modern cardiovascular surgery and found
him a delightful and very entertaining person. He
is fully recovered from an accidental trauma with
prolonged coma, which caused his colleague, Oliva-
crona, to open his skull three times. Eric Jorpes,
who contributed much to the purification of heparin,
without which no artificial organ can work, was much
interested in our attempts to prevent clotting with
negative electrical charges. After all, heparin, as
he pointed out many years ago, consists of 40 per
cent sulfuric acid and probably owes its anticlotting
effect to its negative charge.
Radiology has always been far developed in Swe-
den, and I met Seldinger, the man who introduced
a new way to catheterize blood vessels by pushing a
catheter over a guide wire, which is introduced first
through a venopuncture needle.
Dr. Bodo von Garrelts made a coil kidney in 1946,
undoubtedly the first kidney of this type. He is an
old friend and was my host. He has developed a
324
simple electronic device to define the physiology of
voiding. The patient voids in the solitude of a bath-
room, but the weight change of the pot is recorded.
The acceleration of the flow is computed. Urology is
becoming very scientific!
Edinburgh
The contributions of Prof. M. F. A. Woodruff and of
his laboratory to the field of transplantation are great.
His associate, Mr. J. L. Roalc, F. R. C. S. E., showed
me the laboratory.
Prof. Woodruff’s group is now concentrating on the
role of immunologically competent cells for the pos-
sible treatment of cancer, endeavoring to induce a
homograft reaction against transplanted mouse mam-
mary carcinoma by the transplantation of preim-
munized spleen and thoracic duct lymphocytes.
Mr. Roak is able to cannulate the thoracic duct of
a mouse, using a small nylon or polyethylene can-
nula (Portex plastic tubing) and glue (Eastman 910),
instead of ligatures. He obtains as much as 20 mis of
lymph in the first 24 hours containing 100x1,000,000
lymphocytes. The mice are kept relatively happy,
suspended over a wire wheel so that they can walk
without making any progress and can reach food and
water. This variation of a technique initiated by the
now classic work of Gowans on lymphocytes opens
new avenues for research.
Work conducted in the same laboratory by Howard,
Roak, and Christie elucidates the origin and possible
role of Kupfer cells in the liver. With the recog-
nition of two identifiable chromosomes in the cells
of C-57 black mice, the lymphocytes can be traced
following transplantation, as can their offspring. By
transplanting parenterally C-57 black mice lympho-
cytes into C-57 black T6F-L hybrid mice and subse-
quently isolating the Kupfer cells from the liver, it has
been demonstrated that cells within the sinusoids of
the liver are 90 per cent of donor origin. Thus, it is
claimed that the conversion of lymphocytes to macro-
phage can take place in the context of graft versus
host disease. The lymphocytes were obtained from
spleens or other sources. It is intended to repeat
this work, culturing lymphocytes obtained by thoracic
duct cannulation for 24 hours and subsequently in-
jecting only small lymphocytes into the F1} to dem-
onstrate small lymphocyte to macrophage conversion.
Dr. Robson, in the nephrology section, demon-
strated the sterile rooms in which patients were kept
following total body irradiation. Infection in gen-
eral is introduced with food, by contact with person-
nel, or is airborne. The airborne infection is mini-
mized by a relatively inexpensive system of over-
pressured outside air taken from the rooftop.
Open culture plates placed in the sterile room pro-
duce only one colony per hour in contrast to several
hundred in a ward. Personnel showers, changes
clothes completely, and is most of the time separated
from the patient by a glass wall. The loneliness of
The Ohio State Medical Journal
the patient becomes a real problem. It bothered the
patient to the point of distraction, when he could see
the rain hit the window, but could not hear it.
Woodruff and Robson had the satisfaction that they
have never lost a patient from aerogenous infection,
but unfortunately several immunologically incom-
petent patients succumbed from bacteria they already
carried with them. The lessons learned, however,
are worthy to be applied to general patient care. In
Stockholm, I had already observed a complete sepa-
ration of clean and infected patients in the Depart-
ment of Urology.
Robson has been fortunate in having obtained the
cooperation of a charming woman pathologist who
specialized in ultramicroscopic studies of the renal
changes in diabetes. The early changes, which are
later classified as Kimmelstiel-Wilson disease, can be
detected in young diabetics as soon as the diagnosis is
made and even before the need of insulin exists. I
spent a fascinating hour with her reviewing her
electron microphotographs.
The highlight of my entire trip was the Cameron
Prize Lecture! Dr. Andrew Robertson Cameron left
2,000 pounds to institute the lecture in 1878. The
third lecturer was Mr. Louis Pasteur. Since 1954 the
prize has been awarded once every two years.
Closing the academic procession were Prof. Gird-
wood, Professor of Medicine, and myself in dark red
robes. After Prof. Girdwood had explained the sig-
nificance of the prize, the theatre was all mine. Both
the audience and the occasion were inspiring! Title,
"To Live Without Heart and Kidneys.”
I was fortunate that I could present the work of
our Cleveland Clinic Kidney Transplantation Team.
We have the largest and, so far, the most successful
series of cadaver kidney transplants. This is the
more significant because so many others had given up
the use of cadaver kidneys. I showed the film which
features 14 bilaterally nephrectomized patients riding
on a trailer over our farm and enjoying a picnic,
thanks to functioning transplanted kidneys. It brought
the message across that results may be worthwhile in
terms of human happiness even when we cannot yet
predict the duration of the useful function of the
transplant.
Following the lecture, there was an official dinner,
presided over by Sir Edward Appleton, renowned
physicist, discoverer of the Appleton layer in the sky
used for reflection of radio waves. The discovery
brought him the Nobel prize. Sir Edward is prin-
cipal of the Edinburgh University and a more inspir-
ing man to dine with I have never met. A toast to
the Queen, a toast to the Chancellor of the University
(Prince Philip), a toast to the Cameron Prize win-
ner, to his health, and a reply.
That night the dome of the University was flooded
in honor of the Cameron Prize Lecturer.
Ghana
I know that Ghana is in Africa and not in Europe,
but I made a little side trip. From Cleveland I had
written to the President of the University of Ghana
in Lagos (near Accra). It turned out that the Presi-
dent of the University is Kwame Nkrumah himself,
and he ordered the Medical Society of Ghana to
arrange a meeting for me in the hospital connected
with the new medical school. Its beautiful new build-
ings were under construction.
The lecture room was filled. Three fourths of
the doctors were Negroes and all were trained abroad.
Most had functions at the medical school. I was
impressed by the caliber of these men. One of them,
Dr. Quartey, arranged a dinner at his house. His
wife, for the occasion in Ghananian dress, European
trained, and a charming lady, works as an operating
room nurse.
Spain
The Fondacion Jiminez Diaz was a surprise to me.
It is a private institution. Started 24 years ago, it
now counts 120 members of the staff and 200 fel-
lows. It has an outpatient department, a hospital
of 500 beds and a research department. The Fonda-
cion’s buildings are new and beautiful, their equip-
ment up-to-date. I saw, for example, brand new
German equipment for renal scanning. The analogy
with the Cleveland Clinic is obvious. It indicates
that there is a place for good medical practice under
many different systems. I was presented with three
new mitral valves developed by Dr. Alvarez from
the Fondacion when he was in England. These valves
are hoped to allow larger blood flow than the Starr-
Edwards valve.
The Fondacion has sent staff members all over the
world to be up-to-date. We had three in Cleveland,
among them Dr. de la Barreda and Dr. Sanchez-
Sicilia who worked a year with Dr. Nakamoto in our
department. The Fondacion has superspecialists
much as we do, but they do not have the divisions
with separate chairmen. Instead, there are many
parallel departments each with a Jefe and an asso-
ciado. For example there were five parallel medical
departments. All of this is guided by the Director,
don Carlos, which is how Prof. Jiminez Diaz is
affectionately addressed. He is small in stature but
a great man with a progressive forward looking in-
terest in medicine.
I gave two lectures and a conference with much
discussion. They are treating patients in chronic
renal failure with repeated dialysis, had just started
kidney transplantation, and were in need of some
encouragement.
Dr. Hernando is Jefe of the Nephrology Unit
and Dr. Sanchez-Sicilia, assodado. The artificial kid-
for April , 1966
HEALTH SCIENCES LIBRARY
UNIVERSITY OF MARYLAND
BALTIMORE
?25
ney room looks out over the woods that belonged
to the royal hunting grounds.
Paris
Professor Jean Hamburger, Hospital Necker, in
Paris, has the largest experience with kidney homo-
transplantation in Europe. Since he was among the
early -workers he had already started when total body
irradiation was used to suppress immune response.
He can claim some very long time survivors. The
longest survival in the world is a postal clerk in Paris,
who received a kidney from his (nonidentical) twin
brother (no demonstrable chimerism either) five
years ago. Renal function is normal.
Equally good results have been obtained later,
since Hamburger also began to use 6 M. P. (6 mer-
captopurine) or Imuran, a derivative of 6 M. P. Of
course, the survival times are not that long yet; they
cannot be. They use more Imuran and less pred-
nisone than we do. They nearly always suture the
ureter over an indwelling ureteral catheter and only
rarely implant it in the bladder. Patients trans-
planted less than one year are all reviewed once a
week by the entire staff with Prof. Hamburger him-
self presiding. It is on a Thursday afternoon, and
I sat next to Hamburger and looked over all the
charts and all the data.
Since the patients were doing so well, it was a
festive affair. At the time, they had 20 living pa-
tients (we had 21). They had far fewer cadaver
kidney transplants than we have, but they are now
pursuing this. They sometimes move a patient to
another hospital to bring him close to a potential
cadaver donor.
The law in France requires no permission from the
family to remove the kidneys from a cadaver, but it
requires the signatures from three physicians to de-
clare that the donor is dead and according to the law
they must prove it, which they do by cutting an artery
and showing that no blood flows from it.
Hamburger’s group, with Dr. Antoine and others,
have studied immunological problems for years and
go through extensive testing and typing for selection
of live donors. Since, so far, we are more restric-
tive in the acceptance of living donors, we rarely
have more than one or two donors to choose from,
and therefore such testing would only have academic
value. For the future it may become very impor-
tant. Hamburger’s group has recognized some late
disease in recipients that nobody else has as yet seen.
It is associated with hypersplenism. Therefore they
now remove the spleen in every case. Since they
don’t have Dr. Crile in Paris, they cannot remove
the thymus or most of it without thoracotomy and
they leave the thymus alone.
I gave three lectures, two of which were in French.
My French was not really French, but I got my
points across and without reading from a paper.
Greece
Dr. Moulopoulos wrote his book, Cardiomechanics
(published by Thomas) when he was in my depart-
ment at the Cleveland Clinic. He was a productive
investigator. When I saw his present setup, I
remembered the words of Rutherford, "Since we
have no money we have to think,” and think he
does! Young physicians are paid nothing or little,
if they want to work in hospitals. Twelve hundred
dollars a year would hire a full time researcher
(M. D.) for Moulopoulos, if he had a small grant.
He has induced four groups of physicians, each
consisting of four or five doctors, to work on re-
search projects every Tuesday from 4 p. m. to 12 p. M.
The times are not so strange since the day is cut in
half by a siesta, and normal working hours for physi-
cians are from 9 a. m. to 1 p. m. and 4 p. m. to 8
p. M. It occurred to Moulopolous and a Greek elec-
trical engineer, that the normal rhythm of the heart
and its generation might be explained as a system of
natural oscillators with various frequencies. They
made a model to demonstrate this, using 12 pen-
dulums of varying length, trailing their tails through
charged NaCl solution so that the resulting electro-
(cardio)gram could easily be recorded. Thus they
revived the work by a Dutchman, van de Poll, in the
early thirties, brought to my attention as being bril-
liant by Sir Edward Appleton, who was mentioned
before. If the heart were a system of electrical oscil-
lators then it should be possible to put it in fibrilla-
tion, which is true, and the threshold to fibrillation
might be influenced by putting a grid with a certain
charge somewhere in the ventricle. Experiments in
dogs to this extent I witnessed in Moulopoulos’ lab-
oratory at 11 P. M. It seemed that the threshold to
fibrillation could be significantly increased.
The engineer hates the sight of blood and analyzes
the curves in another room. Although this work was
started as basic research, clinical application may not
be far off. In one patient I have recently seen ven-
tricular fibrillation recur within one and a half
minutes all during the night, which necessitated elec-
tric shock every time. In the future such a patient
might be saved if properly grounded platinum needles
were put in the myocardium to form a grid.
A second group of Moulopoulos’ investigators put
radioactive strontium inside the ventricle and, with
a Geiger counter, could record exactly the thickness
of the ventricular wall during contraction of the
ventricle. The influence of drugs on the contraction
of an ischemic area produced by ligation of a coronary
artery was studied. Strophantine was shown to in-
crease contraction.
A third group of Moulopoulos’ investigators led
by a thoracic surgeon, replaced the function of right
or left ventricle in a dog at will, in a carefully con-
trolled fashion. The only reward the investigators
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The Ohio State Medical Journal
get is the possibility of writing a thesis. Moulopoulos’
department produced six last year. The equipment
is largely the same equipment (good and up-to-date)
used during the rest of the week on patients. The
laboratory space is a modern cardiac laboratory. The
siesta period facilitates the conversion from men to
animals. The specific equipment required for animal
experiments is made from odds and ends. Instead
of burets they use old bottles, upside down with the
bottom cut off. The work is of high quality and
articles have recently been accepted by American
Journal of Physiology, by Lancet, and by other inter-
nationally known journals. "Since we have no money
we have to think.”
In Athens, I gave two lectures. Dr. Moulopoulos
gave simultaneous translation in Greek. The techni-
cal equipment of the auditorium allows translation
in four languages simultaneously. Meetings with
visitors from many countries often take place.
Vienna
Prof. K. Fellinger was our host and Dr. Bruno
Watschinger our guide and manager. Watschinger
was coauthor of the twin-coil kidney developed in
Cleveland. Fellinger is Rector Magnificus of the
Alma Mater Rudolphina, the University of Vienna.
The significance of the appointment lies in the fact
that during his tenure the University celebrated its
600th anniversary.
In 1365 when the University was established, a
medical faculty was also begun, but its fame came
later when van Swieten, personal physician to Maria
Theresa, organized the medical school and when her
son, Josef II, (1780-1790) built a general hospital
of 2000 beds. The hospital has two artificial kidney
departments, one in the department of Urology situ-
ated in the surgical constant care unit and one in the
Medical department headed by Dr. Fritzer, the suc-
cessor to Watschinger. They are very well equipped,
roomy, and, of course, well run. Professor Fellinger
is particularly popular with such patients as the Shah
of Persia, Ibn Shaoed, President Sukarno, and many
other sheiks, Arabs, and Africans. He is an impres-
sive man, moreover gay, and he prefers a weinstule
over an international hotel. We could not agree
more.
I gave two lectures, both in German, one for a
meeting of the medical society of Vienna, held at the
University. It was one of their regular meetings
and first there were short papers by others. The
first, which I thought was excellent, was about dem-
onstration of phosphatase in electron microscopical
slides and one was about an echo method to dem-
onstrate hematomas and displacement of brain struc-
tures, especially useful after brain accidents. It takes
less than three minutes, is not painful. This was
developed in Vienna. Half a dozen neurosurgeons
stood up to testify that they too used the method,
much to the gratification of the patient.
Miinchen
Adolf Hitler, without knowing it or wanting it, did
one good thing. He had built for himself a bomb
shelter with walls of three meter concrete inside the
garden of the hospital. It was complete with two
operating rooms, et cetera, just in case he would be
wounded while visiting Munich.
This bomb shelter has now become the experi-
mental surgical laboratory for Dr. Brendel and,
thanks to its walls of armoured concrete, it is free of
vibration and electrical disturbance. Brendel and
co-workers reduce the lymphocyte count in blood of
dogs and rats by radiation of the animals’ blood out-
side the body while it runs through a plastic tube.
(The same technique has been used in leukemia.)
A temporary lymphocytopenia results and, during
this period, skin grafts in rats and kidney grafts in
dogs last longer than usual. This is still another
argument to indicate the importance of small lympho-
cytes in the rejection of homografts.
Unfortunately, a lymphocytosis follows the lympho-
cytopenia, which then leads to accelerated rejection.
Brendel and co-workers have not tried to suppress
this reactive lymphocytosis with Imuran.
Another way to destroy the lymphocytosis is first
to do thymectomy and then to give total body irradia-
tion. Some bone marrow removed before the ir-
radiation is implanted and the result is an animal
with leukocytes, but no lymphocytes. Tolerance for
homografting is increased.
Brendel and co-workers explore the possibility of
preserving kidneys for transplantation. It was found
that dog kidneys stored at -6°C still have some phos-
phatase activity and one has to assume that this
would gradually destroy the tissue. The conclusion
is that for long term storage, the temperature must
be lower than -6 C. Unfortunately, lower temper-
atures cause the formation of ice crystals inside the
cells with total destruction of same. Glycerine is
added to the solution with which the kidney is per-
fused to prevent crystal formation. When the kid-
ney, 12 hours after perfusion with glycerine and
cooling, was reimplanted in the same dog a disap-
pointing experience occurred. The kidney swelled
and burst. Others had suggested that slowly opening
the arterial blood supply might help to prevent this.
Tretbar and Figueroa have done the same in Cleveland.
Dr. Wolfgang Seidel, former Fellow in our depart-
ment, and Dr. Hans Gurland, in charge of the artificial
kidney in Munich, were our guides and managers.
Professor Zenker had arranged a lecture for the Uni-
versity of Munich (in German). During and after
lectures in Universities in Germany, approval is not
indicated by clapping of hands but by knocking with
knuckles on the tables. Disapproval is indicated by
"scharren” (to shuffle your feet on the floor). In
the afternoon a special meeting had been arranged
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327
in which 14 of the leading kidney men from all of
Germany were brought together with 14 kidney men
from Munich, and I led a two hour conference and
discussion on the basis of our experience in Cleveland.
I had never seen Erdhornchen, small ground squir-
rels, the cutest little animals. They are true hiber-
nators and since it was already quite cold in Munich
they were already kind of sleepy and did not bite as
much as in summertime. They can blame their
presence in the University courtyard to the fact that
rats, when refrigerated for two hours to under -f-10°C
develop edema of the brain. The intracellular sodi-
um in the brain goes up, the potassium goes down.
Erdhornchen do likewise in summer, but in winter
they cannot possibly do so, or they would all die.
They continue a healthy sleep at 5-6°C, but they have
an inbuilt safety mechanism, which makes them wake
up and move when they are cooled under 5°C, until
they develop enough heat to prevent edema of the
brain from developing. What is the essential dif-
ference between the rat and the wintering ground
squirrel ?
The Alte Pinakothek in Munich has a large and
extraordinary collection of paintings. The enormous
painting by Rubens, "The Last Judgment,” shows
the Lord and Christ sitting on clouds looking down
on the crowd of damned naked woman that try to
struggle upwards from Hell, while being bitten by all
kinds of monsters. It reminded me of committees
instituted in some places to decide which patients in
chronic renal failure may be treated with the artificial
kidney and which may not be.
Berlin
We were guests of the Free University of Berlin.
I gave two lectures (German) and two conferences
(in German). Our host was Dr. Biicherl, Professor
of Surgery. I wanted to come to Berlin to see the
experimental work of his group since they have made
artificial hearts for many years. Dr. Kirsch is the
ingenious assistant concerned with the artificial heart
work in Berlin.
(1) They have a Teflon that can be sprayed on
latex so that the surface properties of Teflon are
combined with the elasticity of rubber.
(2) They have made interesting air driven, very
light artificial hearts that fit inside the chest of
dogs.
(3) They have also built an epoxy-rubber pump
that fits so well in the dog’s chest, between the
lobes of the left lung, that it can be used as an
auxiliary left ventricle. The blood is taken from
the left atrium and pumped into the aorta.
In the beginning they lost their animals from a
hemorrhagic diathesis, which was due to excess of
fibrinolytic activity. They now use E (epsilon)
aminocaproic acid which is an antifibrinolytic agent.
Prof. Biicherl uses this routinely in all his open heart
cases. The hemorrhagic diathesis sometimes seen af-
ter extracorporeal circulation has not been seen in
Berlin since the use of their E aminocaproic acid.
They give 0.1 Gm/Kg every two hours. If started
early this dose suffices. However, if you give it late
when the fibrinogen is already low, then you have
to give 20 times as much. It is nontoxic and in-
expensive, in contrast to Trosylal that is no better,
but is very expensive. When you are scientifically
inclined, then you can determine the need by making
a thromboelastogram. We will at once try the use
of antifibrinolytic agents in our calves sustained
with artificial hearts inside the chest.
Various methods now recommended for treatment
of hemorrhagic shock have been reinvestigated by
Biicherl using standardized techniques. Results of
groups of ten dogs each were compared. When used
alone, transfusion with double the amount of blood
lost or hyperbaric 02 treatment, each save two or
three of the ten dogs. Treatment of acidosis, pres-
sor agents, depressor agents, digitalis, antibiotics, et
cetera may prolong life but do not influence ultimate
survival. Combination of blood (double dose of
what is lost) and hyperbaric oxygen together in-
creases the number of survivors to 8 of every 10 dogs.
Lung specialists will be pleased to know that Dr.
Biicherl and another associate, Dr. Massed, have
homotransplanted 150 lungs in dogs. In the entire
series only one dog was lost postoperatively. The
technical problems are therefore solved. The func-
tion of the transplanted lung is good if one lung
only is transplanted. It seems that at least some
original lung tissue must be left to prevent atelec-
tasis shortly following transplantation. It seems,
then, that a substance normally formed by the lung,
perhaps surfactant material, is not immediately formed
by the transplant, although it later is.
Three dogs treated with Imuran lived longer than
one year and the transplanted lung proved to be
fully normal with bronchospirometry. I personally
saw a black dog in good condition with a lung
homotransplanted five months before. This dog had
one peculiarity — he bit only ordinarius (i. e., full)
professors, but no associates. These dogs are given
more Imuran when their white count increases over
6,000, thus some of them get as much as 10 mg/Kg.
The clinical implication is obvious. What else can
a patient with severe asthma or emphysema look for-
ward to? What about obtaining donors? A person
may request his family to donate after his death, all
the internal organs that can be used, his kidneys, his
liver, and his lungs, perhaps also his heart. Eyes,
bones and aorta are welcome as before. Only if we
give every person admitted to a hospital an option to
do so will we get some of the organs that are so
desperately needed.
328
The Ohio State Medical Journal
Treatment of Septic Shock
A Progress Report
FRANK W. AMES, M. D., and MARTIN J. FISCHER, M. D.
T
"'THIS paper is a progress report on the treat-
ment of septic shock. It will deal with two
phases; fifty-eight consecutive cases of gram-
negative septicemia occurring between April 1, 1963
and April 1, 1964, and a comparison with 50 con-
secutive cases between April 1, 1962 and April 1,
1963. Whereas the authors saw and played some
role in diagnosis and management of approximately
90 per cent of the 1962-1963 series, only 69 per
cent of the 1963 - 1964 group were seen. We will
compare the two groups with regard to several clinical
features, and then analyze the entire 108 cases con-
centrating on therapy, particularly on the choice and
dosage of antibiotic and steroid drugs.
Clinical Features
The signs, symptoms, and laboratory results showed
little change from the previous year.1 Neither did
our original impression of the three separate stages
of gram-negative septicemia.1
There are some points we would mention concern-
ing the portal of entry and the organisms cultured
(see Tables 1 and 2). As one can see in Table 1,
the urinary tract still holds a commanding lead as a
portal of entry. Of interest is the increase in the
number of patients with a portal of entry elsewhere
than the urinary, Gl-biliary, or gynecological systems.
These include skin and lungs for the greater part.
This indicates the increasing adaptability of gram-
negative organisms and we might postulate their in-
creased presence in other systems in future years.
Table 1. Portal of Entry
System 62-3 63-4 Total
Urinary 28 29 57
GI - biliary 11 12 23
Gynecological 6 6 12
Elsewhere 5 11 16
In Table 2 the types and numbers of organisms are
listed. Of note is the marked increase in uniden-
tifiable species. We must consider the possibility of
organism mutation secondary to the marked increase
in use of broad spectrum antibiotics.
There has been a continuance of little success with
Pseudomonas septicemia. Shock has developed in all
Submitted July 5, 1965.
The Authors
• Dr. Ames, Bellevue, formerly co-chief Resident
in Internal Medicine, Akron General Hospital, is
now serving with the Armed Forces.
• Dr. Fischer, Akron, is co-chief Resident in
General Surgery, Akron General Hospital.
cases with over 50 per cent mortality. Over the past
year there was an increase in the incidence of Proteus
septicemia. Septic shock was universal but with
adequate therapy the mortality rate has been less than
33 per cent.
The cases with sepsis from biliary portal of entry
were characterized by very poor results — only 2 of
Table 2. Organisms
Organism
62-3
63-4
Total
Escherichia coli
21
18
39
Proteus
6
10
16
Pseudomonas
5
4
9
Aerobactor
3
1
4
Bacteroides
3
2
5
Klebsiella Aerobactor
3
1
4
Alkaligenes Fecalis
2
2
Hemophilus
2
1
3
Klebsiella Pseudomonas ....
1
1
Klebsiella
1
1
2
Paracolon (Prov. )
1
3
4
Salmonella
1
1
2
Unidentified Gram-negative
bacilli
2
15
17
15 patients survived.
Four patients
died
of septi-
cemia complicating hepatic decompensation. Two
were postoperative patients. Four patients died after
operations on the biliary tract — - three were follow-
ing cholecystectomy plus common duct exploration,
and one was several months post-cholecystectomy.
There were four patients with biliary tract obstruction
due to stone, complicated by acute cholangitis. Three
were treated without operation and died. One died
post-cholecystostomy. The treatment of this special
situation should be appropriate antibiotics, steroids
and to surgically decompress the liver. Because of
edema secondary to the acute process and/or previous
cholecystitis, the cystic duct will almost always be too
narrowed for cholecystostomy to provide adequate
for April , 1966
329
biliary tract drainage, and T-tube drainage of the
common duct should be performed.
There were three cases of acute cholecystitis with-
out cholangitis. The patient treated medically died.
The two treated with cholecystectomy were the only
survivors of this entire biliary group. The errors
most frequently encountered in this group are: (1)
to undertreat with respect to drugs, (2) to delay
or not surgically intervene, and (3) to perform the
incorrect surgical procedure.
The authors have seen three cases of fulminant
septicemia with shock occurring in the third trimester
of pregnancy. None of the patients were in labor.
The etiology in all was urinary tract infection, at-
tendant upon the physiologic changes of the upper
urinary tract during pregnancy. An attempt to al-
leviate the physiologic obstruction with ureteral cath-
eterization was made in two. Frank pus was obtained.
Both patients continued to worsen. In one, eclampsia
masked shock for several hours. Emergency cesarian
section was performed in both cases; both mothers
and both babies survived without sequelae. The
third case was successfully managed with antibiotics
and steroids.
Therapy of Gram-Negative Septicemia
And Shock
Correct therapy still requires early diagnosis, im-
mediate antibiotics in adequate dosage, and restoration
or maintenance of blood pressure and urinary output.
Further evidence is present that adequate antibiotic
coverage is the cornerstone of treatment. In Table 3
the results and dosages of antibiotic therapy are
shown. These figures represent cases where the drugs
Table 3. Results of Antibiotic Therapy
Good Poor
Antibiotic Result Result Dosage/24 hrs.
Penicillin 37 10 39-90 mil. units I.V.
Tetracycline + 13 5
Streptomycin
Chloramphenicol + 13 2
Kanamycin
Tetracycline 11 8 2 Gm., I.V.
Streptomycin 26 10 2 Gm., I.M.
Chloramphenicol 26 9 4-8 Gm., I.V.
Kanamycin 7 2 1.5-2 Gm., I.M.
Colymycin 9 3 250-300 mg., I.M.
were used in adequate dosage only and the table rep-
resents the results of 108 cases over the two year
period.
Important facts which can be gleaned from this
table are: (1) results are better with combinations
of drugs, (2) the best combinations are penicillin
with either chloramphenicol and kanamycin, chlor-
amphenicol and streptomycin, or tetracycline and
streptomycin (penicillin in combination with other
drugs in adequate dosages has given good results in
three out of four cases), and (3) kanamycin or
colymycin may be used alone in very selected cases
with good results to be expected. It is still sug-
gested that adequate antibiotic therapy be continued
at least 48 to 72 hours after control of shock, until
the patient is clinically improved, afebrile (not hy-
pothermic), has a normal blood count, and/or after
three successive negative blood cultures. The au-
thors still do not advise changing an antibiotic regi-
men because of conflicting sensitivity reports if the
patient is doing well clinically. It is also advisable
to switch combinations of antibiotics after 18 to 36
hours if the patient has not clinically responded to the
initial regimen.
Treatment of Septic Shock with Steroids
When shock occurs, the authors’ ideas on the use
of large doses of steroids are unchanged. Despite
the increase in published literature in favor of their
use2'4 and their availability in this hospital free of
cost* to the patient, a disappointingly small amount
of this compound was used in treating septic shock
during the past year. We still advise their use in-
travenously or by intravenous infusion in the dosage
of 80 milligrams of methylprednisolone every 6 to
8 hours up to a period of 72 hours. The drug may
be stopped abruptly at this time without tapering
their dosage; however if used longer than 72 hours,
it is safer to gradually taper the dosage to zero to
prevent adrenal decompensation.3’ 5
Vasopressor drugs are still advised with the thought
in mind that they are supportive and not therapeutic
agents. It is advised that they should not be used
without steroids for theoretical5’ 6 and practical
reasons.1, 7
Results of Treatment of Septic Shock
In the 1963-1964 group 38 of 58 patients with
positive blood cultures for gram-negative organisms
developed septic shock. A comparison with the
1962-1963 group and the total series may be seen
in Table 4.
Table 4. Results of the Treatment of Septic Shock
April 1962-3 April 1963-64 Total
Number of patients with positive
blood cultures
50
58
108
Number of patients that developed
septic shock
34
38
72
Mortality rate — shock and non-shock
groups
40%
31%
35%
Mortality rate — shock group only
59%
48%
53%
Mortality rate in cases treated with
adequate antibiotics
35%
50%
42%
Mortality rate in cases treated with
adequate antibiotics and steroids
23%
40%
30%
There was some improvement in the mortality
rate in the 1963-1964 group but as you can see the
overall mortality of septic shock is greater than 50
per cent.
Results of antibiotic therapy in the 1963-1964
group only strengthens the concept of their primary
role in treatment of septic shock. In the 1962-1963
series, no patients survived treated with inadequate
antibiotics. This year one patient survived on inade-
*Solu-Medrol® (480 vials) has been supplied by Dr. S. S. Stubbs
of The Upjohn Company.
330
The Ohio State Medical Journal
Table 5. Evaluation of 72 Patients With Shock
Lived
Died
Inadequate antibiotics
No steroids
1
21
Adequate antibiotics
No steroids
11
7
Adequate antibiotics
Inadequate steroids
2
7
Adequate antibiotics
Adequate steroids
16
7
quate antibiotics but overall there have been very
poor results (see Fig. 1).
Steroids in adequate dosage were used in only five
patients in the last nine months of the 1963-1964
group. Three of these patients received steroids in
Fig. 1. Mortality Related to Antibiotic Therapy
inadequate amounts. No conclusions could be drawn
from this small group. However over the two year
period steroids were used in adequate dosage in 23
patients and 16 of these survived. There were 49
patients who developed septic shock and had in-
adequate or no steroids; 35 (or 71 per cent) of these
died. The difference between these two groups is
statistically significant (see Fig. 2).
Fig. 2. Mortality Related to Steroid Therapy. (These
patients all had adequate antibiotic therapy.)
From these figures we can surely conclude that
treatment of septic shock with adequate antibiotics
and steroids is of utmost importance in promoting
patient survival. With early diagnosis and immedi-
ate therapy good results can be expected in a majority
of cases.
Summary
1. Fifty-eight patients with gram-negative septi-
cemia and septic shock occurring from April 1, 1963
to April 1, 1964 are compared with 50 patients from
April 1, 1962 to April 1, 1963, and the overall group
is reviewed.
2. The urinary tract remains the leading portal
of entry, but skin and lungs showed a substantial
increase.
3. Notable changes in the organisms cultured are
an increase in Proteus species and a marked increase
in unidentifiable genera of gram-negative bacilli.
4. An increasing incidence and poor outcome of
biliary tract sepsis is recorded. Well timed ap-
propriate surgery is stressed in the therapy of these
problems.
5. Massive antibiotic therapy is still urged. The
most effective combination found useful by the au-
thors is penicillin, chloramphenicol and kanamycin.
6. Adrenal corticosteroids are recommended for
all cases in which shock is present. A statistically
significant improvement in mortality resulted from
their use in pharmacologic dosage in this series.
Acknowledgment : The authors acknowledge the cooperation of
the Attending Staff of Akron General Hospital in making their pa-
tients available for this study.
We wish to thank Dr. Jack Mostow for his encouragement and
assistance in preparing this paper. We further thank Mr. D. Souders
and the Bacteriology Department of Akron General Hospital for their
cooperation in this study.
References
1. Fischer, M. J., and Ames F. W. : Septic Shock. A Discus-
sion of Treatment in Forty-five Patients with Infection Due to Gram-
Negative Bacilli. Ohio State Med. J., 60:457-460 (May) 1964.
2. Weil, M. H., and Spink, W. W. : Shock Syndrome Associated
with Bacteremia Due to Gram Negative Bacilli. Arch. Intern. Med.,
101:184-193 (Feb.) 1958.
3. Spink, W. W. : Adrenocortical Steroids in the Management of
Selected Patients with Infectious Diseases. Ann. Intern. Med.,
53:1-32 (July) I960.
4. Weil, M. H.: The Cardiovascular Effects of Corticosteroids.
Circulation, 25:718-725 (Apr.) 1962.
5. Spink, W. W. : The Pathogenesis and Management of Shock
Due to Infection. Arch. Intern. Med., 106:433-442 (Sept.) I960.
6. Weil, M. H., and Miller, B. S.: Experimental Studies on
Therapy of Circulatory Failure Produced by Endotoxin. J. Lab. Clin.
Med., 57:683-693 (May) 1961.
7. Shubin, H., and Weil, M. H. : Bacterial Shock. A Serious Com-
plication in Urological Practice. J. A. Al. A., 185:850-853 (Sept. 14)
1963.
CONTACT LENSES. — In a survey of ophthalmologist members of the Fly-
ing Physicians Association, the general feeling was that the pilot should have
proven himself to be a successful wearer for 3 to 6 months prior to using them
for flying. There is some indication that perhaps liberalization of the FAA regu-
lations regarding the use of contact lenses is in order. — David C. Boyce, M. D.,
Grand Rapids, Mich.: Southern Medical Journal, 59:61-63, January, 1966.
for April, 1966
331
Adverse Reactions
To Drugs
Report Them to New AMA Registry!
A REGISTRY ON ADVERSE REACTIONS has been established by the
Council on Drugs of the AMA. The Council has prepared several mailing
pieces relating to this subject, and the following material has been extracted
from one of those pieces:
* ❖ *
The following reaction chart has been compiled from suspected cases re-
ported to the Registry on Adverse Reactions. In addition we have included data
culled from current literature. The list is necessarily limited, and further informa-
tion is available upon request. It must be stressed that this is not a condemnation
of any particular drug or chemical. Rather, it is a means of alerting the physician
to the potential of drug or chemical reaction. It may serve also as a reminder in
differential diagnosis when drugs or chemicals often are overlooked.
Aplastic Anemia
Benzene & other organic
solvents
Chloramphenicol
Diphenylhydantoin
Insecticides
Mephenytoin
Sulfonamides
Trimethadione
Auditory Dysfunction
Chloroquine
Kanamycin
Quinine
Streptomycin
Viomycin
Collagen Disorders
Diphenylhydantoin
Griseofulvin
Hydralazine
Isoniazid
Sulfonamides
Jaundice (Cholestatic)
Aminosalicylic Acid (PAS)
Chlorpropamide
Ectylurea
Erythromycin Estolate
Imipramine
Methimazole
Methyltestosterone
Norethindrone
Norethynodrel
Phenothiazines
Triacetyloleandomycin
Jaundice
(Hepatocellular)
Aminosalicylic Acid
Diphenylhydantoin
Halothane
Iproniazid & Other
Hydrazines
MAO Inhibitors
Leukopenia
Chloramphenicol
Chlorothiazide
Chlorpropamide
Diphenylhydantoin
Dipyrone
Imipramine
Penicillamine
Phenothiazines
Phenylbutazone
Sulfonamides
Parkinsonism
Imipramine
Mecamylamine
Phenothiazines
Rauwolfia Alkaloids
Peripheral Neuropathy
Colistimethate Sodium
❖ * *
Ethionamide
Ethoxzolamide
Furaltadone
Isoniazid
Methimazole
Nitrofurantoin
Nitrofurazone
Streptomycin
Sulfonamides
Photosensitivity
Chlorothiazide
Griseofulvin
Nalidixic Acid
Phenothiazines
Sulfonamides
Tetracyclines
Psychoses
Carbarsone
Chloroquine
Isoniazid
Quinacrine
Sulfonamides
Toxic Nephropathy
Colistimethate Sodium
Kanamycin
Phenacetin
Phenindione
Phenylbutazone
Probenecid
Salicylates
Tetracyclines
This is another of the outstanding services rendered by the AMA to the
public through practicing physicians. From time to time, we hope to publish addi-
tional information from this source. Physicians are encouraged to report unpub-
lished data on serious, unusual, or unexpected reactions, even though such observa-
tions may be based only on suspicion or circumstantial evidence.
Additional information and report forms are available from the AMA Reg-
istry on Adverse Reactions, Council on Drugs, American Medical Association,
535 North Dearborn Street, Chicago, Illinois 60610.
— The Editor
332
The Ohio State Medical Journal
Demethylchlortetracycline Overdosage
A Case Report of Toxic Effects in a Patient with
Impaired Renal Function
ARMAND MANDEL,. M. D.
The Author
• Dr. Mandel, Parma, is Director of the De-
partment of Internal Medicine, Evangelical Dea-
coness Hospital, Cleveland, and a member of the
Active Staff, Parma Community General Hospital;
Physician, Cleveland Metropolitan General Hos-
pital; Senior Clinical Instructor in Medicine,
Western Reserve University School of Medicine.
EMETHYLCHLORTETRACYCLINE* * is the
most recent of the tetracycline compounds
to be isolated.1 Since the discovery of chlor-
tetracy cline in 1948 by Duggar,2 and the sub-
sequent isolation of its analogues, these antibiotics
have proved extremely valuable in clinical practice be-
cause of their wide range of antibacterial activity.
Most gram-positive and gram-negative bacteria, the
rickettsiae, and some of the large viruses are suscep-
tible to their action. The tetracyclines are among the
safest antibiotics in clinical use and serious adverse
reactions are rare. The case presented has certain
features which might be considered evidence of the
toxicity of demethylchlortetracycline (DMCT) when
given in excessive doses to a patient with impaired
renal function.
Report of a Case
A 40 year old white man was admitted to the hospital 40
hours after the onset of the present illness. He had consulted
a physician a few hours after the onset, with the complaint
that he had awakened with chills and fever and had felt un-
able to continue with his work. His physician had diagnosed
pneumonia and prescribed DMCT. The patient had re-
turned home and slept almost continuously for 34 hours,
waking only to take DMCT in doses of 450 mg. every four
to six hours. The total dosage taken was 2400 to 2700
mg. in about 36 hours. No explanation could be obtained
for the administration of this high dosage. No urine had
been passed in the 20 hours prior to admission.
The previous medical history was relevant in that the
patient admitted a heavy consumption of alcohol for a period
of 10 years, although there had been total abstinence for
the four years prior to the present illness. There was no
history of liver or renal disease. The patient maintained
an unusually busy work schedule, arising at 3:30 A. M.
and working for about 20 hours a day almost every day of
the week. He took dextropropoxyphene hydrochloride
(Darvon®) in doses up to 160 mg. daily, and secobarbital
occasionally. He used isoproterenol hydrochloride as a
nebulizer.
On admission the patient was asleep and could be roused
only with difficulty. When aroused he was well oriented,
but was unable to stay awake while the history was being
taken, and fell asleep even during funduscopic examination.
The only other significant finding on examination was a
slightly elevated blood pressure of 158/102. The pulse and
temperature were normal, the lungs clear, the heart sounds
Submitted July 15, 1965.
*Declomycin(g) (demethylchlortetracycline) is the registered trade-
mark of Lederle Laboratories, a Division of American Cyanamid
Company, Pearl River, New York.
Reprint requests to 6681 Ridge Road, Parma, Ohio 44129 (Dr.
Mandel. )
physiological and the abdomen soft and free of tenderness
or palpable masses. Neurologic examination revealed no
evidence of a focal cerebral lesion or of meningeal irritation.
The patient was catheterized and 450 ml. of dark amber
urine was obtained. Urinalysis showed a specific gravity of
1.018 and 3 plus proteinuria. On microscopic examination
there were 1 to 2 red blood cells and 1 to 2 granular casts
per high power field. The blood urea nitrogen was moder-
ately elevated (Table 1).
Intravenous infusions were given because the patient was
too drowsy to take fluids orally. In the first 24 hours he
developed puffiness of the face and periorbital edema, and
there was a weight gain of 8 lb. Oliguria persisted during
the first four hospital days. On the second day the blood
chemistries revealed a rising blood urea nitrogen (BUN)
and marked abnormalities of serum glutamic oxalacetic
transaminase (SGOT) and serum glutamic pyruvic transami-
nase (SGPT). The SGPT was so high that it could not
be determined in a 1:20 serum dilution. At this time, the
serum antistreptolysin titer was found to be 150 units. From
the third day on, there was a gradual decline in the SGOT
and SGPT levels, but the BUN continued to rise until the
ninth day and there was marked elevation of the serum
creatinine and uric acid levels. The serum potassium levels
remained within the upper limits of normal (Table 1). Daily
urinalyses showed a persistently low specific gravity, traces
of proteinuria, microscopic hematuria, and occasional granu-
lar casts.
The urinary output increased gradually after the fourth
hospital day, and the patient then began to recover. Nine-
teen days after admission the BUN was still slightly elevated
but the serum transaminase levels were normal. The blood
pressure remained moderately elevated throughout the hospi-
tal course. There was no icterus or hepatomegaly at any
time, but on one occasion there was tenderness on palpa-
tion of the right upper quadrant of the abdomen.
In view of the excessive dosage of DMCT, samples of
blood were assayed for DMCT activity by the agar dif-
fusion method, using Bacillus cereus as the test organism.!
The first specimen, obtained about 12 hours after the last
dose of DMCT, contained 6.24 /rg/ml and the second speci-
fAssay of both specimens was performed by Lederle Laboratories,
Pearl River, New York.
for April, 1966
333
Table 1. Blood Chemistries During Hospitalization
Day of Illness
3
4
5
6
7
8
9
10
11
12
13
21
BUN in mg/100 ml
36
41
56
61
80
88
77
77
56
24
NPN in mg/100 ml
125
Creatinine in mg/100 ml
10.5
12
11
8.5
5.4
1.85
Uric Acid in mg/100 ml
11.2
13
9.2
6.7
Potassium in mEq
3.2
3.9
4.5
4.8
5.3
4.9
SGOT in units
1800
930
570
73
55
48
32
32
SGPT in units
<2520
2520
960
194
43
Antistreptolysin-O
titer in units
150
men, obtained 33 hours later, contained 4.84 figl ml of
DMCT. Both specimens contained traces of barbiturates, the
levels being too low for quantitative determination.
Comment
A diagnosis of glomerulonephritis was indicated by
the diastolic hypertension, the elevated antistreptolysin
titer and serum creatinine levels, the oliguria, and the
findings on urinalysis. The absence of more than
moderate azotemia could not be explained. The
extreme drowsiness was probably due to physical ex-
haustion and barbiturates, although it is interesting to
speculate on the possibility of a tetracycline induced
encephalopathy. Manifestations of cerebral toxicity
have been described in association with penicillin,
sulfonamides, and streptomycin.3 The unusually high
serum levels of SGOT and SGPT are submitted as
evidence of liver toxicity following the ingestion of
excessive doses of DMCT.
The tetracyclines are widely distributed through-
out the tissues. They are concentrated in the liver
and excreted via the bile into the intestine, from
where they are reabsorbed into the bloodstream.4’ 5
They are eliminated mainly by renal glomerular filtra-
tion with apparently no tubular reabsorption.4’ 6 The
rate of clearance varies with each analogue, being
dependent on the extent of their binding to the
plasma proteins.7 The renal clearance rate of DMCT
is 43 per cent of the tetracycline clearance rate.8 It
has been shown to have a half-life 44 per cent longer
than that of tetracycline in vivo.& Antibiotic activity
persists for 72 to 9 6 hours after a single dose of
DMCT, whereas none can be detected 72 hours after
a single dose of chlortetracycline or tetracycline.8 For
this reason, the therapeutic dosage of DMCT is al-
most half the therapeutic dosage of the other tetracy-
clines.
In a study of 32 healthy volunteers receiving
DMCT in the recommended oral dosage of 150 mg.
four times daily, the average serum activity was found
to be 1.49 to 1.84 fig/ ml after 24 to 48 hours of
therapy.9 With intact renal function, the serum
levels of the tetracycline compounds are maintained
at a constant level until administration is discon-
tinued. However, when glomerular filtration is in-
adequate, the serum levels continue to rise as long as
the drug is being absorbed, and they fall much more
slowly after therapy is stopped.7’ 10 This is illus-
trated in the present case, in which the serum con-
centration of DMCT fell by about 22.4 per cent in
the 33 hours after admission, whereas an average
decline in serum levels of 86 per cent in 30 hours
has been demonstrated in healthy individuals.10
The tetracyclines are known to be toxic to the liver
in high concentrations. Fatty metamorphosis of the
liver was found in experimental animals after large
doses of tetracyclines over long periods of time, 11
and several cases of acute hepatic dysfunction have
been reported in patients receiving large intravenous
doses of these antibiotics during pregnancy.12’ 13 It
is significant that these patients were being treated
for renal infections, and in two cases a decreased
glomerular filtration rate was demonstrated.12 In
these cases, semm tetracycline levels of up to 63
fig/ ml were associated with severe liver damage. In
the present case, the serum level of 6.24 fig/ ml 12
hours after the last dose of DMCT is not excessive
in view of the dosage ingested. However, since the
patient was not seen until the third day of his illness,
it is probable that much higher serum levels were
present prior to admission. Also, this patient may
have been predisposed to liver damage because
of his previous history of alcoholism and prolonged
physical strain. The liver damage was slight and
reversible, as evidenced by the lack of jaundice and
the rapid return to normal serum transaminase levels.
Nevertheless, the persistence of the antibiotic in the
blood has been clearly demonstrated, and confirms
the findings of others, that the tetracyclines should
334
The Ohio State Medical Journal
be given in greatly reduced dosage in patients with
impaired renal function.7- 14
Summary
A case is reported of suspected acute, reversible
liver toxicity following excessive oral dosage of de-
methylchlortetracycline in a patient with glomerulone-
phritis. Evidence is presented of delayed excretion
of DMCT in the presence of impaired renal function.
Acknowledgment: The author wishes to express his ap-
preciation to Dr. C. P. Masur of the Lederle Laboratories
for his assistance.
References
1. McCormick, J. R. D.; Sjolander, N. O.; Hirsch, U.; Jensen,
E. R.. and Doerschuk, A. P. : A New Family of Antibiotics: The
Demethyltetracyclines. /. Amer. Chem. Soc., 79:4561-4563 (Aug.
20) 1957.
2. Duggar, B. M. : Aureomycin: A Product of the Continuing
Search for New Antibiotics. Ann. NY Acad. Sci., 51:177-181 (Nov.
30) 1948.
3. Finland, M., and Weinstein, L.: Complications Induced by
Antimicrobial Agents. New Eng. J. Med., 248:220-226 (Feb. 5)
1953.
4. Beckman, Harry: Pharmacology; The Nature, Action, and
Use of Drugs, 2nd ed, Philadelphia: W. B. Saunders Company, 1961.
5. Kunin, C. M., and Finland, M.: Excretion or Demethylchlor-
tetracycline Into the Bile. New Eng. J. Med., 261:1069-1071 (Nov.
19) 1959.
6. Kunin, C. M., and Finland, M.: Demethylchlortetracycline;
a New Tetracycline Antibiotic That Yields Greater and More Sus-
tained Antibacterial Activity. New Eng. J. Med., 259:999-1005
(Nov. 20) 1958.
7. Kunin, C. M.; Rees, S. B.; Merrill, J. P., and Finland, M. :
Persistence of Antibiotics in Blood of Patients with Acute Renal
Failure. I. Tetracycline and Chlortetracycline. J. Clin. Invest.,
38:1487-1497 (Sept.) 1959.
8. Hirsch, H. A., and Finland, M.: Antibacterial Activity of
Serum of Normal Subjects After Oral Doses of Demethylchlortetra-
cycline, Chlortetracycline and Oxytetracycline. New Eng. J. Med.,
260:1099-1104 (May 28) 1959.
9. Sweeney, W. M.; Dornbush, A. C., and Hardy, S. M.:
Demethylchlortetracycline and Tetracycline Compared; Relative In
Vitro Activity and Comparative Serum Concentrations During 7
Days of Continuous Therapy. Amer. J. Med. Sci., 243:296-308
(Mar.) 1962.
10. Kunin, C. M.; Dornbush, A. C., and Finland, M.: Distribu-
tion and Excretion of Four Tetracycline Analogues in Normal Young
Men. /. Clin. Invest., 38:1950-1963 (Nov.) 1959.
11. Declomycin (Demethylchlortetracycline) — A Compendium,
Lederle Labs, Div. Amer. Cyanamid Co., Pearl River, New York:
Kingsport Press, Inc., p. 38, 1962.
12. Whalley, P. J.; Adams, R. H., and Combes, B.: Tetracycline
Toxicity in Pregnancy; Liver and Pancreatic Dysfunction. JAMA
189:357-362 (Aug. 3) 1964.
13. Norman, T. D.; Schultz, J. C., and Hoke, R. D.: Fatal
Liver Disease Following the Administration of Tetracycline. South-
ern Med. J., 57:1038-1042 (Sept.) 1964.
14. Dowling, H. F., and Lepper, M. H.: Hepatic Reactions to
Tetracycline. JAMA, 188:307-309 (Apr. 20) 1964.
STAPES SURGERY. — The substitution of stapedectomy for stapes mobiliza-
tion has greatly increased the incidence and degree of hearing restoration
but has also introduced new hazards, one of which is increased possibility of
introducing infection into the labyrinth. Because the surgeon’s fingers must con-
tact the potentially contaminated skin of the ear throughout the operation, the
authors have long adhered to the following rules: perform no surgery in the
presence of latent or recent active infection, sterilize the skin by a multiple prep-
aration over 24 hours, use meticulous sterile technique, place the patient on a
broad spectrum antibiotic for one day before and seven days after operation,
and continue the sterile technique in postoperative care. Because of their
findings in the studies reported here, they now use Ioprep® (a new iodine anti-
septic agent) rather than hexachlorophene for sterilizing the ear canal. The
most effective antibiotic for pre- and postoperative use was found to be tetra-
cycline plus sodium novobiocin (Panalba®). Furthermore, because organisms
present in the ear canal tend to be carried into the middle ear by the surgeon’s
instruments, they now discard any material, such as absorbable gelatin sponge
(Gelfoam®), that has accidentally touched the ear canal while being introduced
into the open oval window. The authors also studied the possibility that the
postoperative sensorineural loss that all surgeons note to some degree might be
due to subclinical infection of the labyrinth; no correlation was found between
presence of a positive culture during surgery and the incidence of sensorineural
loss, but a fairly large statistical population would be required to rule out such
a correlation. — Abstract: William K. Wright, M. D., Houston, and Paul J.
Marmesh, M. D., San Antonio, Texas: Archives of Otolaryngology, 81:566-569
(June) 1965.
for April, 1966
335
Apnea Due To Intramuscular
Colistin Therapy
Report of a Case
MICHAEL A. ANTHONY, M.D., and DAVID L. LOUIS, M.D.
"T ONFATAL apnea due to colistin therapy was
recently reported by Perkins.1 In discussing
^ ^ the toxicity of this drug, Fekety, Norman,
and Cluff refer to transient apnea in an elderly pa-
tient receiving colistin.2 The patient reported by Per-
kins was also receiving corticosteroids during the
period of treatment with sodium colistin. The pa-
tient referred to by Fekety had undergone a surgical
procedure and in the early postoperative period be-
came apneic for several hours. Thiopental sodium,
nitrous oxide, bromochlorotrifluoroethane, and suc-
cinylcholine had been used as anesthetic agents. Both
authors point out that drugs other than colistin could
not be excluded as factors in the development of the
apnea.
The present report is concerned with the occurrence
of apnea in a woman with chronic renal disease, who
became symptomatic following therapy with colistin
and methenamine mandelate. The toxicity of methen-
amine mandelate is related to the systemic acidosis
which it may cause if not adequately excreted. Since
the patient had received only 1 gram of this drug
at the time the initial symptoms developed, it is un-
likely that the methenamine mandelate was a factor
in her course.
Case Report
The patient was a 47 year old female Cuban refugee who
was admitted April 2, 1964, for the evaluation and treat-
ment of chills, fever, and hematuria.
She had had surgical removal of renal calculi four years
prior to admission, while still living in Cuba. On follow-
up evaluation prior to leaving for the United States, she was
informed that the calculi had reformed. She had remained
asymptomatic, however, until three weeks prior to admis-
sion, when she began to experience evening fever with as-
sociated chilling. She also began passing "dark” urine.
The physical examination revealed a swarthy, hyperactive,
normally developed woman, who was not in acute distress
and did not appear chronically ill. The blood pressure was
150/100 mm. Hg, the cardiac rate was 110 with a regular
rhythm, and the temperature was 99-4° F. The only signifi-
cant abnormality on physical examination was the presence
of an easily palpable, nontender right kidney.
The admission hemogram revealed a hemoglobin level of
8.6 Gm. per 100 ml. and a hematocrit of 26 per cent. The
white blood cell count was 6,640 with 73 per cent segmented
neutrophils, 10 per cent lymphocytes, 9 per cent band cells,
and 2 per cent monocytes. The urinalysis revealed a specif-
Submitted June 22, 1965.
The Authors
@ Dr. Anthony, Columbus, is Director of Medical
Education, Mount Carmel Hospital.
• Dr. Louis, Columbus, is a member of the
Intern Staff, Mount Carmel Hospital.
ic gravity of 1.007 and a ph of 7.0 and contained 100 mg.
per 100 ml. of albumin. Examination of the urinary sedi-
ment revealed 20 to 30 white blood cells and many red
blood cells per high power field. The blood urea nitrogen
was 31 mg. per 100 ml., the creatinine was 2.7 mg. per 100
ml., the serum calcium was 4.5 mg. per 100 ml., and the
serum phosphorus was 5.0 mg. per 100 ml. The urine cul-
ture on admission was positive for Proteus mirahilis.
X.-ray films of the chest revealed the heart, mediastinum,
lung fields, bony thorax, and diaphragm to be without
abnormality. The scout film of the abdomen revealed an
"almost complete cast of the calyceal internal collecting
system of both kidneys because of multiple confluent stag-
horn calculi.” Following injection of contrast material,
there was no visible concentration of the material in either
kidney.
The patient received two units of whole blood on the two
days following admission. While receiving the second trans-
fusion the patient’s temperature rose to 102°F., and she ex-
perienced a chill. The transfusion was discontinued, and
there was no laboratory evidence of hemolysis.
Six days following admission cystoscopy and retrograde
studies were carried out. Following injection of indigotin
disulfonate, the dye appeared in nine minutes on the right
but none was observed from the left. Cultures of the blad-
der and kidney urine were positive for P mirabilis. There
were 100,000 bacteria per ml. from the culture of the blad-
der urine, 50,000 per ml. from the right kidney and 15,000
bacteria per ml. from the culture of urine of the left kidney.
The hemoglobin level one week after admission was 10.6
Gm. The white blood cell count was 7,770 with a left
shift. The urinalysis revealed a specific gravity of 1.007
with many red and white blood cells in the urinary sediment.
Two weeks after admission the hemoglobin level was 9.7
Gm. The blood urea nitrogen at this time was 43 mg. per
100 ml., and the creatinine was 2.7 mg. per 100 ml. A
week later the blood urea nitrogen was 66 mg. per 100 ml.
and the creatinine was 3-9 nig. per 100 ml. Serum sodium,
potassium, and chloride were normal. Repeated urinalyses
were positive for red and white blood cells.
Operation: It was the opinion of the physicians attend-
ing the patient that the removal of the calculi in the func-
tioning right kidney was indicated, in an attempt to de-
crease infection and preserve remaining function. Three
weeks after admission, the necessary surgical procedure was
performed. Stones were palpable in most of the calyces.
The lower pole was opened, and approximately 30 cc. of
creamy purulent material was removed. Several calyces were
336
The Ohio State Medical Journal
opened and small stones were removed. Two large stag-
horn calculi were removed from an incision in the upper
pole of the kidney. A mushroom catheter was left in place.
The patient’s course was one of slow but progressive im-
provement during the three weeks following surgery and she
had only minor elevations of temperature. During this
period the hemoglobin level fluctuated between 10 and 11
grams and the white blood cell count was constantly below
10,000, with some left shift. The blood urea nitrogen
levels drawn every other day during this period varied be-
tween 50 and 60 mg. per 100 ml. and creatinine gradually
decreased from a high of 4.1 to a low of 1.7 mg. per 100
ml. Urinalyses during this period were all strongly posi-
tive for red and white blood cells.
Four weeks after the surgical procedure, the patient de-
veloped a fever of 103°F., and the urine culture was again
positive for P mirabilis. The infection was treated with
methenamine mandelate and nitrofurantoin, and the temper-
ature returned to normal within four days.
The patient again improved clinically and was afebrile
over the next three weeks. The urine cytology remained
strongly positive. The blood urea nitrogen slowly dropped
to a level of 21 mg. per 100 ml. and the creatinine to a
level of 1.5 mg. per 100 ml. The urine cultures remained
positive for P mirabilis. The hemoglobin level varied be-
tween 8.5 and 9-5 grams during this period.
Two months after the surgical procedure, the temperature
again elevated to 104°F., and the nephrostomy site was
found to be infected. The blood urea nitrogen rose to
between 40 and 50 mg. per 100 ml. but returned to 20 mg.
per 100 ml. within a week.
Three months following admission a nephrostomy was
successfully performed for the removal of additional calculi,
and a nephrostomy tube was placed. The microscopic re-
port of the biopsy section was as follows:
The sections of soft tissue include portions of kidney and
fibroadipose tissue. The kidney shows an area of extensive
scarring with heavy lymphocytic infiltration and focal depo-
sition of blue staining marrow salts. The fibroadipose
tissue is heavily infiltrated with acute and chronic inflam-
matory cells.
The findings were reported as being consistent with chronic
pyelonephritis. An analysis of the stones removed at sur-
gery revealed them to consist of calcium and ammonium
phosphates. A urine culture on the day of surgery grew
25,000 colonies per ml. of Escherichia coli. The blood urea
nitrogen level on the first postoperative day was 43 mg. per
100 ml. but this gradually dropped to 24 mg. per 100 ml.
over the next two weeks.
During the last week in August, the patient’s blood urea
nitrogen again began to rise to levels of between 40 and 50
mg. per 100 ml. Following the elevation of the blood urea
nitrogen the intake of solid food decreased but her intake
of liquids remained good and her urine output was at least
1000 cc. daily.
On September 27 the urine culture was reported positive
for Pseudomonas , and she was placed in isolation. (In spite
of assurances on the part of the staff and her countrymen
that isolation was routine for all patients with a pseudo-
monas infection, the patient could not accept that she did
not have some terrible disease about which information was
being withheld from her. As a consequence, she became
severely depressed.)
On September 28, 1964, colistin therapy was started and
was to be given as 100 mg. intramuscularly three times daily.
She was also to be given methenamine mandelate, 1.0 gram,
four times daily. Nitrofurantoin, which she had been re-
ceiving as 50 mg. three times daily for approximately four
weeks, was stopped at the time the colistin-mandelate com-
bination was started. The nurses’ notes indicate that the
patient was doing well and taking liquids well on the date
the colistin therapy was started. About eight hours after the
initial injection of colistin, she became quite restless and
was given 25 mg. of meperidine and 25 mg. of prometha-
zine hydrochloride. Several hours later she complained of
numbness about the mouth, and she refused the morning
injection of colistin because she felt it caused the numbness
about the mouth. She received all subsequent injections of
the drug.
After the noon injection of the medication the patient then
developed a sensation of numbness in the hands in addition
to the paresthesia about the mouth. She also complained of
feeling weak. These symptoms were attributed to anxiety,
and she was again treated with meperidine and promethazine
hydrochloride. The sensation of numbness persisted through-
out the day and in the late afternoon while sitting in a
chair she was noted to be "ashen.” The vital signs at this
time revealed the blood pressure to be 130/80, the pulse
rate was 108 per minute and was regular, the respirations
were 20 per minute, and the temperature was 98°. The
symptoms regressed and she was described as having a
"better evening.” Shortly after midnight on September 30,
she was observed to be restless and uncomfortable and was
again treated with meperidine and promethazine hydro-
chloride. At 3:00 A. M. on September 30 she was again
given meperidine and promethazine hydrochloride for rest-
lessness.
At 11:00 A. M. on September 30 the patient was unable
to walk unassisted because of intense weakness, ataxia, and
lightheadedness. These symptoms were intermittently pres-
ent throughout the day. She slept fitfully during the night
and had several episodes of nausea with small amounts of
emesis. On the morning of October 1 she complained of
itching of the face, hands, and arms. There was no visible
rash. Two hours after the onset of the itching, she was
very unsteady when on her feet. She was nauseated and
refused to take any liquid. The nausea persisted throughout
the day, and she refused to leave her bed because of the
difficulty walking. She was again extremely restless during
the night, requiring meperidine and promethazine hydro-
chloride several times. At 11:00 A. M. on October 2 the pa-
tient complained of shortness of breath, and oxygen was
started by nasal cannula. In addition, she was given 50
mg. of hydroxyzine. At 2:00 p. M. her respirations were
noted to be irregular, her blood pressure was 130/80, and
her pulse was 110 with regular rhythm. She was also noted
to have "twitching” of the hands and feet. At 2:40 p. m.
she became completely apneic. She was given an injection
of ethamivan and mouth-to-mouth breathing was instituted
until the respirator could be obtained.
When the authors were asked to see the patient at 3:00
p. M. the respirator was removed and the respirations were
noted to be feeble, shallow, and irregular with little thoracic
expansion and very little air exchange. She was aware of
her surroundings but was not completely lucid and cou'd
speak only with difficulty. Mechanical respiration was again
instituted until a tracheostomy could be performed. At this
time the blood pressure was 140/110 and the pulse rate
was 120 with a regular rhythm. Within 15 minutes after
the tracheostomy and with the respirator operating, she
became alert and responsive, but there was no spontaneous
respiration. At 6:00 P. M. the respirator was discontinued
for approximately 10 minutes. The patient breathed spon-
taneously, regularly, and effectively for approximately five
minutes. During the next five minutes the respiratory ex-
change was adequate, although the respiratory rhythm was
quite irregular. The patient became quite restless and anxi-
ous and requested that the respirator again be started.
The vital signs remained stable until 11:00 p. m. on Octo-
ber 2. At that time the blood pressure began to drop and
she was given an ampule of glucaheptonate sterile solution,
in addition to an intravenous infusion containing noradren-
alin. In spite of the noradrenalin and hydrocortisone given
intravenously the blood pressure continued to drop and the
patient died on October 3 at 1:25 a. m. The cardiac rhythm
was noted to be irregular at about 12:45 a. m. on October 3
and an electrocardiogram at that time revealed a slow and
irregular idioventricular rhythm.
Throughout her illness the patient’s carbon dioxide com-
bining power had been above 20 mEq per liter. Her serum
sodium had been in the range of 130 to 140 mEq /liter,
and her serum potassium had been constantly below 4.5
mEq/liter. On the 2nd of October the carbon dioxide com-
bining power was found to be 11.1 mEq., the serum sodium
118 mEq., and the serum potassium 5.1 mEq/liter. The
carbon dioxide combining power and potassium drawn after
the blood pressure began to fall on October 2nd, were re-
ported as 14.7 mEq/liter and 6.7 mEq/liter respectively.
An autopsy was performed on the morning of her death.
The heart was not enlarged. The myocardium was noted
to be flabby and reddish brown in color. The microscopical
sections of the myocardium revealed large numbers of neu-
337
for April, 1966
trophils scattered loosely through the connective tissue of
the myocardium. The microscopic section of the lungs re-
vealed severe pulmonary edema with considerable precipi-
tated eosinophilic material filling the alveoli. The right
kidney was tightly bound to the lateral and posterior walls
of the abdomen by very tough fibrous adhesions, which fol-
lowed along the nephrostomy wound to the subcutaneous
tissue of the skin. The kidneys revealed very marked
hydronephrosis and dilated calyces and pelves were filled
with a very thick greenish pus. There was a considerable
amount of sandy material mixed with the pus and in both
kidneys there were fragments of stones. There was one
large stone, 2 cm. in length, in each kidney. Together the
kidneys weighed 27 6 Gm„ but this weight included a con-
siderable amount of pericaliceal and peripelvic fatty and scar
tissue. The mucosa of the calices and pelves of both kid-
neys was intensely hyperemic and granular. Histologic
studies of the kidney fragments revealed extensive, acute
and chronic inflammatory exudate throughout all sections of
the kidneys with considerable fibrosis and destruction of
renal architecture. The tubules were filled with hyaline
casts and clumps of neutrophils. There was ulceration of
the caliceal mucosa. There was moderately severe vascular
sclerosis.
Discussion
Colistin is a basic polypeptide closely resembling
polymyxin B in configuration except for the absence
of phenylalanine in its molecular structure. An oral
preparation, colistin sulfate, and an intramuscular
preparation, sodium colistin, are available. Petersdorf
et al. are of the opinion that the daily dose of the
drug in the adult should be no less than 300 mg.
even at the risk of toxicity.3
Colistin has been shown to be effective in the treat-
ment of infections caused by E. col i, Hemophilus,
Aerobacter, Klebsiella, Shigella, and Salmonella 2-3
and it would appear that colistin is the drug of choice
in deep-seated Pseudomonas infection.3
Initial studies reported colistin to be free of serious
toxicity. These studies were based on the reactions
of patients receiving lower dosages than presently
recommended. With the use of higher dosages the
incidence of toxicity due to colistin may be as high as
50 per cent. The toxic effects of the drug are re-
flected in disturbances of renal and neurologic
function.
The impairment of renal function usually mani-
fests as a rise in blood urea nitrogen. In the study
of Fekety2 no patient with good renal function de-
veloped evidence of nephrotoxicity. He did not feel
that azotemia represented a contraindication to the
use of colistin and did, in fact, successfully treat two
patients with acute renal failure. Atuk, Mosca, and
Kunin described the use of colistin in modified dosage
in patients with uremia. These patients did not ex-
hibit evidence of nephrotoxicity with the reduced
dosage schedule.4
The neurologic manifestations of toxicity appar-
ently result from the neuromuscular blocking prop-
erties which colistin shares with other clinically
important polypeptide antibiotics.5-7 The clinical
manifestations of toxicity due to colistin have been
well documented and include paresthesia, pruritis,
ataxia, nystagmus, nausea, fever, and hallucinations.
The paresthesia is most prominent about the mouth
but it may also involve the extremities as it did in
this patient. It may be that restlessness can also be
considered a manifestation of toxicity, since this com-
plaint had not been a problem in our patient until
onset of colistin therapy. The incidence of the devel-
opment of toxicity due to colistin therapy may be as
high as 50 per cent with the highest incidence oc-
curring in those patients with impaired renal function.
The patient discussed in this report developed
symptoms of toxicity within 10 to 12 hours after the
initial injection of the drug. Previous reports do
not describe the onset of symptoms of toxicity so
soon after the initial injection. This would agree
with previous suggestions that the rapidity of onset
of symptoms in the susceptible patient is a function
of the ability of the kidney to clear the drug.
In the management of the severely ill patient it
is difficult to incriminate a single medication or event
which alone causes death or is directly contributory.
The sequence of events leading to the death of this
patient is so typically that previously described in
those patients receiving colistin that the authors felt
an obligation to report the problem.
Previous reports indicate that colistin is an ef-
fective antimicrobial agent and its use should not be
contraindicated so long as the user is aware of the
potentially serious side effects of the drug, particularly
in those patients with impaired renal function.
References
1. Perkins, R. L.: Apnea with Intramuscular Colistin Therapy.
190:421-424, Nov. 2, 1964.
2. Fekety, F. R., Jr.; Norman, P. S., and Cluff, L. E.: Treat-
ment of Gram-Negative Bacillary Infections with Colistin. Ann. In-
tern. Med., 57:214-229 (Aug.) 1962.
3. Petersdorf, R. G., and Plorde, J. J.: Colistin — a Reappraisal.
/. A. M. A., 183:123-125, Jan. 12, 1963.
4. Atuk, N. O.; Mosca, A., and Kunin, C.: The Use of Poten-
tially Nephrotoxic Antibiotics in the Treatment of Gram-Negative
Infections in Uremic Patients. Ann. Intern. Med., 60:28-38 (Jan.)
1964.
5. Adamson, R. H.; Marshall, F. N., and Long, J. P.: Neuro-
muscular Blocking Properties of Various Polypeptide Antibiotics.
Proc. Soc. Exp. Biol. Med., 105:494-497 (Dec.) I960.
6. Sabawall, P. B., and Dillon, J. B.: The Action of Some Anti-
biotics on the Human Intercostal Nerve-Muscle Complex. Anesthes-
iology, 20:659-668 (Sept.-Oct.) 1959-
7. Kubikowski, P., and Szreniawski, Z.: The Mechanism of the
Neuromuscular Blockade by Antibiotics. Arch. Int. Pharmacodyn.,
146:549-560, Dec. 1,1963.
A TTENTION PROGRAM CHAIRMEN: We are most anxious to receive
for consideration manuscripts, abstracts, or news items based upon lectures,
symposia, etc., presented to Ohio physicians or those presented by Ohio physicians
to other groups. — The Editor.
338
The Ohio State Medical Journal
A Clinicopathological Conference
From The Ohio State University Hospital, Columbus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
COLIN R. MACPHERSON, M. D., President
Presented by
0 Arnold M. Weissler, M. D., Columbus, and
• Emmerich von Haam, M. D., Columbus;
Edited by Dr. von Haam.
PRESENTATION OF CASE
FIRST ADMISSION: A 32 year old woman
was admitted to University Hospital because of
swollen, painful feet and legs for several weeks.
Three years prior to admission the patient began to
drink considerable ethanol and after six months of
heavy drinking she developed ascites and swelling of
the feet. She also noted palpitations, dyspnea on
exertion, increasing fatigability, and pain and tender-
ness in both thighs. The patient denied any history
of hepatitis, hematemesis, melena, abdominal or
chest pain. The past history and the review of
systems were noncontributory.
Physical examination revealed a moderately well
developed white woman in moderate acute distress,
complaining of pain in the thighs. The blood pres-
sure was 128/90, the pulse rate 104 per minute and
regular, respiratory rate 28 per minute, and temper-
ature 100.4°F orally. Examination of the skin re-
vealed palmar erythema and scattered spider nevi.
The neck veins were not distended. The lungs were
clear to percussion and auscultation. Examination
of the heart revealed a regular tachycardia and no
apparent cardiomegaly. The second sound was split,
and one examiner noted a soft, short, Grade I/VI
systolic ejection murmur along the left sternal border.
The abdomen was enlarged with obvious ascites. The
liver was palpable 10 cm. below the right costal mar-
gin and was tender. The spleen was palpable 3-4 cm.
below the left costal margin. Two to 3 plus pitting
edema was present in both lower extremities but was
slightly greater on the right with some increased
warmth in the right leg. Homans’ sign was negative
bilaterally. Tenderness to palpation was noted in
both femoral triangles. No abnormalities were de-
scribed in the neurologic examination.
The admission laboratory studies revealed a nor-
mal white blood cell count, a hemoglobin of 12.1
Gm., and a hematocrit of 35 per cent. The urinalysis,
the blood urea nitrogen, creatinine, and blood sugar
were within normal limits. The bilirubin was 1.1
mg./lOO ml., prothrombin time 51 per cent; cephalin
Submitted January 17, 1966.
flocculation 3 plus, thymol turbidity greater than
100; bromsulphalein retention 28 per cent; choles-
terol 84 mg./lOO ml.; alkaline phosphatase 10.9
units; semm glutamic oxalacetic transaminase 89
units; lactic dehydrogenase 250 units; total protein
9.7 Gm/100 ml. (albumin 3.5, globulin 6.2), and
a diffuse homogeneous increase in gamma globulin on
paper electrophoresis. The serum sodium was 132,
potassium 4.7, chloride 108, and C02 28 mEq, /liter.
The chest x-ray revealed diffuse cardiomegaly and
no active lung disease. The upper gastrointestinal
film was reported as normal. The electrocardiogram
revealed right axis deviation, incomplete right bundle
branch block, and nonspecific ST and T wave changes.
The treatment consisted of bed rest, heat and
elevation of the legs, low sodium diet, diuretics, and
heparin. The patient lost 22 lbs. and noted con-
siderable improvement in the pain and tenderness
of her thighs. The pathological report of the liver
biopsy was, "Focal fibrosis and chronic inflamma-
tion.’’ The patient was discharged markedly im-
proved after 12 days in the hospital, on chlorothi-
azide, Aldactone® and low sodium diet.
Second Admission
The patient was readmitted three months later with
a five-day history of chills, fever, and marked short-
ness of breath, and two days prior to admission she
developed vomiting and diarrhea. Since her dis-
charge the patient had noted moderate recurrent
swelling of her abdomen, legs and feet. She had
noted marked dyspnea on exertion with shortness
of breath at rest and two-pillow orthopnea but had
had no episodes of paroxysmal nocturnal dyspnea.
The physical examination revealed an acutely ill
white woman who was lethargic and confused. The
for April , 1966
339
blood pressure was 80/50, the pulse rate 105 per
minute and regular, respiratory rate 20/min., and
temperature 103° rectally. The neck veins were
markedly distended with prominent A waves. Scat-
tered inspiratory rales were heard throughout the lung
fields. Examination of the heart revealed a regular
tachycardia. The point of maximum impulse was 3
cm. outside the midclavicular line; a definite paraster-
nal lift was present. A Grade II/ VI rumbling mid-
diastolic murmur without opening snap was heard
at the apex. Slightly increased splitting of the second
sound was noted with a definite increase in the pul-
monary component. Several examiners described a
right ventricular gallop. Ascites was present, and
the liver was palpable 10 cm. below the right costal
margin and was tender. The spleen was palpable
3 cm. below the left costal margin. Two plus pitting
pretibial edema was noted. No signs of phlebitis,
clubbing of the fingers, or cyanosis were present.
Neurologic examination revealed only lethargy and
confusion.
Laboratory studies revealed a hemoglobin of 11.4
Gm., a hematocrit of 36 per cent and a white blood
cell count of 12,000 with a normal differential count.
The urinalysis showed 320 mg. of protein per 100
ml. Serum electrolyte determinations revealed a
sodium of 120, a potassium of 6.0, chlorides of 95,
and a C02 of 12 mEq. /liter. The serum bilirubin
was 0.8 mg. The prothrombin time was 18.9 per cent.
Serum proteins again revealed a reversal of the al-
bumin/globulin ratio with a diffuse increase in
gamma globulin on electrophoresis. Cultures of the
urine, spinal fluid, blood, sputum, and vagina re-
vealed no pathogens. Blood gas studies revealed a
pH of 7.2; pCOo of 20.1 mm. Hg.; 02 saturation
96.2 per cent (patient on nasal oxygen at time of
determination). She had a red blood cell volume
of 1,950 ml. (theoretical 1,775 ml.), a plasma vol-
ume of 3,625 ml. (theoretical 2,425 ml.), and the
total blood volume was 5,575 ml. (theoretical 4,200
ml.).
Posterior - anterior and left lateral chest films
showed cardiomegaly without specific chamber en-
largement and a prominent pulmonary artery. The
electrocardiogram revealed a wide P wave in leads
II, III, AVF, and a right intraventricular conduc-
tion defect.
The patient presented multiple problems consist-
ing of severe hypotension, oliguria, electrolyte im-
balance, sepsis, and congestive heart failure. She
was initially started on treatment with Chloromycetin
and penicillin for possible sepsis, and Aramine® was
started to maintain her blood pressure. Phlebotomy
was done with some improvement in her dyspnea.
Digitalis therapy and fluid restriction were initiated.
Because of increasing azotemia and severe electro-
lyte imbalance, peritoneal dialysis was begun on the
third hospital day and after 20 exchanges the elec-
trolyte abnormalities had corrected and 5 liters of
excess fluid had been removed. On the second and
fifth hospital days the patient had episodes of hem-
optysis although chest x-rays revealed no change.
After the peritoneal dialysis the patient’s renal func-
tion improved with increased output of urine and
drop in creatinine and blood urea. However, she
continued to be febrile and hypotensive and finally
required Levophed® to maintain blood pressure. Cor-
ticosteroid therapy was started in an attempt to help
stabilize her blood pressure. On the eighth hospital
day the patient developed ventricular tachycardia fol-
lowed by cardiac arrest on the ninth hospital day.
CLINICAL DISCUSSION
Dr. Weissler: To begin with, I find that this
is a very difficult case in that throughout this protocol
we are unable to detect any specific signs of the dis-
ease that killed this patient, and I really wonder
whether Dr. von Haam will be able to tell us why
she died.
Our patient was a 32 year old alcoholic female
who entered the hospital with signs of cirrhosis and
portal hypertension. She had in addition pain in
the thighs which was unexplained throughout her
hospital course. Although the clinicians realized that
she had cirrhosis with portal hypertension, and her
cholesterol means rather severe liver disease, one can
detect certain important misconceptions concerning
her heart disease. We are told that there was no
apparent cardiomegaly and that her neck veins were
not distended, yet we are told also that she had cardi-
omegaly on her chest x-ray. On her x-rays, it’s
quite apparent that this patient had a distended su-
perior vena cava at the time of her first admission.
Her electrocardiogram suggested right atrial disease.
Despite these clues her heart disease was not pursued
on her first admission. She diuresed, improved, and
was discharged.
After three months she came back with acute
dyspnea and a recent febrile illness with chills, vomit-
ing, and diarrhea. On physical examination she had
tachycardia and hypotension. Her neck veins were
noted to be markedly distended, and there was a large
A-wave. She had cardiomegaly and a diastolic rumble
without an opening snap. She presented clearly signs
of pulmonary hypertension. She had a right ventricu-
lar gallop and signs of portal hypertension with sple-
nomegaly as well as hepatomegaly. There are several
complicating factors that became clearly apparent be-
fore this patient died. She had proteinuria and aci-
dosis with uremia. We really have very poor evidence
of the nature of any renal disease that might have
caused these, and apparently her urine did not reflect
anything dramatic other than the proteinuria.
Her doctors were most impressed with the fact
that this woman had sepsis and they looked for bac-
teria and were unable to find them in the numerous
places from which cultures were taken. There was
no apparent decrease in her red blood cell or plasma
340
The Ohio State Medical Journal
volume, and we cannot explain her hypotension by
any blood loss or diminution in blood volume. Her
final hospital course was characterized by persisting
hypotension, oliguria, congestive heart failure, sepsis.
She became acutely uremic and a peritoneal dialysis
was done with quite good improvement of her uremia
and electrolyte imbalance. Prior to her death she
developed hemoptysis followed by ventricular tachy-
cardia and cardiac arrest.
I have searched through the protocol and really
have found no consistent theme that I could use for
a definite diagnosis. I could suspect many disease
processes but I am unable to pick out one that con-
sistently runs through the entire protocol. So I
would like at this time to turn to the two kinds of
information on which the cardiologist must rely
when he is not at the bedside of the patient — the
EKG and the x-ray. I think we can say from her
EKG that she had right atrial hypertrophy and prob-
ably right ventricular hypertrophy. So we have a
woman who came in initially with liver cirrhosis, who
developed the picture of obvious heart failure with
the right side of her circulation as the primary site
of her heart disease. At this point I must turn to
Dr. Dunbar to help me with the recognition of the
abnormalities in her heart and lungs.
Radiologist’s Discussion
Dr. Dunbar: Her heart was definitely enlarged
with some localized prominence of the pulmonary
artery and some localized enlargement of the right
ventricle. I would say that the initial film showed
some increased vascularity of her lung fields but I
don’t think it is passive congestion. Since her pul-
monary artery is big, I think immediately of mitral
stenosis. However, her barium swallow showed no
evidence of left atrial enlargement at all, which
leaves me without any evidence of mitral valvular
disease. The only real objective finding that I have
is right-sided cardiac enlargement without passive pul-
monary congestion. I therefore must think of vascu-
lar obstructions in the lung parenchyma. The cause
of this would be either chronic lung disease or chronic
arterial disease. Since I can’t make a diagnosis of
sarcoid, pulmonary fibrosis, scleroderma, or em-
physema, I am rather stuck with arterial disease in the
lungs. I must say that I cannot rule out stenosis of
the pulmonary valve. All in all, I would like to
call this a right heart enlargement due to capillary or
precapillary obstruction within the lung.
Pulmonary Vasculitis
Dr. Weissler: Dr. Dunbar then extends our
concept of her disease from one which appears to be
affecting the right ventricle in addition to the portal
hepatic circulation to one located somewhere in the
pulmonary vascular tree. He tells us that the periph-
eral lung fields look oligemic either because of
a very low cardiac output or because of something
involving the small blood vessels of the lung. What
do you think about the pericardium, John? I for-
got to mention that.
Dr. Dunbar : It’s not a small heart. Certainly a
constrictive pericarditis will make clear lung fields.
I don’t see calcium and I have no reason to think that
there is pericardial disease. I don’t think there is
pericardial fluid.
Primary Heart Disease?
Dr. Weissler: Let’s see if we can decipher fur-
ther what may be the problem. Here is a 32 year
old female with heart disease. It is unlikely that
this disease is arteriosclerotic or hypertensive heart dis-
ease. Could this be rheumatic heart disease? Silent
mitral stenosis is a very important diagnostic rule-out
in a young female with pulmonary hypertension. By
silent mitral stenosis we mean true mitral stenosis
that is not reflected by the classic signs. Often this
occurs in a thickly calcified mitral valve where there
is extreme pulmonary hypertension and the patient
looks as though he has primary problems in the
pulmonary vascular tree. However, the prime indi-
cation for this condition is an enlarged left atrium,
which was not present in this case. Could the pa-
tient have congenital heart disease? A silent inter-
atrial septal defect may present a problem of conges-
tive heart failure of unknown etiology, but in this
disease cyanosis is usually noticeable at the time the
patient comes to you and I think I’ll have to rule out
that one.
Primary Pulmonary Disease?
Could this woman have had a primary pulmonary
process? I think Dr. Dunbar assures us, and so
does her history, that she did not have primary
parenchymal lung disease of the infectious type, but
she could have had primary or secondary disease of
the small blood vessels in her lungs. We are told
of the pain in the thighs, and she actually had hem-
optysis. Therefore the possibility that she had
pulmonary hypertension secondary to multiple small
pulmonary emboli is real. She also could have pri-
mary pulmonary hypertension, which is a disease of
young females that develops generally over a period
of two to four years.
Finally, could she have had primary myocardial dis-
ease? I am sure most of us thought of alcoholic
myocardial myopathy. However, she had too much
right-sided heart disease to blame it all on the myo-
cardium. So I’ll accept small blood vessel disease
in the lung, and I hope that perhaps the pathologist
can show us a primary site for her pulmonary emboli
that complicated this woman’s cirrhosis, together with
a primary myocardiopathy due to alcoholism.
General Clinical Discussion
Dr. Atwell: Do I understand that your diag-
nosis is cirrhosis of the liver . . .?
Dr. Weissler: Accentuated markedly by right-
sided heart failure.
for April, 1966
341
Dr. Atwell: You don’t think she had cardiac
cirrhosis ?
Dr. Weissler: Well, that’s a hard one. I think
that she had primary cirrhosis and that central venous
congestion will be present as well.
Dr. Greenberger: In so-called cardiac cirrhosis
one may see portal to portal or portal to central scar-
ring, but true full-blown cardiac cirrhosis is much
rarer than people think. It usually develops against
a background of long-standing congestive heart fail-
ure, of much longer duration than was present in this
case.
Dr. Atwell: And your thought, Dr. Weissler,
as to her final episode with all the fever, etc. ?
Dr. Weissler: I would have to say that she was
necrosing lung tissue. I think that this woman did
have a hidden infection somewhere and the one
site that hasn’t been completely ruled out is the
kidney.
Dr. McCoy: This patient with her hypergam-
maglobulinemia and her rather nonspecific liver dis-
ease makes me think of lupoid hepatitis.
Dr. Weissler: I did not want to extend myself
too much.
Dr. Wooley: On what basis are you excluding
a diagnosis of subacute bacterial endocarditis since
you are looking for a source whereby you can get
emboli to the lungs ? Couldn’t she have had a right-
sided endocarditis?
Dr. Weissler: In spite of her negative blood
cultures, right-sided SBE is a very distinct possibility.
Dr. Perkins: Was atrial myxoma one of the
things that you decided not to comment on?
Dr. Weissler: Well, no; actually, I don’t think
of atrial myxoma here. I am looking for an explana-
tion of the protocol, and I think the best explanation
is still a small blood vessel disease in the lung lead-
ing to right-sided heart failure. Perhaps the small
blood vessel disease in the lung is reflecting some
small blood vessel disease throughout the body, and
she does have cirrhosis in addition.
Dr. Atwell: Dr. von Haam, are you going to
tell us the answer?
Dr. von Haam: This was really an unusually
complicated case and I do not think the final answer
can be irrevocably and undeniably made.
CLINICAL DIAGNOSIS
1. Nutritional cirrhosis of the liver.
2. Chronic alcoholic myocardiopathy.
3. Pulmonary hypertension due to small vessel
disease.
PATHOLOGICAL DIAGNOSIS
1. Chronic idiopathic pulmonary hypertension.
2. Chronic myocardiopathy, type undetermined.
3. Cirrhosis of the liver (infectious?).
DISCUSSION OF PATHOLOGY
Dr. von Haam: The body was well developed
and moderately well nourished and showed slight
cyanosis of the lips and nail beds. The heart was
moderately enlarged and weighed 440 Gm.; most of
the enlargement was due to hypertrophy of the myo-
cardium of the right ventricle, which was half as
thick as that of the left ventricle. The pulmonary
artery appeared moderately dilated and showed patchy
atheromatous changes. Her lungs weighed 250 and
350 Gm. and appeared perfectly normal. Her spleen
was firm and moderately enlarged. Her liver weigh-
ed 2150 Gm. and had a nodular surface. No vari-
cosities were noted in the esophagus. Her kidneys
were moderately enlarged but were smooth. There
was gross evidence of endometriosis in both ovaries.
Her brain was small and weighed only 1000 Gm.
The microscopic examination of the heart con-
firmed the marked hypertrophy of the right ventricle.
However, many of the heart muscle fibers were sepa-
rated by edematous fibrous tissue, indicating a degen-
erative process compatible with thiamine deficiency
or myocardial ischemia. This degenerative process
was not as marked in the left ventricle. Her lungs
showed definite arteriosclerosis of the large and me-
dium sized pulmonary vessels. The small vessels
showed occlusion of the lumen with recanalization.
The adventitia of many vessels showed inflammatory
changes suggesting the presence of some type of
vasculitis. There were also present small foci of
hemosiderosis as found in Goodpasture’s syndrome
and evidence of small hemorrhages which had broken
into small bronchi.
The microscopic sections of the spleen showed
perivascular adventitial fibrosis in the form of "onion
rings,” which we usually see in lupus erythematosus.
The liver showed a rather irregular pattern of cirrhosis
with many perfectly normal liver lobules. There
were some liver cells which were enlarged and pyk-
notic, compatible with hepatitis. A few vessels in
the pancreas also showed evidence of a nonspecific
periarteritis rich in plasma cells and lymphocytes.
Sections of the kidneys showed only focal areas of
pyelonephritis with evidence of heavy proteinuria.
There were no changes suggestive of lupus or glomer-
ulonephritis. The striated muscle showed degener-
ative phenomena compatible with Zenker’s degenera-
tion. Her brain also showed evidence of small vessel
disease with small hyaline thrombi and focal gliosis.
She also had the chronic granulomatous ependymitis
sometimes seen in Wernicke’s disease. The meninges
were not involved.
To put the entire picture together and relate it to
her hypergammaglobulinemia, I would suggest that
the patient suffered from small vessel disease, or a
forme fruste of lupus, which belongs in the group of
342
The Ohio State Medical Journal
collagen diseases. Her small vessel lesions were lo-
cated primarily in the lungs, producing a picture
identical to that seen in primary idiopathic pulmonary
hypertension. In addition, the degenerative changes
in her myocardium fulfill some, but not all, criteria
of alcoholic myocardiopathy. I believe that her liver
cirrhosis was not nutritional in origin but can be ex-
plained either on an infectious or vascular basis.
The vessel changes in the spleen and pancreas also
are suggestive of some collagen disorder which for
some unexplained reason had spared her kidneys.
General Discussion
Dr. Atwell: Dr. Weissler, do you have any
comments ?
Dr. Weissler: I worry about the fact that Dr.
von Haam showed us one onion-skin vessel in the
spleen and didn’t show us any diseased small blood
vessels in the liver to corroborate his impression of
lupus hepatitis.
Dr. von Haam: With regard to the liver, I
was really not impressed. I always was holding out
for infectious hepatitis, but when I heard lupus
mentioned in the discussion, suddenly a bell rang.
Dr. Weissler: You find some solitary vessel
disease in the periphery and you are trying to make
this lung disease part of a general vessel disease.
I think she had a primary blood vessel disease in the
lung. Nowadays cardiologists are very loath to diag-
nose primary idiopathic pulmonary hypertension.
This is why I called it small blood vessel disease of
the lungs because I am still not sure that this disease
isn’t due to showers of tiny emboli in the small blood
vessels which over a period of months or years re-
solved and recurred. So I don’t think that finding a
sparse vascular disease in any organ system desig-
nates this case a disease of the vessels generally. I
think this may be a secondary phenomenon.
Dr. von Haam : How do you explain her hyper-
gammaglobulinemia and her liver disease?
Dr. Greenberger: I think the liver as we saw it
and the liver function tests indicate that this woman
had severe chronic liver disease despite the involve-
ment of some parts of her liver and the sparing of
other parts. I think this is consistent with what they
call lupoid hepatitis.
Dr. Perkins: I woud just like to mention that
pulmonary vasculitis has been described in patients
with chronic liver disease. This was reported in
Circulation four or five years ago in a very succinct
editorial. Some people thought it was due to dis-
turbance in the protein metabolism, but I think this
has been denied.
Dr. von Haam: Yes, experimentally it has been
denied.
Dr. Perkins: But I still think we should look
for pulmonary vascular disease in patients with cir-
rhosis and other liver lesions.
Dr. Weissler: If this woman had a small blood
vessel disease in the lungs, this would be compatible
with the diagnosis of primary pulmonary hyperten-
sion. This much chronic pulmonary hypertension
with right ventricular failure, tremendous right ven-
tricular hypertrophy, without small blood vessel dis-
ease in the heart, is not the kind of small blood vessel
disease one gets in collagenosis. This is my point.
STEROIDS AND SHOCK. — Cardiac output and intravascular pressure were
measured before and after large intravenous doses of hydrocortisone, methyl-
prednisolone, prednisolone, or dexamethasone in nine normal subjects and nine
patients in shock. The glucocorticoids caused a highly significant increase in
cardiac output, usually beginning within one-half hour and continuing through-
out the 90-minute study period. Control studies in nine unselected patients with
various diagnoses showed that the changes in cardiac output produced by the
steroids were not due to spontaneous variations or to the experimental conditions.
After glucocorticoid administration, intraarterial pressure was not elevated despite
the increased cardiac output, indicating that peripheral arterial resistance was de-
creased. Central venous pressure was usually unchanged by steroid administra-
tion. The increase in cardiac output and decrease in peripheral resistance induced
by glucocorticoids are opposite to the hemodynamic fault that occurs in shock
due to hypovolemia, myocardial injury, or gram-negative endotoxin, namely, re-
duced cardiac output and increased vasoconstriction. The present study did
not define the distribution of the steroid-induced increase in systemic blood flow
to the regional circuits. Whether the effects of glucocorticoids on systemic blood
flow lead to improvement in perfusion of vital tissues and a reduction in oxygen
debt is the subject of a future study. — Abstract: M. P. Sambhi, Max H. Weil,
M. D., and V. N. Udhoji, Los Angeles: Circulation, 31:523-530, (April) 1965.
for April, 1966
343
In Cardiovascular
Increased
intrathoracic
and
intra-abdominal
pressure
from
straining
METAMUCIL'
brand of psyllium hydrophilic mucilloid
Metamucil Powder: 4, 8 and 16-ounce
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The Ohio State Medical Journal
STfUtOUttCCft#
THE OFFICIAL PROGRAM
for the : <
1966 ANNUAL MEETING
of your
OHIO STATE MEDICAL ASSOCIATION
M i ■
m1 hit
Cleveland
May 24*28
The 118th Annual Meeting
is dedicated to
Herbert M. Platter, M. D.
who retired January 1, 1966, after forty-
eight years of Service to the Medical Profes-
sion as Secretary of the Ohio State Medical
Board. The meeting itself has a . . . NEW
LOOK ... a new schedule, new features,
an expanded scientific exhibit and others.
Highlights of the meeting and a brief Daily
Schedule follow on pages 350-353- Consult
these daily schedules for time and place of
event; then, for details as to subjects, speak-
ers, etc., turn to the chronological program
beginning on page 354.
*
*
(All Times are Daylight Saving Time)
Time and Place: Sessions of the House of Dele-
gates: Tuesday, May 24, beginning with a dinner
at 6:00 P. m. and Friday, May 27, at 9:00 A. M./
both sessions at the Sheraton-Cleveland Hotel,
Cleveland. Resolutions Committees : These will
meet on Wednesday, May 25, beginning at 9:00
a. M. at the Sheraton-Cleveland Hotel and will con-
tinue to meet until their business is completed.
Exhibits will open at 10:00 A. M., Wednesday,
May 25, at the Sheraton-Cleveland Hotel and the
first scientific session will begin at 1:30 P. M.,
Wednesday, May 25, in the Cleveland Room, also
at the Sheraton-Cleveland Hotel.
Registration: Headquarters for Registration is the
Grand Ballroom Foyer, Mezzanine Floor, Shera-
ton-Cleveland Hotel. It will open at 10:00 a. m.
on Wednesday, May 25, and will remain open
until 5:30 p. M. Registration on Thursday, May
26, and Friday, May 27, will be open from 9:00
A. M. to 5:30 P. M. and on Saturday, May 28, from
9:00 A. M. until 12:00 noon. Special provisions
will be made to register persons attending sessions
of the House of Delegates and its Resolutions
Committee meetings.
Those eligible to register are members of the
Ohio State Medical Association (who should
present 1966 Membership Cards at time of regis-
tration) ; physicians from other states who are
members of their respective state medical associa-
tions; residents, interns and medical students;
nurses, health workers and others who are pre-
sented as guests at Registration Headquarters by
members. Letters of introduction on members’
stationery also will be honored at Registration
Headquarters. The Woman’s Auxiliary will pro-
vide registration for its members and others who
are eligible to attend Auxiliary sessions in the
Sheraton-Cleveland Hotel, Main Lobby West.
Scientific, Health Education and Technical Ex-
hibits : The Scientific Exhibit will be on the
Grand Ballroom Balcony; the Health Education
Exhibit in the Exhibit Hall and the Technical Ex-
hibit in the Grand Ballroom and Grand Ballroom
Foyer. All exhibits will be open from 10:00 a. m.
to 5:30 P. m. on Wednesday, May 25; from 9:00
to 5:30 on Thursday, May 26, and from 9:00 to
3:00 on Friday, May 27. Ample recesses have
been scheduled in the program to allow frequent
visits to the exhibits. All participants are urged
to visit these exhibits.
ALL SCIENTIFIC and BUSINESS
SESSIONS and ALL EXHIBITS
UNDER ONE ROOF AT . . .
SHERATON - CLEVELAND HOTEL
Emergency Telephone Service: The Yellow Pages
Division of the Ohio Bell Telephone Company
will maintain an information booth and paging
service during the meeting. This booth will be
located immediately adjacent to OSMA Registra-
tion Headquarters in the Grand Ballroom Foyer
and will be open daily while meetings are in ses-
sion. Names of physicians called will be placed
on a bulletin board at the booth and in the General
Session meeting room. Two telephone numbers
will be used:
For Cleveland Physicians 2 31*3500
For all others 861-8000
348
The Ohio State Medical Journal
Scientific Program: Sessions begin on Wednesday,
May 25, at 1:30 p.m. with a General Session
Program on "Problems in Marriage.” Scientific
sessions will continue through Saturday, May 28,
at 12 noon. All will be held at the Sheraton-
Cleveland Hotel. Consult the detailed program
for a complete listing and specific information re-
garding program content, speakers, etc.
President’s Reception: This principal social event
of the Annual Meeting is scheduled on Friday,
May 27, beginning at 6:00 o’clock in the Gold
and Whitehall Rooms, Sheraton-Cleveland Hotel.
There will be no dinner; merely an informal gath-
ering with refreshments. Dress is optional for
members and their guests. Dancing with music
by the Bob Lorence Orchestra and Salli Lynn,
vocalist, will be provided.
The Woman’s Auxiliary: The Woman’s Auxiliary
to the Association will meet the same week as the
OSMA meeting with headquarters also at the
Sheraton-Cleveland Hotel. All ladies eligible for
membership in the Auxiliary are invited to at-
tend sessions and special events. The Auxiliary
is providing registration facilities at the Sheraton-
Cleveland Hotel, Main Lobby West.
Specialty Societies: A number of Specialty Societies
are cooperating with the Association in various
phases of the program, and several are holding
meetings or special events during the week. These
include the following:
Ohio Psychiatric Association
Ohio Ophthalmological Society
Ohio Committee on Trauma,
American College of Surgeons
Ohio Society of Internal Medicine
Ohio State Surgical Association
Ohio Chapter, American Academy of Pediatrics
Ohio Ear, Nose and Throat Society
Ohio Society of Physical Medicine
and Rehabilitation
Ohio Orthopaedic Society
Ohio Chapter,
American College of Chest Physicians
Ohio Society of Pathologists
Ohio Neurosurgical Society
Consult the detailed program for specific in-
formation regarding these specialty society activities.
THURSDAY, MAY 26
General Session
(Gold Room, Mezzanine Floor)
1:30 P. m.
"Medicare’s Rules and Regulations and Their Effect
on the Practice of Medicine"
CHARLES L. HUDSON, M. D.
Cleveland, Ohio
President-Elect, American Medical Association
FRIDAY, MAY 27
General Session
(Gold Room, Mezzanine Floor)
1 :30 p. m.
"Care of the Patient: 1966”
EDWARD R. ANNIS, M. D.
Miami, Florida
Past President, American Medical Association
ONE OF THE NATION’S FINEST AND LARGEST POSTGRADUATE MEDICAL ASSEMBLIES
for April, 1966
349
SUMMARY OF
ALL TIMES ALL EVENTS AT SHERATON-
DAYLIGHT CLEVELAND HOTEL UNLESS
SAVING OTHERWISE INDICATED
TIME
TUESDAY, MAY 24
(See page 354 for detailed schedule)
5 :()0 p. M,
OSMA House of Delegates
Registration
(Gold Room Assembly, Mezzanine Floor)
6:00 P, M,
OSMA House of Delegates
Complimentary Dinner
(Whitehall Room, Mezzanine Floor)
7:30 P. M.
OSMA House of Delegates
First Business Session
(Gold Room, Mezzanine Floor)
Herbert Morris Platter, M. D., Secretary of the Ohio
State Medical Board for 48 years prior to his re-
tirement on January 1, 1966, and to whom the
entire 1966 Annual Meeting is dedicated, will be
honored. See detailed program for specific in-
formation about ceremonies.
WEDNESDAY, MAY 25
(See pages 356 to 358 for detailed schedule)
9 :00 A. M.
Resolutions Committee No. 1
(Whitehall Room, Mezzanine Floor)
Resolutions Committee No. 2
(Empire Room, Parlor Floor)
Resolutions Committee No. 3
(Terminal Room, Parlor Floor)
Committee on President’s Address
(Teepee Room, First Floor)
Registration for Exhibitors Opens
(Grand Ballroom Foyer, Mezzanine Floor)
WEDNESDAY (Contd.)
4:00 p. M.
Organizational Meeting of Hospital
Directors of Medical Education
(Mohawk Room, First Floor)
THURSDAY, MAY 26
(See pages 359 to 362 for detailed schedule)
8:30 A. M.
Film:
"A New Look at Tetanus Prophylaxis”
(Gold Room, Mezzanine Floor)
9:00 A, M,
General Session
"Athletic Injuries”
(Gold Room, Mezzanine Floor)
9:00 A, M,
OSMA Registration Opens
(Grand Ballroom Foyer, Mezzanine Floor)
Scientific, Health-Education and
Technical Exhibits Open
(Grand Ballroom and Ballroom Balcony)
9:00 A. M.
Ohio Health Commissioners’ Institute
SECOND SESSION
(Lewis Room, Lobby Floor)
9:00 A. M.
Psychiatry
(Grand Ballroom — Terrace, Parlor Floor)
WEDNESDAY (Contd.)
10:00 A. M.
OSMA Registration Opens
(Grand Ballroom Foyer, Mezzanine Floor)
Scientific, Health-Education and
Technical Exhibits Open
(Grand Ballroom and Ballroom Balcony)
11 :30 A, M.
Ohio Medical Political Action
Committee and AMPAC
Luncheon
(Gold Room, Mezzanine Floor)
1:00 P. M.
Ohio Health Commissioners’
Meeting with Director
(Grand Ballroom — Terrace, Parlor Floor)
1 :30 P. M.
General Session
"Problems in Marriage”
(Cleveland Room, Lobby Floor)
2:00 P. M.
Ohio Health Commissioners’ Institute
FIRST SESSION
(Grand Ballroom — Terrace, Parlor Floor)
2:30 P. M.
Ophthalmology
(Lewis Room, Lobby Floor)
3:00 P. M.
Intermission for Tour of Exhibits
3:30 p. M.
General Session
"What I Do About It”
(Gold Room, Mezzanine Floor)
9:30 a. M.
Executive Session of Resolutions
COMMITTEE NO. 1
(Wigwam Room, First Floor)
for April, 1966
351
THURSDAY (Contd.)
Executive Session of Resolutions
COMMITTEE No. 2
(Mohawk Room, First Floor)
Executive Session of Resolutions
COMMITTEE NO. 3
(Chieftain Room, First Floor)
10:30 A. m.
Intermission for Tour of Exhibits
1 1 :00 A. M.
Continuation of General Session
and Scientific Section Meetings
1:30 P. M.
GENERAL SESSION
'Medicare’s Rules and Regulations and Their
Effect on the Practice of Medicine” —
Charles L. Hudson, M. D., President-Elect
American Medical Association
(Gold Room, Mezzanine Floor)
2:30 P. M.
intermission for Tour of Exhibits
3 :00 P. m.
Anesthesiology
(Terminal Room, Parlor Floor)
Internal Medicine
(Gold Room, Mezzanine Floor)
Psychiatry
(Grand Ballroom — Terrace, Parlor Floor)
Ohio State Surgical Association
(Whitehall Room, Mezzanine Floor)
THURSDAY (Contd.)
Ohio Health Commissioners' Institute
THIRD SESSION
(Lewis Room, Lobby Floor)
Ohio Academy of Medical History
(Erie Room. Parlor Floor)
FRIDAY, MAY 27
(See pages 363 to 369 for detailed schedule)
7 :30 a. m.
Woman's Auxiliary Breakfast
(Cleveland Room, Lobby Floor)
8:30 a. M.
Ohio Health Commissioners' Institute
FOURTH SESSION
(Lewis Room, Lobby Floor)
9:00 a. M.
OSMA Registration Opens
(Grand Ballroom Foyer, Mezzanine Floor)
Scientific, Health-Education and
Technical Exhibits Open
(Grand Ballroom and Ballroom Balcony)
Medical Booth Seminars
(Exhibit Hall Area)
Starting time: 9:00, 10:00 and 11:00 A. m.
Booth No. 1 — "Conditioning, Prevention and
First Aid for Athletic Injuries”
Booth No. 3 — "Bedside Pulmonary Function
Testing”
Booth No. 5 — "Physical Medicine in the Home”
Starting time: 9:30, 10:30 and 11:30 a. m.
Booth No. 2 — "Resuscitation”
Booth No. 4 — "Lacerations”
Booth No. 6 — "Fractures”
352
The Ohio State Medical Journal
FRIDAY ( Contd. )
9:00 a. M.
OSMA House of Delegates
FINAL SESSION
(Gold Room, Mezzanine Floor)
11:00 a. M.
Ohio State Surgical Association
Business Meeting and Installation of Officers
(Terminal Room, Parlor Floor)
1:30 p. M.
General Session
"Care of the Patient: 1966” — Edward R. Annis,
M. D., Past President, American Medical Association
(Gold Room, Mezzanine Floor)
2:30 P. M.
Orthopaedic Surgery
(Lewis Room, Lobby Floor)
2:30 P. M.
Intermission for Tour of Exhibits
3:00 P. M.
General Practice; Obstetrics and
Gynecology and Pediatrics
(Gold Room, Mezzanine Floor)
EAR, NOSE AND THROAT
(Terminal Room, Parlor Floor)
Occupational Medicine
(Erie Room, Parlor Floor)
Physical Medicine and Rehabilitation
(Navajo Room, First Floor)
Radiology and Chest Physicians
(Whitehall Room, Mezzanine Floor)
FRIDAY (Contd.)
Pathology
(Cleveland Room, Lobby Floor)
Neurosurgery
(Empire Room, Parlor Floor)
3:00 P. M.
All Exhibits Close
6:00 p, M.
OSMA President’s Reception
(Whitehall and Gold Rooms, Mezzanine Floor)
SATURDAY, MAY 28
(See page 370 for detailed program)
9:00 A, M.
OSMA Registration Opens
(Grand Ballroom Foyer, Mezzanine Floor)
9:00 a. M.
Conference on Laboratory Medicine
(Gold Room, Mezzanine Floor)
12:00 Noon
Organizational Meeting Luncheon,
Ohio Association of Blood Banks
(Gold Room, Mezzanine Floor)
9:00 a. m. - 12:00 Noon
Clinical Conference
Ohio Chapter, American
Academy of Pediatrics
(Babies and Childrens Hospital)
12:00 Noon
OSMA Annual Meeting Closes
12:00 to 12:30 P. M.
Ohio Chapter, American Academy
of Pediatrics Annual Meeting
(Babies and Childrens Hospital)
for April, 1966
353
TUESDAY, MAY 24
5:00 p. m. (d. s. t.)
House of Delegates
Registration
(Gold Room Assembly, Mezzanine Floor)
6:00 P. .M (d. s. t.)
House of Delegates
Complimentary Dinner for Delegates,
Alternates, and OSMA Council
(Whitehall Room, Mezzanine Floor)
7:30 p. m. (d. s. t.)
House of Delegates
First Business Session
(Gold Room, Mezzanine Floor)
Invocation — The Reverend Frederick T. Schumacher,
The First Church in Oberlin, Oberlin.
Welcome by David Fishman, M. D., Cleveland, Acad-
emy of Medicine of Cleveland and Cuyahoga
County.
Introduction of President Henry A. Crawford, M. D.,
Cleveland.
Roll Call of Delegates.
Consideration of the Minutes of the last Annual
Meeting (July, 1965 issue of The Journal).
Introduction of honored guests.
Presentation of AMA-ERF checks to representatives
of the University of Cincinnati College of Medi-
cine; Western Reserve University School of Medi-
cine; and Ohio State University College of Medicine
— Robert S. Martin, M. D., Chairman, Ohio Com-
mittee on AMA-ERF.
Presentation of plaques honoring physicians serving
with Project Viet Nam — Dr. Crawford.
Ceremonies honoring Herbert Morris Platter, M. D.,
Secretary of the Ohio State Medical Board for 48
years, to whom the entire 1966 Annual Meeting
is dedicated. Participating in the ceremonies will
be: Dr. Henry A. Crawford, President of the
Ohio State Medical Association, Lt. Governor John
W. Brown and others.
Report by the President of the Woman’s Auxiliary —
Mrs. Herbert F. VanEpps, Dover.
Appointment of Reference Committees by the Presi-
dent:
Credentials
President’s Address
Resolutions
Tellers and Judges of Election
Nomination and election of Committee on Nomina-
tions: (Nominations from the floor. One represen-
tative (delegate) from each Councilor District.
The Committee shall report to the Final Session,
Friday, May 27, 9:00 A. Mv its recommendations
in the form of a ticket containing nominees for
offices to be filled at this meeting as required under
the Constitution and Bylaws.)
Introduction of Resolutions:
(Resolutions must be introduced at this session
of the House of Delegates, referred to the Ref-
erence Committees on Resolutions, and reported
back to the House of Delegates at the Friday
morning session before any action can be taken.
All resolutions must be typewritten and sub-
mitted in triplicate.)
Announcement of meeting places of Reference Com-
mittees.
Miscellaneous business.
Announcements of Annual Meeting events.
Recess.
DELEGATES AND ALTERNATES
Counties Delegates
Alternates
Counties Delegates Alternates
FIRST DISTRICT
SECOND DISTRICT
ADAMS
BROWN
.Francis L. Stevens
John R. Donohoo
Juan Young
BUTLER
.John H. Varney
Paul N. Ivins
James L. Sawyer
James A. Stewart
CLERMONT..
Carl A. Minning
Richard K. Lancaster
CLINTON. .....
Edmond K. Yantes
H. Richard Bath
HAMILTON .
Ralph S. Grace
Garfield L. Suder
Howard F. C. Pfister
Joseph E. Ghory
John J. Cranley, Jr.
Joseph G. Crotty
Clyde S. Roof
Daniel V. Jones
Robert M. Woolford
Harry K. Hines
Carl W. Koehler
Charles A. Sebastian
Frank P. Cleveland
Bruce G. MacMillan
Taylor W. Barker
Louis C. Buente
Eli Rubenstein
Kenneth A. J. Frederick
William C. Ahlering
Frederick Brockmeier
Robert S. Heidt
Warner A. Peck
Joseph J. Podesta
Glenn W. Pfister, Jr.
HIGHLAND..
J. Martin Byers
Clifford G. Foor
WARREN.
Thomas E. Fox
Orville L. Layman
..Isador Miller
Victor R. Frederick
..Ernest H. Winterhoff
David D. Smith
Charles J. Townsend
Max H. Gerke
. Maurice M. Kane
V. Ray Boli
Roger C. Henderson
Paul C. Vernier
Dale A. Hudson
Jerry L. Hammon
..Sylvan L. Weinberg
J. Richard Strawsburg
James G. Tye
Robert A. Bruce
William M. Porter
Kenneth D. Am
M. V. Lingle
Daniel E. Brannen
John Robert Brown
John H. Muehlstein
John R. Keys
. Chester J. Brian
Willard C. Clark, Jr.
George J. Schroer
Thomas W. Hunter
354
The Ohio State Medical Journal
DELEGATES AND ALTERNATES (Contd.)
Counties Delegates Alternates
THIRD DISTRICT
ALLEN Dwight L. Becker
Fred P. Berlin
AUGLAIZE Robert S. Oyer
CRAWFORD Dan-el D. Bibler
HANCOCK Donald R. Brumley
HARDIN Clarence L. Johnson
LOGAN .Ralph K. Updegraff
MARION Albert M. Mogg
MERCER - —Donald R. Fox
SENECA Walter A. Daniel
VAN WERT Edwin William Burnes
WYANDOT Donald Phillip Smith
Ronald P. Bell
John A. Glorioso
Elizabeth Y. Kuffner
Horace B. New-hard
William F. Binkley
Charles A. Browning, J r.
Paul E. Lyon
George H. Mcllroy
Emmet T. Sheeran
Edward E. White
Richard L. Garster
FOURTH DISTRICT
DEFIANCE Charles E. Jaeckle Francis M. Lenhart
FULTON .—William J. Neal Vernon L. Cotterman
HENRY Edwin C. Winzeler Homer C. Brown
LUCAS
Edmond F. Glow
William G. Henry
Edward F. Ockuly
Frederick P. Osgood
F. F. A. Rawling
Max T. Schnitker
George N. Bates
Edward L. Doermann
J. B. Sawyer
Merl B. Smith
Gordon M. Todd
R. P. Whitehead
OTTAWA V. William Wagner Cyrus R. Wood
PAULDING Doyt E. Farling
PUTNAM Milo B. Rice
SANDUSKY John G. Bushman
WILLIAMS Allen G. Jackson
Edythe C. Pritchard
James B. Overmier
Carroll D. Miller
Robert W. Dilworth
WOOD Paul F. Orr
Clarence B. Nyce
FIFTH DISTRICT
ASHTABULA Shepard A. Burroughs James G. Macaulay
CUYAHOGA
Joseph C. Avellone
James O. Barr
Joseph L. Bilton
William F. Boukalik
John H. Budd
E. Peter Coppedge
Eduard Eichner
David Fishman
William E. Forsythe
John J. Grady
Harry A. Haller
Chester R. Jablonoski
Fred R. Kelly
Vincent T. LaMaida
Christopher A. Colombi
Russell B. Crawford
Nicholas G. DePiero
John J. Gaughan
Ray W. Gifford, Jr.
Harry R. Grau
Edward O. Hahn
Charles H. Jobe
Herbert H. Johnson, Jr.
Roscoe J. Kennedy
Richard P. Levy
Frederick V. Light
Joseph P. Martin
Thomas E. Meaney
Middleton H.Lambright Hermann Menges, Jr.
L. Philip Longley Russell P. Rizzo
Lawrence J. McCormack Frederick R. Schnell
Paul A. Mielcarek
George W. Petznick
John H. Sanders
A. B. Schneider, Jr.
Frederick T. Suppes
Elden C. Weckesser
GEAUGA Simon Ohanessian
LAKE
Lawrence P. Schumake
Edward E. Siegler
Leo H. Simoson
William V. Trowbridge
Robert F. Williams
Bruce F. Andreas
...Robert A. Irvin Herbert S. Wells
Joseph W. Koelliker, Jr. Maxwell Burnham
SIXTH DISTRICT
COLUMBIANA— William S. Banfield
MAHONING Joseph V. Newsome
Charles W. Stertzbach
Leonard P. Caccamo
Jack Schreiber
PORTAGE Edward A. Webb
STARK William A. White, Jr.
Aubrey R. Furnas, Jr.
Maurice F. Lieber
Mark G. Herbst
SUMMIT James W. Parks
Francis J. Waickman
William Dorner, Jr.
Leonard V. Phillips
Thomas W. Jackson
Robert E. Yeakley
TRUMBULL Rex K. Whiteman
L. A. Loria
Leonard S. Pritchard
Hugh N. Bennett
Joseph W. Tandatnick
Robert B. McConnell
Frederick A. Friedrich
David Palmstrom
Andreas S. Ahbel
Frank O. Goodnough
Edward E. Grable
Richard V. Skibbens
James G. Roberts
Robert R. Clark
Melvin E. Farris
Uffe Trier Jensen
W. Paul Kilway, Jr.
Russell L. Platt
Raymond Ralston
Steven A. Pollis
Counties
Delegates Alternates
SEVENTH DISTRICT
BELMONT James F. Sutherland
CARROLL Samuel L. Weir
COSHOCTON Norman L. Wright
HARRISON Charles D. Evans, Jr.
JEFFERSON Sanford Press
MONROE Byron Gillespie
TUSCARAWAS ... Robert E. Rinderknecht
David M. Creamer
Carl A. Lincke
N. Harry Carpenter
Gerald E. Vorhies
Crist G. Strovilas
William E. Hudson
EIGHTH DISTRICT
ATHENS Don R. Johnson
FAIRFIELD— Jack L. Kraker
GUERNSEY James A. L. Toland
LICKING Jay Ross Wells
MORGAN Austin A. Coulson
MUSKINGUM Joseph C. Greene
NOBLE.__ Edward G. Ditch
PERRY Charles E. Bope
WASHINGTON— Kenneth E. Bennett
Herbert N. Whanger
William S. Jasper
Robert A. Ringer
R. Gilbert Mannino
Henry Bachman
Carl E. Spragg
Frederick M. Cox
Michael P. Clouse
George E. Huston
NINTH DISTRICT
GALLIA Thomas W. Morgan
HOCKING Richard C. Jones
JACKSON Clarence C. Fitzpatrick
LAWRENCE Thomas E. Miller
MEIGS Roger P. Daniels
PIKE _ Mack E. Moore
SCIOTO William M. Singleton
VINTON Richard E. Bullock
James A. Kemp
L. W. Starr
John C. MacLennan
Harry Nenni
Albert M. Shrader
Sol Asch
TENTH DISTRICT
DELAWARE ...
Adelbert R. Callander
Mary K. Kuhn
FAYETTE
. —Robert A. Heiny
Thomas J. Hancock
FRANKLIN. ...
..... Homer A. Anderson
William E. Hunt
Allen D. Puppel
Donald W. Traphagen
Robert M. Inglis
John R. Huston
Joseph A. Bonta
Charles W. Pavey
Dale R. Dickens
Thomas M. Hughes
Samuel Saslaw
Mark Louis Saylor
Charles J. Hatfield
George 0. Kress
•James C. Good
Alexander Pollack
Robert A. Heilman
Norman H. Baker
KNOX
James C. McLarnan
Henry T. Lapp
MADISON
Sol Maggied
John C. Starr
MORROW
Joseph P. Ingmire
David James Hickson
PICKAWAY.....
Jasper M. Hedges
Carlos Alvarez
ROSS
Robert E. Swank
Lewis W. Coppel
UNION
E. J. Marsh
Fred C. Callaway
ELEVENTH DISTRICT
ASHLAND— Charles H. McMullen Myrle D. Shilling
ERIE Emil J. Meckstroth Richard H. Williamson
HOLMES Adam J. Earney Owen F. Patterson
HURON— William R. Graham Earl R. McLoney
LORAIN Ben V. Myers William H. Miller
James T. Stephens Max L. Durfee
MEDINA... Richard W. Avery William G. Halley
RICHLAND Carroll E. Damron C. Karl Kuehne
Stanley L. Brody Carl M. Quick
WAYNE Albert Burney Huff Robert E. Reiheld
OFFICERS
Pres. Henry A. Crawford Treas Philip B. Hardymon
Pres.-Elect L. C. Meredith Past Pres. Robert E. Tschantz
COUNCILORS
District
First Robert E. Howard
Second Theodore L. Light
Third .. Frederick T. Merchant
Fourth Robert N. Smith
Fifth P. John Robechek
Sixth Edwin R. Westbrook
District
Seventh Benj. C. Diefenbach
Eighth Robert C. Beardsley
Ninth George N. Spears
Tenth Richard L. Fulton
Eleventh ... William R. Schultz
for April, 1966
355
WEDNESDAY, MAY 25
9:00 a, M. (d. s. t,)
House of Delegates Resolutions
Committees
RESOLUTIONS COMMITTEE NO. 1
(Whitehall Room, Mezzanine Floor)
RESOLUTIONS COMMITTEE NO. 2
(Empire Room, Parlor Floor)
RESOLUTIONS COMMITTEE NO. 3
(Terminal Room, Parlor Floor)
COMMITTEE ON PRESIDENT’S ADDRESS
(Teepee Room, First Floor)
COMMITTEE ON NOMINATIONS
(Chieftain Room, First Floor)
Any member of the Association is privileged to at-
tend these meetings.
WEDNESDAY, MAY 25
9:00 a. m. (d. s. t.)
Registration for Exhibitors Open
(Grand Ballroom Foyer, Mezzanine Floor)
WEDNESDAY, MAY 25
10:00 a. m. (d. s. t.)
OSMA Registration Opens
(Grand Ballroom Foyer, Mezzanine Floor)
10:00 A. M. (d. S. t.)
Opening of Scientific, Health
Education and Technical Exhibits
(Grand Ballroom and Ballroom Balcony)
WEDNESDAY, MAY 25
11:30 - 1:30 p. m. (d. s. t.)
Ohio Medical Political Action
Committee — American Medical
Political Action Committee Luncheon
11:30 - 12:00 Social Half-hour (Cash Bar Open)
(Gold Room Foyer, Mezzanine Floor)
12:00 - 12:45 Luncheon
(Gold Room, Mezzanine Floor)
12:45 - 12:55 Presiding Officer: Frank H. Mayfield,
M. D., Chairman, OMPAC
12:55 - 1:20 Speaker: Hoyt D. Gardner, M. D.,
Louisville, Kentucky, Member of AMPAC
Board of Directors
"Success Can Be Ours”
Tickets for this luncheon are on sale for $5.00 per
person. They may be purchased from your county
Woman’s Auxiliary legislative chairmen or by send-
ing check in the amount of $5.00 to the Ohio Medical
Political Action Committee, P. O. Box 5617, Colum-
bus, Ohio 43221.
WEDNESDAY, MAY 25
1 :30 p. m. (d. s. t.)
General Session
(Cleveland Room, Lobby Floor)
"Problems in Marriage”
Program sponsored by the Section on Psychiatry and
Neurology and Ohio Psychiatric Association; cosponsored
by all other OSMA Scientific Sections and OSMA Commit-
tee on Medicine and Religion.
Dean Loegler Dr. Lovshin
THE PARTICIPANTS
Frances K. Harding, M. D., Columbus, Assistant Pro-
fessor, Ohio State University.
The Very Reverend David Loegler, Cleveland, Dean
of Trinity Cathedral.
Leonard L. Lovshin, M. D., Cleveland, Head of De-
partment of Internal Medicine, Cleveland Clinic.
Miss Myra F. Thomas, Cleveland, District Director,
Family Service Association.
Presiding: Dr. Lovshin.
1:30 Introductory Remarks — Dr. Lovshin.
1 :40 The Clergyman’s Approach to Marriage
Problems — Dean Loegler
1 :50 Family Planning — Dr. Harding
2:00 How a Family Caseworker Approaches the
Problems in Marriage — Miss Thomas
2:10 How a Psychiatrist Approaches the Prob-
lems in Marriage
2:30 Panel Discussion.
Moderator: Dr. Lovshin.
Members of Panel:
Dr. Harding, Dean Loegler and Miss
Thomas
3 : 00 Adjournment.
6:30 p. m. (d. s. t.)
(Lewis Room, Lobby Floor)
Dinner sponsored by the Ohio Psychiatric Association
and the Cleveland Society of Neurology and Psychiatry.
356
The Ohio State Medical Journal
HELP EXTEND THE PROFESSION’S
STRONG RIGHT ARM
f£C'd'CC » • t
THE OHIO MEDICAL POLITICAL
ACTION COMMITTEE LUNCHEON
Wednesday, May 25
Gold Room
Sheraton-Cleveland Hotel
HOYT D. GARDNER, M.D.
Louisville, Kentucky
Member, Board of Directors
American Medical Political Action Committee
cvtCC <ut . , ,
"Success Can Be Ours ”
Dr. Gardner
11:30 A. M. Cash Bar
12:00 Noon Luncheon
12:45 P. M. Progress Report on OMPAC
Frank H. Mayfield, M. D.
Chairman, OMPAC Board
12:55 P. M. “Success Can Be Ours”
Dr. Gardner
1:20 P. M. Question and Answer Period
Pr; Gardner s presentation will be aimed at giving
guides to successful grass-roots political activity.
PLEASE COMPLETE THIS FORM AND FORWARD WITH CHECK TO
The Ohio Medical Political Action
Committee
P. O. Box 5617
Columbus, Ohio 43221
in payment for
ttC'nu please find check in amount of $ Tor f|(
O.M.P.A.C. luncheon, Wednesday, May 25, 1966, at the Sheraton-Cleveland Hotel.
Please send tickets to: Name
tickets for
Address.
WEDNESDAY, MAY 25
2:30 p. m. (d. s. t.)
Ophthalmology
(Lewis Room, Lobby Floor)
Program sponsored by the Section on Ophthalmology,
Ohio Ophthalmological Society and the Cleveland Ophthal-
mological Club.
THE PARTICIPANTS
James M. Andrew, M. D., Columbus, Associate Pro-
fessor of Ophthalmology, Ohio State University
College of Medicine.
Taylor Asbury, M. D., Cincinnati, Coordinator of
Teaching Program for students and residents, De-
partment of Ophthalmology, University of Cin-
cinnati.
John G. Bellows, M. D.,
Chicago, Illinois, Associ-
ate Professor of Ophthal-
mology, Northwestern
Reserve University Medi-
cal School.
Dr. Bellows
Frederick M. Kapetansky,
M. D., Columbus, Assist-
ant Professor of Oph-
thalmology, Ohio State
University College of
Medicine, Director of
Glaucoma Clinic.
Torrence A. Makley, Jr., M. D., Columbus, Profes-
sor and Chairman of the Department of Ophthal-
mology, Ohio State University.
Daniel T. Weidenthal, M. D., Cleveland Attending
Staff, St. Luke’s and Mt. Sinai Hospitals.
2:30 Current Status of Presumed Ocular Histo-
plasmosis — Dr. Asbury
3:00 Discussion.
3:05 Cryosurgery of Ocular Diseases — Dr.
Bellows
3:45 Discussion.
3:55 Glaucoma under 40 — Dr. Andrew
4:05 Glaucoma under 40 — Dr. Kapetansky
4:15 Traumatic Retinal Detachment — Dr.
Weidenthal
4:45 Discussion.
4:50 Uveitis in Children — Dr. Makley
5:00 Election of Officers for 1967.
The foregoing program was arranged under the direction
of the following: James M. Andrew, M. D., Columbus,
Chairman, Russell J. Nicholl, M. D., Cleveland, Secretary,
Section on Ophthalmology; Herbert Kesinger, M. D., San-
dusky, President, Robert H. Magnuson, M. D., Columbus,
Secretary, Ohio Ophthalmological Society.
6:30 p. m. (d. s. t.)
Cleveland Ophthalmological Club
(Wade Park Manor)
Cocktails and dinner. Guest speaker: John G. Bel-
lows, M. D., Chicago; "Life History of the Lens.”
Tickets at $10 each may be secured at the door.
WEDNESDAY, MAY 25
3:30 p. m. (d. s. t.)
General Session
(Gold Room, Mezzanine Floor)
"What I Do About It”
Program presented by the Faculty, Western Reserve
University School of Medicine, Cleveland.
Presiding: Samuel Saslaw, M. D., Columbus, Chair-
man, Committee on Scientific Work.
Jerome S. Abrams, M. D., Instructor, Department of
Surgery.
John H. Davis, M. D., Instructor, Department of Sur-
gery.
Brown M. Dobyns, M. D., Instructor, Department of
Surgery.
Robert W. Hopkins, M. D., Senior Instructor, De-
partment of Surgery.
Lester Persky, M. D., Associate Professor, Department
of Urology.
Walter H. Pritchard, M. D., Professor, Department
of Internal Medicine.
Maurice Victor, M. D., Instructor, Department of
Neurology.
Austin S. Weisberger, M. D., Head of Department
of Internal Medicine.
3:30 What Splenectomy Has To Offer in Blood
Dyscrasias and Other Disorders — Dr.
Davis.
3:45 Acute Urinary Retention: Do’s and Dont’s
— Dr. Persky.
4:00 How We Can Be Fooled by Myxoedema
— Dr. Dobyns.
4:15 What Has Surgery Accomplished for Myo-
cardial Ischemia — Dr. Pritchard.
4:30 Polyneuritis: Its Diagnosis and Treatment
— Dr. Victor.
4:45 Significance of Iron Deficiency Anemia —
Dr. Weisberger.
5:00 Diagnostic Value of Rectal Valve Biopsy
— Dr. Abrams.
5:15 Amputation for Vascular Disease: A Case
for Conservatism — Dr. Hopkins.
5:30 Adjournment.
WEDNESDAY, MAY 25
4:00 p. m. (d. s. t.)
OSMA Section for Hospital Directors
of Medical Education
ORGANIZATIONAL MEETING
(Mohawk Room, First Floor)
5:00 P. M. (d. S. T.)
(Navajo Room, First Floor)
Reception sponsored by the Ohio State Medical Associa-
tion for those Hospital Directors in attendance.
358
The Ohio State Medical Journal
THURSDAY, MAY 26
THURSDAY, MAY 26
8:30 A. M. (d. s. t.)
Film entitled: "A New Look at Tetanus Prophylaxis”
Shown by — Dr. Wesley Furste
Sponsored by Ohio Committee on Trauma,
American College of Surgeons
(Gold Room, Mezzanine Floor)
THURSDAY, MAY 26
9:00 A. M. (d. s. t.)
Registration
(Grand Ballroom Foyer, Mezzanine Floor)
9:00 A. M. (d. s. t.)
Scientific, Health Education and
Technical Exhibits
(Grand Ballroom and Ballroom Balcony)
THURSDAY, MAY 26
9:00 a. M. (d. s. t.)
Psychiatry and Neurology
(Grand Ballroom — Terrace, Parlor Floor)
Annual Meeting of the Ohio Psychiatric Association
and OSMA Section on Psychiatry and Neurology.
THE PARTICIPANTS
Charles W. Harding, M. D., Worthington, Psychiatry,
Harding Hospital, Inc.
Charles K. Hofling, M. D., Cincinnati, Assistant Pro-
fessor of Psychiatry, University of Cincinnati Col-
lege of Medicine.
Lothar B. Kalinowsky, M. D., New York, Flower and
Fifth Avenue Hospitals, New York.
James J. Strain, M. D., Cleveland, University Hospi-
tals.
Presiding: Dr. Hofling.
9:00 Indoklon Shock Therapy — Dr. Harding.
Discussant: Dr. Kalinowsky.
9:30 Unilateral vs Bilateral ECT, A Double
Blind Study — Dr. Strain.
Discussant: Dr. Kalinowsky.
10:15 Recess for Tour of Exhibits.
10:45 The Present Status of Somatic Therapies in
Psychiatry — Dr. Kalinowsky.
11:45 a. m. (d. s. t.)
Luncheon and Business Meeting of
the Ohio Psychiatric Association
(Empire Room, Parlor Floor)
9:00 A. M. (d. s. t.)
General Session
(Gold Room, Mezzanine Floor)
"Athletic Injuries"
Program presented by Ohio Committee on Trauma, American
College of Surgeons; Joint Advisory Committee on Athletic
Injuries of the OSMA, and the Ohio High School Athletic
Association.
Dr. Quigley
THE PARTICIPANTS
Wesley Furste, M. D., Columbus, Member Subcom-
mittee on Prophylaxis Against Tetanus of the Na-
tional Committee on Trauma, American College of
Surgeons.
Nicholas J. Giannestras, M. D., Cincinnati, Chair-
man, Section on Fractures and Orthopaedics, Good
Samaritan Hospital, Cincinnati.
Robert J. Murphy, M. D., Columbus, Assistant Clini-
cal Professor of Medicine at Ohio State University
College of Medicine.
Richard Patton, M. D., Columbus, Assistant Clinical
Professor of Surgery at Ohio State University Col-
lege of Medicine.
T. B. Quigley, M. D., Boston, Mass., Clinical Pro-
fessor of Surgery, Harvard Medical School.
Presiding: Thomas W. Morgan, M. D., Gallipolis,
Chief, Section 5, Committee on Trauma, American
College of Surgeons.
9:00 Heat Stroke: Leading Cause of Death in
Football — Dr. Murphy.
9:30 Common Ruptures of Ligaments, Tendons,
and Muscles; Their Recognition and
Treatment — Dr. Quigley.
10:00 Intermission for Tour of Exhibits.
10:30 Problems Most Commonly Encountered by
Team Physicians.
(Panel Discussion)
Moderator: Dr. Quigley.
Members of Panel: Drs. Giannestras, Patton
and Murphy.
12:00 Adjournment.
for April, 1966
359
THURSDAY, MAY 26
9:30 a. m. (d. s. t.)
Executive Sessions
RESOLUTIONS COMMITTEE NO. 1
(Wigwam Room, First Floor)
RESOLUTIONS COMMITTEE NO. 2
(Mohawk Room, First Floor)
RESOLUTIONS COMMITTEE NO. 3
(Chieftain Room, First Floor)
10:30 to 11:00 A. M. (d. s. t.)
Intermission for Tour of Exhibits
11 :00 A. M. (d. s. t.)
Continuation of General Session
and Scientific Section Meetings
THURSDAY, MAY 26
1 :30 P. m. (d. s. t.)
General Session
(Gold Room, Mezzanine Floor)
"Medicare’s Rules and Regulations and Their
Effect on the Practice of Medicine’’
Dr. Hudson
Charles L. Hudson, M. D., Cleveland
President-Elect, American Medical Association
Dr. Hudson will present detailed information regarding
the rules and regulations of Public Law 89-97 which be-
comes effective July 1, 1966. He has participated in the
activities of the AMA’s Task Force in its consultations with
the Federal Government on the development of these rules
and regulations. Dr. Hudson will answer questions from
the audience following his formal presentation.
Dr. Aldrete Dr. Phillips
THURSDAY, MAY 26
3:00 P. m. (d. s. t.)
Anesthesiology
(Terminal Room, Parlor Floor)
Program sponsored by the OSMA Section on Anesthesiology
THE PARTICIPANTS
J. Antonio Aldrete, M. D., Denver, Colorado, In-
structor in Anesthesiology, University of Colorado.
John G. Fraser, M. D., Cleveland, Department of
Anesthesiology, University Hospitals.
John P. Garvin, M. D., Columbus, Director of Anes-
thesiology, Columbus Children’s Hospital.
Charles W. Hoyt, M. D., Cincinnati, Director, De-
partment of Anesthesia, Bethesda Hospital.
David M. Katchka, M. D., Toledo, Director of Anes-
thesiology, Toledo Hospital.
Henry E. Kretchmer, M. D., Cleveland, Director of
Department of Anesthesia, Cleveland Metropolitan
General Hospital.
Otto C. Phillips, M. D., Pittsburgh, Pennsylvania,
Professor of Anesthesiology, University of Pitts-
burgh School of Medicine.
Brant B. Sankey, M. D., Cleveland, Head, Depart-
ment of Anesthesiology, St. Luke’s Hospital.
John E. Steinhaus, M. D., Atlanta, Georgia, Profes-
sor and Chairman of Anesthesiology, Emory Uni-
versity School of Medicine.
3:00 Anesthesia for Obstetrical Patients with
Endocrine Disorders — Dr. Kretchmer.
3:20 Current Concepts in Obstetrical Anesthesia
— Dr. Phillips.
3:50 Management of the Asthmatic Patient Un-
der Anesthesia — Dr. Aldrete.
4:05 Endoscopy Revisited — Dr. Hoyt.
4:20 The Anesthesiologist’s Dilemma — Dr.
Steinhaus.
4:50 Hyperpyrexia During and Following Anes-
thesia. (Panel Discussion)
Moderator: Dr. Garvin; Members of Panel:
Drs. Fraser, Katchka, and Sankey.
5:20 Election of Officers for 1967.
The foregoing program was arranged under the direction
of the following: Nicholas G. DePiero, Cleveland, Chair-
man, and Edward Hartenian, M. D., Cincinnati, Secretary.
Section on Anesthesiology.
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The Ohio State Medical Journal
Dr. Steinhaus Dr. Feffer
THURSDAY/ MAY 26
3:00 p. m. (d. s. t.)
Medical History
(Erie Room, Parlor Floor)
Annual Meeting of the Ohio Academy of
Medical History
President: Bruno Gebhard, M. D., Cleveland
THE PARTICIPANTS
Dr. John J. Beeston, Cleveland
Ralph W. Dexter, Ph. D., Kent
Linden F. Edwards, Ph. D., Columbus
George R. L. Gaughran, Ph. D., Columbus
Kenneth I. E. MacLeod, M. D., M. P. H., Cincinnati
Cecil Striker, M. D., Cincinnati
3:00 Opening Session and Business Meeting.
3:30 Program.
Newspapers as Sources of the History of
Medicine of Ohio — Dr. Edwards.
Ohio Contacts of Physicians Included in
Hume’s Ornithologists of the U. S. Army
Medical Corps — Dr. Dexter.
The Stormy Career of G. S. Pattison — 19th
Century Anatomist — Dr. Gaughran.
William E. Clendenning, M. D., First Health
Officer of Cincinnati — Dr. MacLeod.
Subject to be announced — Dr. Striker.
6:00 p. m. (d. s. t.)
Cocktails and Dinner at the Howard Dittrick
Museum of Historical Medicine, Cleveland
Medical Library, 11000 Euclid Avenue.
After-Dinner Speaker — Dr. John J. Beeston,
Director of the Cleveland Health Museum.
"1066 and All That”
8:00 P. M. (d. s. t.)
Inspection of Rare Medical Books in the
Cleveland Medical Library.
THURSDAY, MAY 26
3:00 p. M. (d. s. t.)
Internal Medicine
(Gold Room, Mezzanine Floor)
Program sponsored by the Section on Internal Medicine and
the Ohio Society of Internal Medicine.
THE PARTICIPANTS
Albert A. Brust, M. D., Dayton, Associate Professor
of Medicine, University of Cincinnati College of
Medicine.
Harriet P. Dustan, M. D., Cleveland, Research Di-
vision, Cleveland Clinic Foundation.
James J. Feffer, M. D., Washington, D. C., Consult-
ant to Division of Medical Care Administration,
U. S. P. H. S.; Clinical Professor of Medicine and
Chief of Pulmonary Disease Division, George
Washington University School of Medicine.
Ray W. Gifford, Jr., M. D., Cleveland, Department
of Hypertension and Renal Disease, Cleveland
Clinic Foundation.
James F. Schieve, M. D., Columbus, Head of Renal
Disease Division, Ohio State University College
of Medicine.
Robert F. Williams, M. D., Cleveland, Associate Pro-
fessor of Medicine, Western Reserve University
School of Medicine.
Panel on Hypertension
Moderator: Dr. Gifford.
3:00 Evaluation of the Hypertensive Patient —
Dr. Brust.
3:15 Renovascular Hypertension — Dr. Dustan.
3:30 Management of Essential Hypertension —
Dr. Williams.
3 :45 Management of Hypertensive Crises —
Dr. Schieve.
3:55 Panel Discussion.
4:30 Public Law, 89*97, Title XVIII —
Dr. Feffer.
5:15 Business Meeting and Election of Officers,
OSMA Section on Internal Medicine and
Ohio Society of Internal Medicine.
5:30 Adjournment.
The foregoing program was arranged under the direction
of the following: William Bradley, M. D., Columbus, Chair-
man, and R. A. Van Ommen, M. D., Cleveland, Secretary,
Section on Internal Medicine; John T. Grady, M. D., Cleve-
land, President, and Edward O. Hahn, M. D., Cleveland,
Secretary-Treasurer, Ohio Society of Internal Medicine.
6:30 p. m. (d. s. t.)
Reception and Dinner, Ohio Society
of Internal Medicine
(Grand Ballroom — Terrace, Parlor Floor)
for April, 1966
361
THURSDAY, MAY 26
THURSDAY, MAY 26
3:00 P. M. (d. s. t.)
Psychiatry and Neurology
(Grand Ballroom — Terrace, Parlor Floor)
Program sponsored by the Section on Psychiatry and
Neurology and the Ohio Psychiatric Association.
Dr. Goldfarb
THE PARTICIPANTS
Norman S. Brandes, M. D., Columbus, Teaching Con-
sultant at Columbus State Hospital.
Alvin I. Goldfarb, M. D., New York, Consultant on
Services for the Aged, New York State Department
of Mental Hygiene.
James R. Hodge, M. D., Akron, Senior Staff and
Chief of Psychiatry Section, Akron City Hospital.
W. Hugh Missildine, M. D., Columbus, Assistant
Professor of Psychiatry at Ohio State University
and Associate Professor of Pediatrics.
Howard P. Rome, M. D., Rochester, Minnesota, Presi-
dent, American Psychiatric Association, Chief, De-
partment of Psychiatry, Mayo Clinic.
Presiding: Dr. Hodge.
3:00 Contributions of Psychiatrists to the Care
and Treatment of Aging by Other Physi-
cians — Dr. Goldfarb.
4:00 A Dynamic Focus on School Phobias in
Children and Adolescents — Dr. Brandes.
Discussant: Dr. Missildine.
4:30 Rapid Personality Evaluation in General
Hospital Patients — Dr. Rome.
The foregoing program was arranged under the direction
of the following: W. Donald Ross, M. D., Cincinnati, Presi-
dent of Ohio Psychiatric Association and the Section on
Psychiatry and Neurology; Philip Rond, M. D., Columbus,
Secretary of Ohio Psychiatric Association and the Section
on Psychiatry and Neurology, and J. Patrick Duffy, M. D.,
Cleveland, Program Chairman.
3:00 p. m. (d. s. t.)
Ohio State Surgical Association
(Whitehall Room, Mezzanine Floor)
THE PARTICIPANTS
Theron L. Hopple, M. D., Toledo, Private Practice of
Neurological Surgery.
Alfred W. Humphries, M. D., Cleveland, Head, De-
partment of Vascular Surgery, Cleveland Clinic
Foundation.
John C. Kelleher, M. D., Toledo, Director of Plastic
Surgery, Maumee Valley and Mercy Hospitals of
Toledo.
Thomas W. Morgan, M. D., Gallipolis, Holzer Clinic
Staff.
3:00 Mass Traumatic Disease — The Automobile
— Dr. Morgan.
3:30 The Treatment of Head Injuries — Dr.
Hopple.
4:00 Facial Trauma Associated with Automobile
Accidents — Dr. Kelleher.
4:30 Arterial Trauma as a Result of Automobile
Accidents — Dr. Humphries.
6:30 p. m. (d. s. t.)
Ohio State Surgical Association
(Cleveland Room, Lobby Floor)
Cocktail Hour Followed by Banquet at 7:30 p. m.
(Open to other than members by preregistration)
Speaker: Thomas L. Dwyer, M. D., Mexico, Missouri
President of the American Association of
Physicians and Surgeons.
10:30 p. m. (d. s. t.)
Ohio State Surgical Association
Board of Directors Hospitality Party
(Navajo Room, First Floor)
362
The Ohio State Medical Journal
FRIDAY, MAY 27
7:30 a, M. (d. s. t.)
Woman’s Auxiliary Breakfast
for Physicians and Auxiliary
Members
(Cleveland Room, Lobby Floor)
FRIDAY, MAY 27
9:00 A, M. (d. s. t.)
Registration
(Grand Ballroom Foyer, Mezzanine Floor)
FRIDAY, MAY 27
9:00 a. m. (d, s. t.)
Scientific, Health Education and
Technical Exhibits
(Grand Ballroom and Ballroom Balcony)
FRIDAY, MAY 27
9:00 A. M. (D. S. T.)
House of Delegates
Final Business Session
(Gold Room, Mezzanine Floor)
Roll Call of Delegates.
Introduction of honored guests.
Consideration of unfinished business.
Reports of Reference Committees:
President’s Address
Resolutions
Election of President-Elect.
Report of Committee on Nominations:
(a) Nominations for The Council.
(Members of The Council are elected for two-
year terms; terms of those representing the odd-
numbered districts expire in even-numbered
years.) To be elected:
First District — (Incumbent, Robert E. How-
ard, M. D., Cincinnati.)
Third District — (Incumbent, Frederick T.
Merchant, M. D., Marion.)
Fifth District — (Incumbent, P. John Robe-
chek, M. D., Cleveland.)
Seventh District — (Incumbent, Benjamin C.
Diefenbach, M. D., Martins Ferry.) Note:
Ineligible for re-election, having served the
maximum time on The Council as provided in
the Constitution and Bylaws of the Association.
Ninth District — (Incumbent, George N.
Spears, M. D., Ironton.)
Eleventh District — (Incumbent, William R.
Schultz, M. D., Wooster.)
(b) Election of Delegates and Alternates to the
American Medical Association — four Delegates
and four Alternates to be elected, each for a
two-year term starting, January 1, 1967, in com-
pliance with the Constitution and Bylaws of the
American Medical Association.
The following incumbent Delegates and Alternates
will serve for the remainder of 1966 and they may be
considered by the nominating committee for re-elec-
tion for two-year terms starting January 1, 1967.
Theodore L. Light, M. D., Dayton
(Delegate)
Kenneth D. Arn, M. D., Dayton
(Alternate)
Carl A. Lincke, M. D., Carrollton
(Delegate)
Robert S. Martin, M. D., Zanesville
(Alternate)
George W. Petznick, M. D., Cleveland
(Delegate)
Horatio T. Pease, M. D., Wadsworth
(Alternate)
Edmond K. Yantes, M. D., Wilmington
(Delegate)
Harry K. Hines, M. D., Cincinnati
(Alternate)
Due to increased AMA membership, the Ohio
State Medical Association is eligible to elect a tenth
Delegate and a tenth Alternate Delegate to the
American Medical Association. It will be necessary
to select a Delegate and an Alternate Delegate for a
partial term ending December 31, 1966, and a Dele-
gate and an Alternate Delegate for the two year term
beginning on January 1, 1967.
Installation of Officers for 1966-1967.
Submission of Committee appointments by the new
President for confirmation by the House of Dele-
gates.
Unfinished or new business.
Adjournment.
12 :00 Noon (d. s. t.)
(Whitehall Room, Mezzanine Floor)
Complimentary Luncheon for Delegates, Alternate
Delegates and OSMA Council.
for April, 1966
363
Dr. Tomashefski
Dr. Kennedy
Dr. Johnson
Dr. Homi
FRIDAY, MAY 27
9:00 a. m. - 12 Noon
Medical Booth Seminars
(Exhibit Hall Area)
These one-half hour booth seminar presentations
will present practical demonstrations of equipment
and procedures that may be used in everyday prac-
tice. As you will note, three of the presentations
will be running simultaneously beginning at 9:00,
10:00 and 11:00. The other three beginning at 9:30,
10:30 and 11:30. It is hoped that physicians will
have an opportunity to view all of the presentations.
Starting time: 9:00, 10:00 and 11:00 A. m.
Booth No. 1 — "Conditioning, Prevention and
First Aid for Athletic Injuries”
Mr. Ernest R. Biggs, Columbus, Head Athletic
Trainer, Ohio State University. Chairman of
Committee on Injuries, National Athletic Train-
ers Association; Member, Committees on Competi-
tive Safeguards and Medical Aspects of Sports;
National Collegiate Athletic Association.
Booth No. 3 — "Bedside Pulmonary Function
Testing”
Joseph F. Tomashefski, M. D., Columbus, Assistant
Professor of Medicine and Associate Professor of
Preventive Medicine and Physiology, O. S. U. Col-
lege of Medicine and Chief of Research and Direc-
tor of Cardiopulmonary Laboratories, Ohio Tuberc-
ulosis Hospitals.
Booth No 5 — "Physical Medicine in the Home”
Ernest W. Johnson, M. D., Columbus, Professor
and Chairman of the Department of Physical Medi-
cine, The Ohio State University College of Medicine.
Starting time: 9:30, 10:30 and 11:30 a. m.
Booth No. 2 — "Resuscitation”
John H. Kennedy, M. D., Cleveland, Surgeon-in-
charge of thoracic surgical services, Cleveland Met-
ropolitan General Hospital and Assistant Professor
of Thoracic Surgery, Western Reserve University.
John Homi, M. D., Cleveland, Department of Anes-
thesiology, Cleveland Clinic Foundation.
Henry E. Kretchmer, M. D., Cleveland, Associate
Professor of Anesthesiology, Western Reserve Uni-
versity School of Medicine; Director, Department
of Anesthesiology at Cleveland Metropolitan Gen-
eral Hospital.
Booth No. 4 — "Lacerations”
H. W. Porterfield, M. D., Columbus, Instructor, De-
partment of Surgery, Ohio State University College
of Medicine, Private Practice of Plastic Surgery.
S. W. Hartwell, Jr., M. D., Cleveland, Department
of Plastic Surgery, Cleveland Clinic Foundation.
Donald M. Glover, M. D., Cleveland, Clinical Pro-
fessor of Surgery, Emeritus, Western Reserve Uni-
versity School of Medicine.
( Continued on next page )
Dr. Porterfield
Dr. Glover
Dr. Brown
Dr. Hartwell
364
The Ohio State Medical Journal
(Medical Booth Seminars — Contd.)
Booth No. 6 — "Fractures”
Charles M. Evarts, M. D., Cleveland, Staff, De-
partment of Orthopedic Surgery, Cleveland Clinic
Foundation.
Kent L. Brown, M. D., Cleveland, Assistant Sur-
geon, St. Luke’s Hospital.
Dr. Evarts
FRIDAY, MAY 27
11:00 A. M. (d. S. T.)
Ohio State Surgical Association
Business Meeting and Installation of Officers
(Terminal Room, Parlor Floor)
12 :00 P. M.
New President’s Luncheon with
Senior Members Honored
(Navajo Room, First Floor)
FRIDAY, MAY 27
1:30 p. M. (d. s. t.)
General Session
(Gold Room, Mezzanine Floor)
"Care of the Patient: 1966”
Dr. Annis
Edward R. Annis, M. D., Miami, Florida
Past President, American Medical Association
Dr. Annis will make his presentation on the theme of
the 1966 OSMA Annual Meeting. He will look at the
future of patient care and the effect of various pieces of
Federal legislation upon the traditional physician-patient
relationship. A question and answer period will follow Dr.
Annis’ formal presentation.
FRIDAY, MAY 27
1 :00 p. m. (d. s. t.)
Orthopaedic Surgery
(Lewis Room, Lobby Floor)
Program sponsored by the Section on Orthopaedic Surgery
and the Ohio Orthopaedic Society
Dr. Curtis
THE PARTICIPANTS
Burr H. Curtis, M. D., Newington, Conn., Medical
Director, Newington Hospital for Children.
Barry A. Friedman, M. D., Cleveland, Assistant Clini-
cal Professor of Orthopaedic Surgery, Western Re-
serve University School of Medicine.
F. W. Rhinelander, M. D., Professor of Orthopaedic
Surgery, Western Reserve University School of
Medicine; Chief, Orthopaedic Service, Cleveland
Metropolitan General Hospital.
James T. Hartman, M. D., Cleveland, Orthopaedic
Surgery, Staff member, Cleveland Clinic and Hos-
pital.
1:00 Registration.
2:30 Correlation of Cine-Roentgenography and
Cervical Spine Injuries — Dr. Hartman.
2:55 Ultrastructural Changes in Osteogenic Sar-
coma— Dr. Friedman.
3:20 Neurofibromatosis with Paralysis — Dr.
Curtis.
4:30 Internal Fixation and Healing of Fractures
— Dr. Rhinelander.
5:00 First Executive Session of the Ohio Ortho-
paedic Society; and Election of OSMA Sec-
tion Officers for 1967.
The foregoing program was arranged under the direction
of the following: Norman J. Rosenberg, M. D., Cleveland,
John Q. Brown, M. D., Columbus, officers of the Section on
Orthopaedic Surgery and the Ohio Orthopaedic Society;
Thomas F. Linke, M. D., Lakewood, and J. George Furey,
M. D., Willoughby, cochairman, Program Committee.
6:30 p. m. (d. s. t.)
Orthopaedic Surgery
(Grand Ballroom — Terrace, Parlor Floor)
Cocktails and Banquet
FRIDAY, MAY 27
2:30 P. M. (d. s. t.)
Intermission for Tour of Exhibits
for April, 1966
365
FRIDAY, MAY 27
3:00 p. M. (d. s. t.)
General Practice of Medicine
Obstetrics and Gynecology
Pediatrics
(Gold Room, Mezzanine Floor)
Program sponsored by the Sections on General Practice of
Medicine, Obstetrics and Gynecology, Pediatrics, and Ohio
Chapter, American Academy of Pediatrics
Dr. Huffman
THE PARTICIPANTS
A. Scott Dowling, M. D., Cleveland, Instructor in
Child Psychiatry, Western Reserve University School
of Medicine.
John W. Huffman, M. D., Chicago, Illinois, Profes-
sor, Department of Obstetrics and Gynecology,
Northwestern University Medical School.
Roger B. Scott, M. D., Cleveland, Professor of Ob-
stetrics and Gynecology, Western Reserve Univer-
sity School of Medicine.
Earl E. Smith, M. D., Cleveland, Assistant Clinical
Professor of Pediatrics, Western Reserve University
School of Medicine.
Samuel Spector, M. D., Cleveland, Professor of Pedi-
atrics, Western Reserve University School of Medi-
cine.
Presiding: Dr. Spector.
Pediatric Gynecology
3:00 Kindergarten Gynecology: Some Common
Gynecological Problems in Childhood - —
Dr. Huffman.
3:50 Recess.
4:00 Pediatric Gynecology (Panel Discussion).
Moderator: Dr. Spector.
Members of Panel: Drs. Dowling, Huff-
man, Scott and Smith.
5:15 Election of Officers for 1967.
5:30 Adjournment.
The foregoing program was arranged under the direction
of the following: Thomas M. Hughes, M. D., Columbus,
Chairman, William M. Wilson, M. D., Columbus, Secretary,
Section on General Practice of Medicine; Lester A. Ballard,
M. D., Cleveland, Chairman, Sidney Kay, M. D., Cincinnati,
Secretary, Section on Obstetrics and Gynecology; Chester T.
Kasmersky, M. D., Columbus, Chairman, Henry Saunders,
M. D., Cleveland, Secretary, Section on Pediatrics; Samuel
Spector, M. D., Cleveland, President, Northern Ohio Pediatric
Society.
FRIDAY, MAY 27
3:00 p. M. (d. s. t.)
Ear, Nose and Throat
(Terminal Room, Parlor Floor)
Program sponsored by the Section on Ear, Nose and Throat
and the Ohio Ear, Nose and Throat Society
Dr. Ogura
THE PARTICIPANTS
Richard B. Fleming, M. D., Cincinnati.
Joseph H. Ogura, M. D., St. Louis, Missouri, Pro-
fessor of Otolaryngology, Washington University
School of Medicine.
Michael M. Paparella, M. D., Columbus, Assistant
Professor, Department of Otolaryngology, Ohio
State University College of Medicine.
Richard L. Ruggles, M. D., Cleveland, Senior Clinical
Instructor of Otolaryngology.
3:00 Tympanic Perforations — Safe or Not —
Dr. Ruggles.
3:20 Open Discussion.
3:30 Modern Management of Facial Fractures
— Dr. Fleming.
3:50 Open Discussion.
4:00 Functions of a Deafness Research Founda-
tion Laboratory — Dr. Paparella.
4:20 Open Discussion.
4:30 Preoperative Radiation for Malignant Tu-
mors of the Head and Neck — Dr. Ogura.
5:00 Open Discussion.
5:15 Election of Officers for 1967.
5:30 Adjournment.
6:45 p. m. (d. s. t.)
(Terminal Room, Parlor Floor)
Ohio Ear, Nose and Throat Society
Cocktails followed by dinner at 7:30 P. M.
"Amusing Experiences in Laryngology
Over the Years”
Joseph H. Ogura, M. D., St. Louis, Missouri
The foregoing program was arranged under the direction
of the following: Charles E. Kinney, M. D., Cleveland,
Chairman of the Section on Ear, Nose and Throat and
President of the Ohio Ear, Nose and Throat Society; Stephen
P. Hogg, M. D., Secretary, Cincinnati, Section on Ear, Nose
and Throat and Secretary of the Ohio Ear, Nose and Throat
Society.
366
The Ohio State Medical Journal
FRIDAY, MAY 27
3:00 p. m. (d. s. t.)
Physical Medicine and Rehabilitation
(Navajo Room, First Floor)
Program sponsored by the Section on Physical Medicine and
Rehabilitation and the Ohio Society of Physical Medicine and
Rehabilitation
Dr. Cailliet
THE PARTICIPANTS
Rene Cailliet, M. D., Los Angeles, California, Asso-
ciate Professor of Physical Medicine and Rehabil-
itation, University of Southern California School of
Medicine.
John S. Collis, M. D., Cleveland, Department of
Physical Medicine, Cleveland Clinic.
Ernest W. Johnson, M. D., Columbus, Professor and
Chairman, Department of Physical Medicine, Ohio
State University College of Medicine.
Karl J. Olsen, M. D., Cleveland, Department of
Physical Medicine, Cleveland Clinic.
3:00 Problems of Back Pain for the General
Practitioner and the Specialist — Dr.
Cailliet.
3:40 Contribution of Discography to Delinea-
tion of Low Back Pains — Dr. Collis.
4:00 Electrodiagnostic Tests and the Problem
of Back Pain — Dr. Olsen.
4:20 What is Adequate Conservative Therapy?
— Dr. Johnson.
4:40 Panel Discussion.
Members of Panel: Drs. Cailliet, Collis,
Johnson and Olsen.
3:00 Election of Officers for 1967.
The foregoing program was arranged under the direction
of the following: Karl J. Olsen, M. D., Cleveland, Chair-
man, Marvin H. Spiegel, M. D., Columbus, Secretary, Sec-
tion on Physical Medicine and Rehabilitation; John D. Guy-
ton, M. D., Worthington, President, Robert J. Gosling,
M. D., Toledo, Secretary, Ohio Society of Physical Medicine
and Rehabilitation.
8:00 P. M. (d. s. t.)
(Navajo Room, First Floor)
Dinner, Ohio Society of Physical
Medicine and Rehabilitation
FRIDAY, MAY 27
3:00 p. m. (d. s. t.)
Occupational Medicine
(Erie Room, Parlor Floor)
Dr. Warshaw
THE PARTICIPANTS
Harold R. Imbus, M. D., Marion, Department of Oc-
cupational Medicine, Marion General Hospital.
Leon J. Warshaw, M. D., New York, N. Y., Medical
Director, Paramount Pictures Corporation and
United Artists Corporation.
3:00 Work and Coronary Heart Disease — Dr.
Warshaw.
3:45 Question and Answer Period.
4:00 Intermission for Tour of Exhibits.
4:10 Help Wanted: Part-Time Physicians for
Industry — Dr. Imbus.
4:55 Election of Officers for 1967.
5:10 Adjournment.
The foregoing program was arranged under the direction
of the following: Lee H. Miller, M. D., Cincinnati, Chair-
man; W. W. Davis, M. D., Columbus, Secretary, Section on
Occupational Medicine.
FRIDAY, MAY 27
3:00 P. M. (d. s. t.)
Pathology
(Cleveland Room, Lobby Floor)
Program sponsored by the Section on Pathology and the
Ohio Society of Pathologists
THE PARTICIPANT
James W. Reagan, M. D., Cleveland, Professor of
Pathology, Western Reserve University School of
Medicine.
3:00 Slide Seminar on Ovarian Tumors — Dr.
Reagan.
5 : 30 Business Meetings of Section on Pathology
and the Ohio Society of Pathologists.
6:30 Adjournment.
The foregoing program was arranged under the direction
of the following: Colin R. Macpherson, M. D., Columbus,
and L. J. McCormack, M. D., Cleveland, Chairman and
Secretary, respectively, Section on Pathology and the Ohio
Society of Pathologists.
8:00 P. M. (d. S. T.)
Banquet, Ohio Society of Pathologists
(Erie and Empire Rooms, Parlor Floor)
for April, 1966
367
FRIDAY, MAY 27
3:00 p. m. (d. s. t.)
Neurological Surgery
(Empire Room, Parlor Floor)
Program sponsored by the Section on Neurological Surgery
and the Ohio Neurosurgical Society
Dr. Shy
THE PARTICIPANTS
Robert C. Atkinson, M. D., Columbus.
Thomas E. Brown, M. D., Cincinnati.
Robert L. McLaurin, M. D., Cincinnati, Director of
Division of Neurosurgery, University of Cincinnati
College of Medicine.
Richard H. Retter, M. D., Columbus, Instructor of
Neurosurgery, Ohio State University College of
Medicine.
Warren H. Leimbach, M. D., Columbus, Instructor
of Neurosurgery, Ohio State University College of
Medicine, Consultant, V. A. and Crippled Chil-
dren’s Society.
Martin P. Sayers, M. D., Chief of Neurosurgery, Chil-
dren’s Hospital, Columbus.
George Milton Shy, M. D., Philadelphia, Pa., Pro-
fessor of Neurology and Chairman, Department of
Neurology, University of Pennsylvania School of
Medicine.
3:00 New Disclosures on the Causes of Muscu-
lar Weakness — Dr. Shy.
4:00 Experiences with Basal Artery Aneurysms
— Drs. Retter, Leimbach and Atkinson.
Effects of Laser Energy on Central Nervous
System Tissue — Drs. McLaurin and
Brown.
Reduction Cranipolasty — Dr. Sayers.
5:00 Election of Officers for 1967.
5:30 Adjournment.
The foregoing program was arranged under the direction
of the following: Laurence M. Weinberger, M. D., Akron,
and George H. Hoke, M. D., Lorain, Chairman and Secre-
tary, respectively, Section on Neurological Surgery and the
Ohio Neurosurgical Society.
FRIDAY, MAY 27
3:00 p. M. (d. s. t.)
Ohio Chapter, American College
of Chest Physicians
Section on Radiology
(Whitehall Room, Mezzanine Floor)
Program sponsored by the Ohio Chapter of the American
College of Chest Physicians and the Section on Radiology
THE PARTICIPANTS
Neil C. Andrews, M. D., Columbus, Associate Pro-
fessor of Thoracic Surgery, Ohio State University
College of Medicine.
F. Mason Jones, Jr., M. D., Cleveland, Department
of Surgery, Cleveland Clinic.
Abbas M. Rejali, M. D., Cleveland, Assistant Pro-
fessor of Radiology, Western Reserve University
School of Medicine.
Frederick A. Rose, M. D., Cleveland, Associate Pro-
fessor of Radiology, Western Reserve University
School of Medicine.
3:00 Lung Scanning with Macro - aggregated
Human Albumin Serum — Dr. Rejali.
3:25 Discussion.
3:30 Palliative Treatment of Primary and Meta-
static Carcinoma of the Lung — Dr.
Andrews.
3:55 Discussion.
5:00 Election of Officers for 1967.
5:30 Adjournment.
The foregoing program was arranged under the direction
of the following: Jane P. McCullough, M. D., Cleveland,
President, John L. Friedman, M. D., Cincinnati, Secretary-
Treasurer, Ohio Chapter, American College of Chest Physi-
cians; Frederick A. Rose, M. D., Cleveland, Chairman, and
Benjamin F. Jackson, Cleveland, Secretary, Section on
Radiology.
FRIDAY, MAY 27
3:00 P. M. (d. s. t.)
All Exhibits May Be Dismantled
FRIDAY, MAY 27
6:00 P. M. (D. S. T.)
OSMA President’s Reception
(Whitehall and Gold Rooms, Mezzanine Floor)
368
The Ohio State Medical Journal
TO ATTEND
THE PRESIDENT’S
RECEPTION
FRIDAY, MAY 27
6:00 to 8:00 P. M.
GOLD AND WHITEHALL ROOMS
Sheraton-Cleveland Hotel
SOCIAL HIGHLIGHT OF THE 1 966 ANNUAL MEETING
A congenial get-together where members, their ladies
and guests may gather for refreshments, dancing and
the atmosphere of a social period.
NO SPEECHES — NO FORMAL PROGRAM
DRESS: OPTIONAL
Hors D’Oeuvres
Compliments of the Association
Cash Bar Will Be Open
Several specialty societies have planned dinners on
this evening, beginning at 7:00, 7:30 or 8:00 p. m.
Other members and guests will have ample time to
dine at one of Cleveland's fine restaurants.
^ » * •
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SATURDAY, MAY 28
9:00 a. m. (d. s. t.)
Registration
(Grand Ballroom Foyer)
9:00 a. M. (d. s. t.)
Conference on Laboratory Medicine
(Gold Room, Mezzanine Floor)
Program sponsored by the Committee on Laboratory Medicine
of the Ohio State Medical Association.
THE PARTICIPANTS
John W. King, M. D., Cleveland, Clinical Pathol-
ogist at Cleveland Clinic.
C. R. Macpherson, M. D., Columbus, Assistant Pro-
fessor, Department of Pathology and Chief Divi-
sion of Bacteriology, Ohio State University Medical
Center.
Samuel Meites, Ph. D., Columbus, Biochemist, Chil-
dren’s Hospital.
Leonard Skeggs, Ph. D., Cleveland.
Charles E. Willis, M. D., Cleveland.
D. M. Young, M. D., Ph. D., Toronto, Ontario,
Canada, Director of Laboratories, Toronto General
Hospital.
Presiding: Horace B. Davidson, M. D., Columbus,
Chairman, Committee on Laboratory Medicine,
Ohio State Medical Association.
9:00 Multiphasic Screening with Autoanalyzer
— Dr. Skeggs.
9:45 Unsolicited Laboratory Information: Its
Effect on Patients and Their Physicians
— Dr. Young.
10:30 Discussion.
10:45 Break.
11:00 Serologic Procedures in Relation to
Amniocentesis — Dr. Macpherson.
11:15 Discussion.
11:20 Studies on Pigments in the Amniotic Fluids
— Drs. Willis and King.
11:35 Discussion.
11:40 Problems in the Estimation of Serum Bili-
rubin in the Newborn — Dr. Meites.
11:55 Discussion.
12:00 Adjournment.
The foregoing program was arranged under the direction
of the following members of the Committee on Laboratory
Medicine of the Ohio State Medical Association: Horace B.
Davidson, M. D , Columbus, Chairman; William H. Ben-
ham, M. D., Columbus; John B. Hazard, M. D., Cleveland;
Melvin Oosting, M. D., Dayton; Arthur E. Rappoport,
M. D., Youngstown; Philip B. Wasserman, M. D., Cincin-
nati; William Sinclair, M. D., Cleveland; and Gilbert B.
Stansell, M. D., Toledo.
SATURDAY, MAY 28
12:00 Noon (d. s. t.)
Organizational Meeting, Ohio
Association of Blood Banks
(Gold Room, Mezzanine Floor)
SATURDAY, MAY 28
9:00 - 12:00 Noon (d, s. t.)
Clinical Conference
Sponsored by the Ohio Chapter, American
Academy of Pediatrics
(Babies and Childrens Hospital)
12 :00 Noon (d. s. T.)
OSMA Annual Meeting Closes
SATURDAY, MAY 28
12:00 - 12:30 P. M. (d. s. t.)
Annual Meeting
Ohio Chapter, American Academy
of Pediatrics
(Babies and Childrens Hospital)
Jefferson Medical Alumni Reunion
Scheduled Thursday, May 26
A get-together has been arranged for the alumni
of Jefferson Medical College, their wives and guests
who will be in attendance at the 1966 Annual Meet-
ing of the Ohio State Medical Association in Cleve-
land, May 24- 28. This will be the 15th annual
dinner meeting of the Ohio group.
The meeting is to be held in the Terminal Room,
Parlor Floor, of the Sheraton -Cleveland Hotel, Thurs-
day, May 26. Activities will commence with a "fel-
lowship hour’’ at 6:30 p. m., followed by dinner at
7:30 p. m., and "Brief Speeches” by representatives
from Alma Mater at 8:30 p. m. Alumni and guests
are urged to attend any portion of the program that
fits their schedule. However, it is important that
those planning to attend dinner, secure reservations
in advance, by sending a card or note to: Russell S.
McGinnis, M. D., ’21, Jefferson Dinner Chairman,
10515 Carnegie Avenue, Cleveland, Ohio 44106.
Tickets may be purchased at the door on Thursday,
May 26.
370
The Ohio State Medical Journal
Ohio Health Commissioners’
Institute, Cleveland
May 25-27, 1966
To Be Held in Conjunction with the Ohio
State Medical Association Annual Meeting
Sheraton-Cleveland Hotel, Cleveland
(All Events on Daylight Saving Time)
WEDNESDAY, MAY 25
10:00 A. M. OSMA Registration Opens. (Grand
Ballroom Foyer, Mezzanine Floor)
12:00 - 1:00 P. M. Lunch Break.
1:00- 2:00 P. M. Greetings and Progress Reports
on Program Activities — Emmett W. Arnold, M. D.,
Director of Health. (Grand Ballroom — Terrace,
Parlor Floor)
FIRST SESSION
2:00 - 5:00 P. M. "Epidemiology of Accidents.’’
(Grand Ballroom — Terrace, Parlor Floor)
Presiding — Donald Day, Engineer in Charge, Ac-
cident Prevention Unit, Division of Engineering,
Ohio Department of Health.
The Prevention of Injuries and the Federal Govern-
ment’s Role — Robert L. Price, M. D., Assistant
Chief, Division of Accident Prevention, United
States Public Health Service, Washington, D. C.
3:15-3:45 P. M. Tour of Exhibits.
The Role of the Physician in Accident Prevention —
Robert E. Reiheld, M. D., Orrville, Ohio.
THURSDAY, MAY 26
SECOND SESSION
9:00 - 12:00 Noon "Adolescence.’’
(Lewis Room, Lobby Floor)
Presiding — T. A. Gardner, M. D., Chief, Bureau of
Local Services, Ohio Department of Health.
Developmental Aspects of the Adolescent Years —
Effie O. Ellis, M. D., Region V, Children’s Bureau,
Chicago, Illinois.
10:15-10:45 a. m. Tour of Exhibits.
Panel: Effie O. Ellis, M. D., Moderator; panel mem-
bers consist of a pediatrician, school psychologist,
teacher of adolescents, and a psychiatrist.
12:00 - 1:30 P. M. Lunch Break.
THIRD SESSION
3:00 - 5:00 p. M. "Rehabilitation."
(Lewis Room, Lobby Floor)
Presiding — Aileen L. MacKenzie, M. D., Chief, Di-
vision of Chronic Diseases, Ohio Department of
Health.
Rehabilitation Needs — Harry D. Bouman, M. D.,
Professor of Physical Medicine and Rehabilitation,
School of Medicine, University of Cincinnati, Cin-
cinnati, Ohio.
Strokes — A Public Health Problem — Amasa B.
Ford, M. D., Medical Director, Benjamin Rose
Hospital, Cleveland.
6:00 - 7:00 P. M. Reception for Health Commis-
sioners (Erie Room, Parlor Floor)
7:00 P. M. Health Commissioners’ Banquet. (Erie
and Empire Rooms, Parlor Floor)
Robert H. Hutcheson, M. D., M. P. H., Commission-
er, Department of Public Health, State of Tennes-
see, Nashville, Tennessee.
FRIDAY, MAY 27
FOURTH SESSION
8:30- 12:00 Noon "Current Communicable Dis-
ease Concerns."
(Lewis Room, Lobby Floor)
Presiding — Calvin B. Spencer, M. D., Acting Chief,
Division of Communicable Diseases, Ohio Depart-
ment of Health.
The Control of Venereal Diseases — M. Brittain
Moore, Jr., M. D., Dermatologist, Lakeland, Flo-
rida. Formerly Director of Venereal Disease Re-
search Laboratory, Venereal Disease Branch,
Communicable Disease Center, United States Pub-
lic Health Service, Atlanta, Georgia.
10:00- 10:30 Tour of Exhibits.
Ohio Control Program — George Sides, Venereal
Disease Program Representative, Chief, Venereal
Disease Section, Division of Communicable Dis-
eases, Ohio Department of Health.
Arthropod-Borne Encephalitides — The National Situ-
ation — Telford H. Work, M. D., Chief, Virology
Section, Laboratory Branch, Communicable Disease
Center, United States Public Health Service, At-
lanta, Georgia.
The Ohio Study — Ralph A. Masterson, D. V. M.,
M. P. H., Epidemiologist, Division of Communi-
cable Diseases, Ohio Department of Health.
12:00 Noon Ohio Health Commissioners’ Institute
Adjourns.
for April, 1966
371
Twenty- Sixth Annual Convention
of the
Woman’s Auxiliary to the Ohio State Medical Association
May 24 - 27, 1966 — Sheraton-Cleveland Hotel
Hospitality Room
(Main Lobby West)
Wednesday, May 25 8:30 a. m. -4:00 p. m.
Thursday, May 26 8:30 A. M. - 4:00 P. M.
Registration and Information Schedule
(Main Lobby West)
Tuesday, May 24 10:00 a. m. - 4:00 p. m.
Wednesday, May 25 8:30 a. m. - 4:00 p. m.
Thursday, May 26 8:30 a. m. - 4:00 P. M.
Friday, May 27 8:30 A. m. - 1:30 p. m.
CONVENTION PROGRAM
Tuesday, May 24
10:00 A. M. - 12:00 Noon Budget and Finance
Committee (Teepee Room, First Floor)
11:00- 12:00 Resolutions Committee (Wigwam
Room, First Floor)
1:30 - 5:00 P. M. Preconvention Board Meeting
(Navajo Room, First Floor)
6:00 P. M. Reception and Dinner for State Board
Members (Long Hut - Kon Tiki Restaurant)
Wednesday, May 25
9:00 - 11:30 A. M. First Business Session (Cleve-
land Room, Lobby Floor)
11:30 A. M. - 12:00 Noon Social Hour (Gold
Room Foyer, Mezzanine Floor)
12:00 Noon- 1:15 p. m. OMPAC Luncheon
(Gold Room, Mezzanine Floor)
1:30 - 2:30 p. M. OSMA General Session
(Cleveland Room, Lobby Floor) "Problems in
Marriage’’
3:00 - 5:00 p. M. County Reports (Cleveland
Room, Lobby Floor)
5:30 - 7:30 P. M. Hixon’s Barn (transportation
provided)
6:30 P. M. Gavel Club Dinner (Parlor 32, Par-
lor Floor)
Thursday, May 26
9:00-11:15 a. m. Second Business Session
(Cleveland Room, Lobby Floor)
11:30 a. m. - 12:00 Noon Social Hour (Cour-
tesy of Tuscarawas County Auxiliary) (White-
hall Room, Mezzanine Floor)
12:00 Noon- 1:15 p. m. Luncheon (Honoring
Past Presidents and County Presidents — Hosted
by Lake County (Whitehall Room, Mezzanine
Floor)
1:30 - 2:30 p. M. OSMA General Session
Charles L. Hudson, M. D., President-Elect,
AMA (Gold Room, Mezzanine Floor)
3:00 - 5:00 p. M. School of Instruction (Cleve-
land Room, Lobby Floor)
3:00- 5:30 P. M. Voting (Mezzanine Lobby
East)
5:30 - 7:30 P. M. Hixon’s Barn (transportation
provided)
Friday, May 27
7:30- 8:45 A. M. Woman’s Auxiliary Breakfast
for Members and Physicians (Cleveland Room,
Lobby Floor)
9:30 a. m. - 12:00 Noon Third Business Ses-
sion, Installation of Officers (Cleveland Room,
Lobby Floor)
12:00 Noon- 12:20 p. m. Happy Time (Cleve-
land Room, Lobby Floor)
12:20 - 1 :00 p. M. Lunch-on-a-Cart (In Honor of
New Officers, Members and Honored Guests)
(Cleveland Room, Lobby Floor)
1:30 - 2:30 p. M. OSMA General Session, "Care
of the Patient: 1966, ’’Edward R. Annis, M. D.,
Past President, AMA (Gold Room, Mezza-
nine Floor)
3:00- 4:30 P. M. Post- Convention Board Meet-
ing (Parlor 34, Parlor Floor)
6:00 - 8:00 p. m. OSMA President’s Reception
(Gold and Whitehall Rooms, Mezzanine
Floor)
Convention Committee Chairmen
Convention — Mrs. Burdett Wylie
Convention Cochairman — Mrs. Roscoe J. Kennedy
Registration — Mrs. James A. Gavin
Registration Cochairman — Mrs. F. M. Freimann
Hospitality Lounge— Mrs. John J. Grady
372
The Ohio State Medical Journal
SCIENTIFIC AND HEALTH EDUCATION EXHIBIT
The Scientific and Health Education Exhibit will be open from 10:00 A. M. to 5:30 P. M. on
Wednesday, May 25; from 9:00 A. M. to 5:30 P. M. on Thursday, May 26; and from 9:00 A. M. to
3:00 P. M. on Friday, May 27, Daylight Saving Time.
Listed below are the Scientific and Health Educa-
tion Exhibit applications which were approved at
the March 3 meeting of the Committee on Scientific
and Health Education Exhibit.
SCIENTIFIC EXHIBITS
(Grand Ballroom Balcony)
S-85 — Phenylketonuria
Emmett W. Arnold, M. D., Director of
Ohio Department of Health, Columbus.
S-86 — Evaluation of Analgesics and a New Epi-
siotomy Procedure in Relief of Post-
partum Pain and Trauma
Ralph C. Benson, M. D., Raphael B. Dur-
fee, M. D., J. Morton Schneider, M. D.,
University of Oregon Medical School,
Portland, Oregon.
S-87 — Practical Treatment of Musculoskeletal Dis-
orders
Fred J. Phillips, M. D., C. L. Chai, M. D.,
M. D. Debuque, M. D., David M. Shoe-
maker, M. D., Quakertown, Pennsylvania.
S-88 — Conserve Vision — Detect Glaucoma
Clifford H. Cole, M. D., Neurological and
Sensory Disease Service Program, U. S.
Public Health Service, Washington, D. C.
S-89 — Mechanical Support for the Failing Heart
John H. Kennedy, M. D., and Nicholas
Bailas, M. D., Cleveland Metropolitan
General Hospital and Western Reserve
University School of Medicine, Cleveland.
S-90 — Surgical Management of Priapism
Chester C. Winter, M. D., F.A.C.S., Divi-
sion of Urology, Ohio State University
Hospital, Columbus.
S-91 — Mechanical Occlusion of the Vertebral
Artery
E. A. Husni, M. D., H. S. Bell, M. D.,
and John Storer, M. D., Huron Road Hos-
pital, Cleveland.
S-92 — Pancreatic Scan
A. R. Antunez, M. D., E. J. Filson, M. D.,
S. O. Hoerr, M. D., R. E. Hermann, M. D.,
C. H. Brown, M. D., B. H. Sullivan Jr.,
M. D., and F. J. Owens, M. D., Cleveland
Clinic Foundation, Cleveland.
S-93 — A Modified Technique for ODDI Sphinc-
terectomy — An Expanding Abdominal
Retractor
Michael Meftah, M. D., Madison County
Hospital, London.
S-94 — Bilateral Transabdominal, Transperitoneal
Omentoureterostomy
Arthur A. Roth, M. D., Cleveland.
S-95 — Anterior Cervical Fusion and the Treat-
ment of Cervical Disk Conditions
Donald F. Dohn, M. D., Cleveland Clinic,
Cleveland.
S-96 — Portal Hypertension — The Selection of Pa-
tients for Portal-Systemic Shunt
R. E. Hermann, M. D., A. E. Rodriguez,
M. D., B. H. Sullivan, Jr., M. D., C. H.
Brown, M. D., and L. J. McCormack,
M. D., Cleveland Clinic Foundation,
Cleveland.
S-97 — Simplified Cleft Lip Repair
Robert C. Kratz, M. D., William B. Hof-
mann, M. D., Elvis R. Thompson, M. D.,
Department of Otolaryngology and Max-
illofacial Surgery, University of Cincinnati
Medical School, Cincinnati.
S-98 — A Program for Sedation and Analgesia in
Obstetrics
John C. Ullery, M. D., Douglas O. Clark,
M. D., and James R. Bair, M. D., Ohio
State University College of Medicine,
Columbus.
S-99 — Motorbike Safety
R. C. Waltz, M. D., Karl Alfred, M. D.,
Vernon Hacker, M. D., J. D. Osmond,
M. D., George Phalen, M. D., Committee
on Trauma, Cleveland Academy of Medi-
cine.
S-100 — Control of Hemorrhage by G-Suit
John Storer, M. D., James Gardner, M. D.,
Huron Road Hospital, Cleveland.
S-101 — Office Evaluation of a Geriatric Patient
Emmett W. Arnold, M. D., Director of
Health, Aileen L. MacKenzie, M. D., Fran-
ces Williamson, Richard W. Orzechowski,
Dennis Webb, Ohio Department of Health
in cooperation with the U.S.P.H.S. Ger-
entology Branch, Columbus.
for April, 1966
373
S-102 — Carotid — Cavernous Fistula: Search for
Effective Therapy
Wallace B. Hamby, M. D., Cleveland Cli-
nic, Cleveland.
S-103 — Advances in Diagnosis and Treatment of
the Lymphomas
J. H. Berman, M. D., C. S. Higley, M. D.,
W. C. Stoner, M. D., Department of Hem-
atology, St. Luke’s Hospital, Cleveland.
S-104 — Maternal Deaths from Anesthesia
Committee on Maternal Health, Ohio
State Medical Association.
S-105 — Traumatic Injury of the Thorax — The
Flail Chest
Jorge Medina, M. D., Cleveland.
S-106 — Auditory Findings in Lesions of the Pon-
tine Portion of the Brain Stem
Willard Parker, M. D., Robert L. Decker,
M. D., and Nelson G. Richards, M. D.,
Cleveland Clinic Foundation, Cleveland.
S-107 — A New Spinal Technic
John S. Collis, M. D., Cleveland Clinic,
Cleveland.
S-108 — Stereoscopic Microangiography: Observa-
tions on the Microcirculation in Bone
Repair
F. W. Rhinelander, M. D., R. S. Phillips,
M. D., and W. M. Steel, M. D., Western
Reserve University School of Medicine and
Cleveland Metropolitan General Hospital,
Cleveland.
S-109 — Congestive Heart Failure in Local Water
Supplies
Division of Chronic Diseases, Ohio De-
partment of Health, Columbus.
S-110 — Let’s Control Rubella in Ohio
Gilbert M. Schiff, M. D., College of Medi-
cine, University of Cincinnati.
HEALTH EDUCATION EXHIBITS
(Exhibit Hall Area)
H-lll — FDA’s Adverse Reaction Reporting
Program
Food and Drug Administration, Bureau of
Medicine, Washington, D. C.
H-112 — Vocational Rehabilitation in Ohio
Bureau of Vocational Rehabilitation (State
Board of Education), Columbus.
H-113 — The Regulation of Dietary Fat
Mary Jane Kibler, American Medical As-
sociation, Chicago, Illinois.
H-114 — The American Association of Blood Banks
E. A. Dreskin, M. D., President; Lois J.
James, Central Office Manager, American
Association of Blood Banks, Chicago,
Illinois.
H-115 — Activities of the Ohio Cancer Coordinat-
ing Committee, Inc.
Arthur G. James, M. D., President, Ohio
Cancer Coordinating Committee, Inc.,
Columbus.
H-116 — Packaged Disaster Hospital Familiariza-
tion Unit
Ohio Department of Health, Health Mobi-
lization Unit and the OSMA Committee
on Disaster Medical Care.
H-117 — Ohio Medical History
Howard Dittrick Museum of Historical
Medicine, Cleveland.
H-118 — United Ostomy Association, Inc.
United Ostomy Association, Inc., Los An-
geles, California.
H-I19 — Occupational Health Literature
Henry F. Howe, M. D., and Mr. Lee N.
Hames, American Medical Association,
Chicago, Illinois.
H-120— Checkups ARE Worthwhile
American Cancer Society, Ohio Division,
Inc., Cleveland.
H-121 — Coordinated Home Care
The Coordinated Home Care Program of
Dayton and Montgomery County, Dayton,
Ohio.
H-122 — County Auxiliary Projects
Woman’s Auxiliary to the Ohio State
Medical Association.
Good Samaritan of Cincinnati
Seminar on Premature Care
On April 21 the Pediatric Department of Good
Samaritan Hospital, Cincinnati, will sponsor its
Fourth Annual Seminar on Premature Care. This
symposium will be held in the South 200 Conference
Room of the Hospital from 1:00 p. m. to 6:00 p. m.
Dr. Ernst G. Rolfes, Chairman, has arranged an
informative program that will be of great educational
benefit to medical staff members. The speakers and
their topics are:
Dr. Mary Ellen Engle, Associate Professor Pedi-
atrics, Cornell University Medical College, speaking
on 'Diagnosis of Heart Disease in the Newborn
Period.”
Dr. William B. Richardson, Department of Sur-
gery, Good Samaritan Hospital, speaking on "Recent
Advances in Neonatal Surgical Care.”
Dr. Alvin Zipursky, Assistant Professor - Pediatrics
(Hematology), University of Manitoba, speaking on
"Pathogenesis and Prevention of Rh Sensitization
During Pregnancy.”
There is no registration fee but advance notice
should be given so that necessary arrangements can
be made.
374
The Ohio State Medical Journal
TECHNICAL EXHIBITORS
GRAND BALLROOM, MEZZANINE FLOOR, SHERATON-CLEVELAND HOTEL
Open from 10:00 A. M. to 5:30 P. M., Wednesday, May 25; from 9:00 A. M. to 5:30 P. M.
on Thursday, May 26; and from 9:00 A. M. to 3:00 P. M. on Friday, May 27. (DST)
Exhibitor Address Booth No.
Allergy Laboratories of Ohio, Inc.,
Columbus, Ohio 30
Aloe Medical, Div. of Brunswick, St. Louis, Mo. 32
The Americana Corporation,
Beverly Hills, California 49
Arnar-Stone Laboratories, Inc., Mt. Prospect, 111. 57
Astra Pharmaceutical Products, Inc.,
Worcester, Mass 29
Audio-Digest Foundation, Pacific Medical
Equipment Co., N. Hollywood, Calif 38
Ayerst Laboratories, Arlington, Va 13, 20
Barnes-Hind Laboratories,
Sunnyvale, California 18
Beverage Management, Inc., 7 Up Bottling Co.,
Columbus, Ohio 10
Breon Laboratories Inc., New York, N. Y 63
Brewer & Company, Inc., Worcester, Mass 50
Burroughs Wellcome & Co. (U.S.A.) Inc.,
Tuckahoe, N. Y 45
Cameron-Miller Surgical Instruments Co.,
Chicago, Illinois 35
S. H. Camp & Co., Jackson, Michigan 27
Ciba Pharmaceutical Company, Summit, N. J. 72, 73
Cleveland District Dairy Council,
Cleveland, Ohio 79
The Coca-Cola Company, Atlanta, Ga 23
P. F. Collier, Inc., New York, N. Y 75
Daniels-Head & Associates, Inc.,
Portsmouth, Ohio 47
Davies, Rose-Hoyt, Needham, Mass 31
Dome Chemicals Inc., New York, N. Y 39
Encyclopaedia Britannica, Inc., Chicago, Illinois 81
Esta Medical Laboratories, New York, N. Y 43
Fellows-Testagar, Div. of Fellows Medical
Manufacturing Co., Inc., Detroit, Michigan .... 6l
Fringe Benefits, Inc., Cleveland, Ohio 53
Geigy Pharmaceuticals, Yonkers, N. Y 1
Gerber Products Company, Fremont, Michigan .. 4
Greene & Ladd, Members New York
Stock Exchange, Columbus, Ohio 15
Hartzmark & Co., Inc., Cleveland, Ohio 9
Hewlett Packard Co., Sanborn Division,
Waltham, Mass 34
Hoechst Pharmaceuticals, Inc., Cincinnati, Ohio 26
Huntington National Bank, Columbus, Ohio 60
Key Pharmaceuticals, Inc., Miami, Florida 11
Lederle Laboratories, Div. American
Cyanamid Co., Pearl River, N. Y 3
Lemmon Pharmacal Company, Sellersville, Pa. .. 12
Eli Lilly and Company, Indianapolis, Ind 51
Exhibitor Address Booth No.
J. B. Lippincott Company, Philadelphia, Pa 76
Loma Linda Foods, Riverside, California 41
Mead Johnson Laboratories, Evansville, Ind 70
Medco Products Co., Inc., Tulsa, Oklahoma 14
The Medical Protective Company,
Fort Wayne, Ind 33
Merck Sharp & Dohme, West Point, Pa 46
The Wm. S. Merrell Co., Cincinnati, Ohio 84
North American Pharmacal,
Dearborn, Michigan 7
Ohio Bell Telephone Co., Cleveland, Ohio 71
Ohio Medical Indemnity, Inc., Columbus, Ohio 6
Ohio Medical Political Action Committee,
Columbus, Ohio 42
Ohio State Society of Medical Assistants 16
Ortho Pharmaceutical Corp., Raritan, N. J 77
Parke, Davis & Company, Detroit, Michigan 66
Pfizer Laboratories, Div., Chas. Pfizer & Co.,
Inc., New York, N. Y 65
Philips Roxane Laboratories, Columbus, Ohio .... 54
Physicians’ Placement Service, OSMA 80
Professional Building & Equipment Corp.,
Mansfield, Ohio 8
Roche Laboratories, Nutley, N. J 17
J. B. Roerig & Company, New York, N. Y 62
Ross Laboratories, Columbus, Ohio 55
Sandoz Pharmaceuticals, Hanover, N. J 44
W. B. Saunders Company, Philadelphia, Pa 2
The Schuemann- Jones Co., Cleveland, 0 36, 37
G. D. Searle & Co., Chicago, Illinois 58
Siemens Medical of America, Inc.
Hinsdale, Illinois 21
Smith Kline & French Laboratories,
Philadelphia, Pa 56
Smith, Miller & Patch, Inc., New York, N. Y. 40
Spray Lin, Inc., Cleveland, Ohio 19
E. R. Squibb & Sons, New York, N. Y 25
Stiefel Laboratories, Inc., Oak Hill, N. Y 69
Stryker Corporation, Kalamazoo, Mich 64
Swift & Company, Chicago, Illinois 68
3M Company, Business Products Center,
Cleveland, Ohio 48
Turner and Shepard, Inc., Columbus, Ohio 83
S. J. Tutag and Company, Detroit, Michigan .... 74
The Upjohn Company, Kalamazoo, Michigan .... 28
U. S. Vitamin & Pharmaceutical Corporation,
New York, N. Y 24
Wallace Laboratories, Div. of Carter- Wallace,
Inc., Cranbury, N. J 59
Winthrop Laboratories, New York, N. Y 22
Max Wocher & Son Co., Cincinnati, Ohio 67
X-ray Identification Corporation,
Dearborn, Michigan 5
Yale Medical Supply Company,
Royal Oak, Michigan 52
for April, 1966
375
Things to do in ...
CLEVELAND
Listed below are many varied activities,
events and places that may be of interest
to those attending the Annual Meeting.
Included are activities during the period
May 24 - May 31.
BASEBALL
CLEVELAND STADIUM
W. 3rd at Lakeside Avenue
May 27 — 7:30 P. M. Minnesota
May 28 — 2:15 P. M. Minnesota
May 29 — 1:00 P. M. Minnesota
Doubleheader
HORSE RACING
RUNNING RACES
Daily, except Sundays
Post Time — 2:15 P. M.
THISTLEDOWN, Warrensville
Center Rd. at Emery Rd.
NIGHT HARNESS RACES
Post Time — 8:30 P. M.
NORTHFIELD PARK
Northfield, Ohio
BOAT TOURS
THE GOODTIME BOATS — Beginning May 9th
daily River cruise at 10:00 A. M. Starting May
30th, narrated River tours depart daily from E. 9th
St. pier at 11:00 A. M., 2:00 P. M. and 6:30 P. M.
Lake and Harbor cruise daily at 4:30 P. M. Dance
cruises every night, except Monday, at 9:00 and
10:30 P.M.
ERIE VIEW BOATS — Starting May 27 narrated
River tours depart daily from E. 9th St. Pier on
Showboat Paddlewheeler and "Route 66’’ T. V.
Showboat Carol Diane at 11:15 A. M., 1:15, 2:15,
3:15 and 6:00 P. M. Starlight and cruise dances
Friday and Saturday nights at 9:15 P. M. and Mid-
night on Showboat Paddlewheeler. Lake and har-
bor cruises daily. Charter service for dances on
heated Paddlewheeler winter and summer. Tele-
phone 771-0450 or 771-4414.
THEATRE
KARAMU THEATRE — 2355 East 89th St.
Tuesdays through Saturdays, 8:30 P. M.
Sundays, 7:30 P. M.
May 6 - June 25 "The House of Flowers” —
Proscenium Theatre
May 20 - June 25 "The Death and Life of Sneaky
Fitch” — Arena Theatre
LAKEWOOD LITTLE THEATRE
17823 Detroit Avenue
Wednesdays through Saturdays, 8:30 P. M.
May 4 - 28 "Never Too Late”
MUSEUMS
THE CLEVELAND MUSEUM OF ART
11150 East Boulevard
Tuesday, Thursday and Friday — 10:00 A. M. to
6:00 P. M.
Wednesday, 10:00 A. M. to 10:00 P. M.
Saturday, 9:00 A. M. to 5:00 P. M.
Sunday 1:00 to 6:00 P. M. — Closed Mondays
CLEVELAND MUSEUM OF NATURAL HISTORY
10600 East Boulevard
Weekdays, 9:00 A. M. to 5:00 P. M.
Sundays, 1:00 to 5:00 P. M. — Closed Mondays
Observatory open Wednesday evenings, 8:30 to
11:00 P.M.
THE HOWARD DITTRICK MUSEUM OF
HISTORICAL MEDICINE
11000 Euclid Avenue
Monday through Saturday, 1:00 to 5:00 P. M.
Closed Sunday
Nearly 10,000 interesting objects relating to the
history of medicine, dentistry and pharmacy from
all periods of history, with special emphasis on
Cleveland and the Western Reserve.
THE WESTERN RESERVE HISTORICAL SOCIETY
10825 East Boulevard
Weekdays, 10:00 A. M. to 5:00 P. M.
Sundays, 2:00 P. M. to 5:00 P. M. — Closed Mon-
days.
Permanent exhibits of Period Furniture, Costumes,
China, Glass, Lighting Material, Ohio Made Pot-
tery, Transportation and Communication.
AUTO AVIATION MUSEUM OF THE WESTERN
RESERVE HISTORICAL SOCIETY
10825 East Boulevard
Tuesdays through Saturdays, 10:00 A. M. to 5:00
P. M.
Sundays, 2:00 to 5:00 P. M. Closed Mondays.
Exhibit of 130 ancient autos and assorted flying
machines.
376
The Ohio State Medical Journal
THE CLEVELAND HEALTH MUSEUM
891 1 Euclid Avenue
Weekdays, 9:00 A. M. to 5:00 P. M.
Sundays, 1:00 P. M. to 5:00 P. M.
Home of "JUNO” — the Transparent Woman.
SHOPPING
America’s sixth greatest concentration of domestic
and foreign merchandise is to be found in the
major department and specialty stores located be-
tween Public Square and East 14th Street on Euclid,
Prospect and Huron Avenues. Store hours are as
follows :
Monday 9:30 A. M. - 9:00 P. M.
Tuesday 9:30 A. M. - 5:45 P. M.
Wednesday 9:30 A. M. - 5:45 P. M.
Thursday 9:30 A. M. - 9:00 P. M.
Friday 9:30 A. M. - 5:45 P. M.
Saturday 9:30 A. M. - 5:45 P. M.
CHURCH SERVICES
Church services in the downtown area are
listed here for Sunday, unless otherwise noted.
CATHOLIC — St. John’s Cathedral, E. 9th and Su-
perior Ave. Masses: 2:00, 5:15, 6:00, 7:00, 8:00,
9:00, 10:00, 11:00 a. m., 12:15 p. m.
CHRISTIAN SCIENCE — Fourth Church of Christ,
Scientist, 10515 Chester Ave., 11:00 a. m. Wednes-
days, 8:00 p. m.
EMANUEL EVANGELICAL UNITED BRETHREN
CHURCH — W. 14th St. and Starkweather, 10:45
a. m.
EPISCOPAL — Trinity Cathedral, Euclid at E. 22nd
St., 8:00 and 11:00 a. m.
JEWISH — The Temple, Ansel Rd., and E. 105th St.,
Fridays, 5:30 p. m., Saturdays, 11:00 a. m., Sun-
days, 10:30 a. m.
LUTHERAN — Trinity Evangelical Lutheran Church,
2049 W. 30th St., 10:30 a. m.
METHODIST — First Methodist Church, Euclid at
E. 30th St., 10:45 a. m.
MORMON — Church of Jesus Christ of Latter Day
Saints, 9509 Lake Ave., 10:30 a. m.
ORTHODOX — St. Theodosius Cathedral, 733 Stark-
weather St., 8:30 and 10:30 a. m.
PRESBYTERIAN — Old Stone Church on Public
Square, 10:45 a. m.
POINTS OF INTEREST
AQUARIUM — Gordon Park at E. 72nd Street
Weekdays 10:00 A. M. to 5:00 P. M.
Sundays, 12:00 Noon to 6:00 P. M.
Closed Mondays
PLANETARIUM — 10600 East Boulevard
Public programs Saturdays and Sundays at 2:00,
3:00 and 4:00 P. M. Closed Mondays.
BUILDERS EXCHANGE HOME EXHIBITS
1737 Euclid Ave.
Nothing sold. Free exhibit presents best features
and materials for home building and remodeling.
Weekdays 10:00 A. M. to 5:00 P. M. Saturdays,
10:00 A. M. to 12:00 Noon.
NELA PARK — East Cleveland, Noble Rd.
General Electric Lighting Institute. Full-scale dem-
onstrations of advanced lighting for residential,
commercial, and industrial areas. Group programs
by appointment. Tours for business visitors at 10
a. m. and 3 p. m., Monday through Friday. Open
to the public Tuesdays, 7:30 p. m. to 10:00 p. m.
ZOO — West 25th and Brookside Park
Open daily, 10:00 A. M. to 5:00 P. M.
Sundays and Holidays, 10:00 A. M. to 7:00 P. M.
CLEVELAND STADIUM
Seating capacity 80,000. Home of the Cleveland
Indians and Cleveland Browns.
AIRPORT — Cleveland Hopkins International
Among the largest airports in the world. Seven
miles southwest of Cleveland. Home of NASA
flight propulsion research.
TERMINAL TOWER
Eighth tallest building in the world. Observation
floor open daily 9:00 a. M. to 5:00 P. M. Admis-
sion charge.
CLEVELAND PUBLIC LIBRARY
325 Superior Avenue
A world-famous research library, the second largest
public library in the United States.
Drug Information Association,
Allied Groups to Meet
New techniques for processing the enormous
amount of information about drugs that pours from
drug firms, universities, government agencies and
medical organizations will be aired in Chicago on
June 25-26, at the 1966 meeting of the Drug In-
formation Association. "Advances in Drug Informa-
tion Processing” is the theme of the meeting.
The Drug Information Association is a recently-
formed organization which held its first national
meeting in October, 1965. Its membership consists
of representatives of the American Medical Associa-
tion and other medical or para-medical groups, the
Food and Drug Administration and other government
agencies, pharmaceutical firms, and universities. Its
purpose is "to further modern technology of com-
muncation in medical, pharmaceutical and allied
fields.”
for April, 1966
377
Separate Events of Special Groups
During Annual Meeting Week
IN addition to features in the Annual Meeting
Program, cosponsored in many instances, a num-
ber of specialty societies and other special groups
are holding independent meetings, luncheons and
dinners for their respective members during the week
of the OSMA Annual Meeting. Readers should con-
sult the program for parts these groups are playing
in the scientific program.
Following is information on events of special in-
terest announced to The Journal before this issue went
to press.
Wednesday, May 25
Ohio Medical Political Action Committee: 11:30
A. M., luncheon in the Gold Room, Mezzanine Floor
to be followed by Hoyt D. Gardner, M. D., of Louis-
ville, Kentucky, Member of AMPAC Board of Di-
rectors. Dr. Gardner’s talk will be on "Success Can
Be Ours.” The luncheon is $5.00 per person. 1:30
p. mv OMPAC Board Meeting, Parlor 34, Parlor
Floor, Sheraton Cleveland Hotel.
Ohio Psychiatric Association and the Cleveland
Society of Neurology and Psychiatry: 6:00 p. m.
dinner, Lewis Room, Lobby Floor, Sheraton Cleveland
Hotel. First Ewing Crawfis Memorial Address:
"Osier’s 'Way of Life’ amended for the Space of Age.”
Speaker: W. Donald Ross, M. D., President, O. P. A.,
Professor of Psychiatry, University of Cincinnati Col-
lege of Medicine.
Cleveland Ophthalmological Club: 6:30 p. m.,
cocktails and dinner at Wade Park Manor. Guest
speaker: John G. Bellows, M. D., Chicago. Speaking
on "Life History of the Lens.” Tickets at $10 each
may be secured at the door.
OSMA Section for Hospital Directors of Medi-
cal Education: 4:00 p. m., organizational meeting,
Mohawk Room, First Floor followed by OSMA spon-
sored reception for those Hospital Directors in at-
tendance in the Navajo Room, First Floor, Sheraton-
Cleveland Hotel.
Ohio Society of Internal Medicine: 6:30 p. m.,
cocktails followed by dinner at 7:30 P. m., Board of
Directors Meeting, Wigwam Room, First Floor.
Thursday, May 26
Ohio State Surgical Association: 10:30 a. m.,
registration of members in Parlor 34, followed by
Past President’s Luncheon in Parlor 32 at 12:00
Noon in the Sheraton-Cleveland Hotel.
Ohio Psychiatric Association Luncheon and Busi-
ness Meeting: 11:45 a. m., Empire Room, Parlor
Floor, Sheraton-Cleveland Hotel.
Ohio Academy of Medical History: 6:00 P. m.,
cocktails and dinner at the Howard Dittrick Museum
of Historical Medicine, Cleveland Medical Library,
11000 Euclid Avenue. After dinner speaker: Dr.
John J. Beeston, Director of the Cleveland Health
Museum. Title of speech: "1066 and All That.”
8:00 P. M., inspection of rare medical books in the
Cleveland Medical Library.
Ohio Society of Internal Medicine: 6:30 P. M.,
reception followed by a dinner at 7:30 p. m. in the
Grand Ballroom — Terrace, Parlor Floor, Sheraton-
Cleveland Hotel.
Ohio State Surgical Association: 6:30 p. m.,
cocktail hour and banquet, Cleveland Room, Lobby
Floor. Open to other than members by preregistra-
tion. Speaker: Thomas L. Dwyer, M. D., Mexico,
Missouri, President of the American Association of
Physicians and Surgeons. 10:30 p. m., Board of Di-
rectors’ Hospitality Party, Navajo Room, First Floor,
Sheraton-Cleveland Hotel.
Cleveland Society of Anesthesiologists: 6:30
p. M., dinner, Gold and Whitehall Rooms, Mezzanine
Floor.
Jefferson Medical College Alumni Reunion:
6:30 p. m., fellowship hour followed by dinner at
7:30 p. M., in the Terminal Room, Parlor Floor,
Sheraton-Cleveland Hotel.
Ohio Health Commissioners: 6:00 p. m., recep-
tion followed by dinner at 7:00 p. m. in the Erie
and Empire Rooms, Parlor Floor, Sheraton-Cleveland
Hotel.
Friday, May 27
Ohio Chapter, American Academy of Pediatrics:
9:30 A. M., Parlor 24, Parlor Floor, Executive Com-
mittee meeting, Sheraton-Cleveland Hotel.
Ohio State Surgical Association: 12:00 Noon,
Navajo Room, First Floor — New President’s lunch-
eon.
Ohio Orthopaedic Society: 6:30 p. m., cocktails
and banquet in the Grand Ballroom — Terrace, Par-
lor Floor, Sheraton-Cleveland Hotel.
378
The Ohio State Medical Journal
Advance Resolutions, Nominations
To Be Published in May Issue
Resolutions filed at the OSMA Headquarters
Office in advance for presentation at the OSMA
1966 Annual Meeting will be published in the
May issue of The Journal, and copies also
will be mailed to members of the House of
Delegates.
The deadline for filing was March 25. A
resolution not filed with the Executive Secretary
60 days before the meeting may be presented
only if the deadline requirement is waived by
a two-thirds vote of the House.
Only an authorized member of the House of
Delegates may present a resolution, and each
resolution must be presented at the first session
of the House even though it was submitted in
advance. Copies in triplicate are to be fur-
nished at time of presentation.
Under a new provision of the OSMA By-
laws, nominations for the office of President-
Elect are to be made and announced to the
Headquarters Office 60 days in advance of the
election. Information on persons nominated
before the deadline will be published in the
May issue also. These provisions may be waived
only by a two-thirds majority of the House of
Delegates.
Ohio Chapter, American Academy of Pediatrics,
Northern Ohio Pediatric Society and the OSMA
Section on Pediatrics: 8:00 p. mv banquet and
dance, Cleveland Room, Lobby Floor, Sheraton- Cleve-
land Hotel.
Ohio Society of Pathologists: 8:00 p.m., ban-
quet in the Empire and Erie Rooms, Parlor Floor,
Sheraton- Cleveland Hotel.
Ohio Ear, Nose and Throat Society, and Section
on Ear, Nose and Throat: 6:45 p. m., cocktails,
Terminal Room, Parlor Floor followed by dinner at
7:30 P. M. Speaker: Joseph H. Ogura, M. D., St.
Louis, Missouri, "Amusing Experiences in Laryn-
gology over the Years.’’
Ohio Society of Physical Medicine and Rehabil-
itation: 8:00 P. M., dinner in the Navajo Room,
First Floor, Sheraton- Cleveland Hotel.
Saturday, May 28
Ohio Association of Blood Banks: 12:00 Noon,
Gold Room, Mezzanine Floor, Sheraton-Cleveland
Hotel, organizational meeting and luncheon.
Cleveland Health Museum Offers
“Operation Bus Stop”
The Women’s Committee of the Cleveland Health
Museum offers the doctors’ wives a cultural and de-
lightful form of entertainment during the coming
Annual Meeting in Cleveland.
The Committee’s "Operation Bus Stop,” a four-
hour luncheon tour of Cleveland highlights, will be
comprised of the following features:
Hostesses from the Women’s Committee will meet
the women at their hotel at 9:45 a.m. and accompany
them on a descriptive chartered bus trip of the cultural
center of Cleveland. This will include views of the
Lake Erie shoreline and the Cleveland Stadium, home
of the Browns and Indians. The tour proceeds to Uni-
versity Circle which is composed of more than thirty
cultural, educational, medical and service institutions
in a setting of natural and architectural beauty. The
Cleveland Museum of Art and the home of the world-
famous Cleveland Orchestra are located in this area,
and the group will visit the recently opened New
Garden Center of Greater Cleveland.
A stop is in order at the Cleveland Health Mu-
seum, for an hour’s guided tour of this remarkable
and unique institution, the first of its kind in the
country. In addition to exciting displays showing how
the human body functions, new exhibits from the
New York World’s Fair, including an electronic rep-
resentation of the human brain, may be seen.
Luncheon follows at a private town club of choice.
Over the teacups hostesses will suggest shopping tips.
The women will be promptly returned to their hotels
at 2:00 P.M.
Proceeds from "Operation Bus Stop” will further
the progress of the Cleveland Health Museum, that
all may enjoy good health.
Time: 10:00 A. M. to 2:00 p. M. $ 7.50 per person
(minimum 40 people) .
Tour date reservations must be made 3 weeks in
advance.
For further information contact Mrs. Adalyn B.
Ross, Special Tours Representative, Cleveland Health
Museum, 8911 Euclid Avenue, Cleveland, Ohio
44106.
University of Virginia Alumni
Cleveland Reception
A cocktail reception will be held on Thursday eve-
ning, May 26, at about 5:30 p.m. in the Navajo
Room of the Sheraton-Cleveland Hotel, for all medi-
cal alumni, interns, and residents of the University
of Virginia.
Dr. Chester R. Nuckolls, of Cleveland, chairman
for Ohio, will serve as host for the reception, and
Dr. A. J. Gabriele, of Dayton, as cohost. The recep-
tion is scheduled in connection with the Annual
Meeting of the Ohio State Medical Association.
for April, 1966
379
Proceedings of The Council . . .
Report of Matters Discussed and Actions Taken at
Meeting of The Council in Columbus on February 20
A REGULAR MEETING of The Council of the
Ohio State Medical Association was held
- Febmary 20, 1966, at the headquarters of-
fice, Columbus. All members of The Council were
present except Dr. Philip B. Hardymon, Columbus,
Treasurer, and Dr. Robert C. Beardsley, Zanesville,
Councilor of the Eighth District. Others attending
the meeting were: Drs. Richard L. Meiling, Colum-
bus, and John H. Budd, Cleveland, delegates to the
AMA; Messrs. Page, Edgar, Gillen, Traphagan and
Moore, members of the OSMA staff.
AMA Pathologist-Hospital Agreement
Withdrawn
President Crawford read a letter dated February 9
from Dr. F. J. L. Blasingame, Executive Vice Presi-
dent of the AMA, acknowledging Dr. Crawford’s
letter of January 18, in which he raised a number of
questions about a sample form of agreement between
a pathologist and a hospital. This agreement had
been prepared by the AMA Law Department after
consultation with the staff of the College of Ameri-
can Pathologists and with the assistance of the AMA
Department of Hospitals and Related Facilities. Dr.
Blasingame stated that, in view of the objections
from the Ohio State Medical Association, the form
was being withdrawn from further distribution.
Plaques for Physicians Serving
In Vietnam
It was announced that the American Medical Asso-
ciation will issue plaques to physician volunteers who
have served in the project Vietnam program. It was
The Council’s opinion that these should be presented
at the OSMA Annual Meeting.
Minutes Approved
Minutes of the meeting of The Council held De-
cember 11-12, 1965, were approved by official ac-
tion. Minutes of the meeting of the Committee on
Auditing and Appropriations held December 30,
1965, were ratified.
Reports of Councilors
The Councilors reported on activities in their re-
spective districts.
Radiology and Laboratory Services
In connection with the report of the Tenth District,
Dr. Fulton submitted a letter from Dr. William B.
Schwartz, Director, Department of Radiology, River-
side Methodist Hospital, Columbus.
Dr. Schwartz reported that the hospital administra-
tor and the President of Blue Cross of Central Ohio
had been developing a plan that would provide insur-
ance coverage for preadmission outpatient diagnostic
radiology and laboratory services to patients who were
scheduled for subsequent admission to Riverside Hos-
pital. This insurance coverage would be offered by
the Blue Cross Plan. Dr. Schwartz expressed very
strong objection on the part of his group of radi-
ologists to this plan.
Dr. Fulton stated that a committee of the Columbus
Academy of Medicine was investigating this matter.
The Council instructed the Executive Secretary to
communicate with the Columbus Academy of
Medicine and ask for a report of the Academy’s
deliberations and requested that The Council be kept
informed of developments.
1966 Annual Meeting
A progress report on the 1966 Annual Meeting in
Cleveland, May 24 - May 28, was presented by Mr.
Traphagan.
The Council voted to decline with thanks an offer
from the Mead Johnson Company to present an award
in connection with the scientific exhibit.
Six resolutions filed with the Executive Secretary
for the 1966 Annual Meeting in May were referred
to The Council for information.
Ohio Medical Indemnity
A resolution by the Ohio Medical Indemnity Board
of Directors, unanimously adopted at a regular meet-
ing of the Board on January 19, 1966, was received
for the information of The Council. Such resolution
requested the executive office of the National Asso-
ciation of Blue Shield Plans to refrain from issuing
publicity and statements "which imply that the pre-
vailing fees concept is the official policy of the Na-
tional Association of Blue Shield Plans’’ and which
confuse the profession and the public concerning this
and the "usual and customary fee” method of com-
pensation approved and supported by the House of
Delegates of the American Medical Association.
The resolution also pointed out that there are im-
portant basic differences between the so called pre-
vailing fees technique and the usual and customary
fee concept which has been approved by the Ohio
State Medical Association and which is the keystone
of the comprehensive contract of Ohio Medical In-
demnity, Inc. National Blue Shield publicity has
implied that the plans are the same.
The committee to select nominees for the OMI
Board of Directors, to be voted on in April, was an-
nounced by the President, as follows: Dr. Robert E.
Tschantz, Canton, chairman; Dr. Robert N. Smith,
Toledo and Dr. Robert E. Howard, Cincinnati.
380
The Ohio State Medical Journal
An advertisement by Hospital Service Association
of Canton, cosigned by Blue Shield and Blue Cross,
was brought to the attention of The Council by Dr.
Tschantz.
1966 County Society Officers Conference
Mr. Edgar announced plans for the County Medi-
cal Society Officers Conference to be held on Sunday,
February 27, at the Pick Fort-Hayes Hotel.
Meeting of County Society Executive Secretaries
The Council voted to repeat its cosponsorship of
a conference of Ohio county medical society execu-
tives at the AMA Headquarters in Chicago, August
23, the day preceding the annual seminar of the
Medical Society Executives Association and the AMA
Public Relations Institute. The Council authorized
the appropriation of sufficient funds to reimburse
each executive attending to the extent of $75.00.
Resolution To Be Resubmitted to AMA in June
Dr. Budd and Dr. Meiling discussed the coming
meeting of the AMA House of Delegates, June 23,
1966, in Chicago. The Council instructed the dele-
gates and the staff to draft a resolution demanding
that AMA Councils to which resolutions of the AMA
House of Delegates are referred for study or imple-
mentation be obligated to invite representatives of the
originating delegation to hearings which are held on
such resolutions. It was noted that the Ohio dele-
gates were not invited to participate in Council on
Medical Education discussions of Resolution No. 7
on osteopathy (AMA Annual Meeting, 1965) nor
to hearings on Resolution No. 60 regarding definitive
care of American casualties of the war in Vietnam in
the continental United States (AMA Clinical Meet-
ing, 1965).
The Council voted to instruct the Ohio AMA
delegates to resubmit Resolution No. 7 regarding the
eligibility of osteopathic physicians for internships
and residency programs, to the Annual Meeting of
the AMA in 1966. This resolution originated from
Resolution No. 17, Ohio House of Delegates, May,
1965.
The Council reviewed correspondence between Dr.
Meiling and Dr. Milford O. Rouse, Speaker of the
AMA House of Delegates, and voted to instruct the
delegates and staff to draft a resolution for consider-
ation at the next meeting of The Council for possible
presentation to the AMA House of Delegates, em-
bodying the concept of four business meetings of the
AMA House each year in Chicago with ceremonial
meetings and elections being left to the annual and
clinical AMA scientific sessions.
Dr. Budd reported on the initial meeting of the
Committee on Future Development and Planning for
the AMA.
Medicare
Mr. Edgar reported that the Nationwide Mutual
Insurance Company and Medical Mutual of Cleve-
land, Inc., had been chosen as intermediaries in con-
nection with the administration of Part B of Medicare
in Ohio. Ohio Medical Indemnity, Inc., Ohio’s Blue
Shield Plan, applied for consideration as an inter-
mediary7 but was not one of those chosen.
Dr. Light, who had been appointed by President
Crawford as an OSMA representative on the Medical
Care Advisory Committee to the Ohio Director of
Public Welfare on medical assistance problems, re-
ported on a meeting of this committee held on Feb-
ruary 18. Dr. Light said that one of the problems
being faced by the Welfare Department is that, by
virtue of the Medicare Law, many of the department’s
costs are cared for under Part A of the Act and that
it is indicated that $8,000,000 of the present budget
might become available. The concept of using such
funds to buy Part B insurance is being considered by
the department. The Advisory Committee is so
recommending.
Mr. Edgar reported that in discussions of Title 19,
wherein all five major programs will be combined
in Ohio, the idea of paying the individual physician’s
usual and customary fee is being presented by the
OSMA to the Welfare Department officials and that
the Ohio Citizens Council for Health and Welfare, a
voluntary organization in the welfare field, is investi-
gating this concept for possible recommendation to
the Welfare Department.
S. B. 2568, the Hart Bill
The Council discussed Senate Bill 2568, the Hart
Bill, which would prohibit the dispensing of phar-
maceuticals, "devices” and "other products” by physi-
cians at a profit. The definition of the term "profit”
in the bill is "any markup above the actual cost of
the product” to the physician. Also covered is any
discount, refund, rebate, commission, rental for space
leased from a physician based on a percentage of
income from drugs or "devices” sold by the tenant.
On motion duly made, seconded and carried, The
Council voted to oppose Senate Bill 2568.
Drug Abuse Control Amendments of 1965
Mr. Page distributed communications which had
been prepared and issued by the Columbus office to
keep physicians informed about the Drug Abuse Con-
trol Amendments of 1965, P. L. 89-74.
Dirksen Amendment, S. J. R. 103
The Council discussed S. J. R. 103, known as the
Dirksen Amendment, which is being considered by
the 1966 session of the Congress and which would
permit geographical factors to be taken into consider-
ation in determining the districts from which mem-
bers of one of the houses of two-house state legisla-
tures are elected. By official action, The Council
voted to support S. J. R. 103 and to send out infor-
mational materials on the proposal to the membership.
Federal Unemployment Compensation Bill
House Resolution 8282, the Federal Unemploy-
ment Compensation Bill, was then discussed. It was
pointed out that this bill would force Federal stand-
for April, 1966
381
ards on state unemployment insurance at huge in-
creases in cost; that small businessmen and profes-
sional people, who now employ one or two and who
are not now subject to the tax, would be required to
pay both Federal and State Unemployment Taxes. It
was also stated that the enactment of the bill would
be the beginning of the end of merit rating in unem-
ployment compensation so that small businessmen
and professional men whose employees are not gen-
erally laid off by slack periods would be taxed at the
same rates as industry with poor employment experi-
ence. The Council voted to actively oppose H. R.
8282.
Ohio Association of Blood Banks
A request for the endorsement of the organization
of Ohio Association of Blood Banks was referred
to the Committee on Laboratory medicine.
Physician Ownership of Pharmacies and
Physician Dispensing
Regarding a request for advice on a resolution from
the National Council of State Pharmaceutical Asso-
ciation Executives with regard to the AMA policy on
physician ownership of pharmacies and physician dis-
pensing, The Council expressed the opinion that the
current AMA position on this matter is sound.
Medical Doctors Practicing in Osteopathic
Hospitals
In answer to a request for an opinion on the
ethics of medical doctors practicing in osteopathic
hospitals, The Council reaffirmed that it is the respon-
sibility of each county medical society in Ohio to
determine whether it is, or is not, ethical for members
of that society to voluntarily associate professionally
with doctors of osteopathy, and that the statement
adopted December 16-17, 1961, as the official policy
of the Association still applies.
The four-point criteria recommended for use in
determining the professional, ethical and scientific
standing of a doctor of osteopathy is as follows:
"(1) The doctor of osteopathy must have qual-
ified to practice osteopathic medicine and surgery
under the Ohio Medical Practice Act as amended
in 1943 which confers on him unrestricted rights
and legal recognition in Ohio as a physician.
"(2) He must practice a method of healing
founded on the principles of scientific medicine.
"(3) He must in good faith endeavor to con-
form to ethical principles equivalent to the Prin-
ciples of Medical Ethics of the AMA.
"(4) His professional and scientific com-
petence must be such that he can give his patients
scientific medical care and make contributions to
programs to maintain and improve the health of the
community.
"In the opinion of The Council of the Ohio
State Medical Association voluntary professional
association between a doctor of medicine and a
doctor of osteopathy who meets all the foregoing
basic standards would not be deemed unethical.”
Woman’s Auxiliary
The Council endorsed the proposed program of
the Woman’s Auxiliary to conduct precinct action
training courses and a doctor-wife voter registration
campaign.
Travel Plan Request Approved
A request from the Cleveland Academy of Medi-
cine for permission to include OSMA members in
clinical or recreational trips arranged by the Travel
Committee of the Cleveland Academy of Medicine
was approved.
World Medical Association
The Executive Secretary was instructed to advise
the U. S. Committee of the World Medical Associa-
tion that funds would not be available for a contribu-
tion to that committee in 1966.
OSMA Group Life Insurance Plan
A report from Turner and Shepard on the OSMA
Group Life Insurance Plan for the period March 1
to September 1, 1965, was accepted for information.
Mahoning County Amendments
Amendments to the Constitution and Bylaws of
the Mahoning County Medical Society were ap-
proved, subject to the rewording of the language
as suggested by the OSMA legal counsel.
OSMA Sponsored Major Medical Insurance
A request from Daniels-Head, Inc., for permission
to waive underwriting for new OSMA members un-
der age 40 years in connection with the OSMA spon-
sored major medical insurance was granted.
Funds for Student AMA
A request from the OSU Chapter, Student AMA,
for funds to assist with the entertaining of student
AMA members at the regional meeting of the or-
ganization in Columbus, April 2, was considered.
The Council appropriated $275.00 to sponsor the
dinner meeting of the registrants.
Workmen’s Compensation
The Council endorsed the recommendation of the
Committee on Workmen’s Compensation that of-
ficers and staff of the Ohio State Medical Association
meet with the officials of the Ohio Manufacturers’
Association to explain to them the usual and custom-
ary fee concept as applied to Ohio Workmen’s
Compensation.
Doctor Draft Situation
Mr. Edgar told of developments in the doctor draft
situation and indicated that this activity of the Ohio
State Medical Association has again grown to the
extent that much of the chairman’s office time is taken
up with telephone calls, delegations and correspond-
ence with regard to military advisory activities.
Date Set for Next Meeting
The date for the next meeting of The Council
was established as March 20, 1966.
Attest: Hart F. Page,
Executive Secretary
382
The Ohio State Medical Journal
In Our Opinion
Comments on Current Economic, Social
And Professional Problems
MEDICO HELPS PEOPLE TO HELP
THEMSELVES; MERITS SUPPORT
Many people associated with the medical field are
unfamiliar with the work being done overseas by
doctors, nurses and technicians who have unselfishly
volunteered their time (often at their own expense)
to work for MEDICO, the Medical International
Cooperation Organization, founded in 1958 by Dr.
Peter D. Comanduras and the late Dr. Tom Dooley.
This humanitarian organization became a service
of CARE, Inc., in 1962 and since then has expanded
its operations to many more Latin American, African,
and Asian countries and, in a typical year, has helped
half a million diseased and maimed persons on the
road to better health.
MEDICO’S advisory board includes many out-
standing leaders of the American medical profes-
sion in both the United States and Canada, and it
has been endorsed by 22 important medical, surgical,
and allied specialty organizations, such as the Ameri-
can College of Surgeons and the American College
of Physicians. Dr. Charles Hauser, of Hamilton,
Ohio, has been appointed Assistant Executive Direc-
tor of CARE in charge of MEDICO service.
There is a great need for personnel to man the
overseas medical staffs and for contributions to con-
tinue their work. Physicians can help spread infor-
mation about the work MEDICO is doing to friends
and associates, perhaps by suggesting they include
a MEDICO program in their county society programs.
The Columbus CARE office will supply speakers,
films (13 V2 minutes in color), pamphlets and slides.
Interested persons may contact MEDICO by phon-
ing Columbus 224-3858, or writing to MEDICO at
8 East Chestnut Street, Columbus, Ohio 43215.
MEDICO is devoting its efforts to helping people
help themselves. In our opinion, it merits support.
CONTINUING EDUCATION,
A MARK OF THE PROFESSION
Physicians are attending "refresher courses” and
postgraduate education programs at ever increasing
rates, according to the recent report of the AMA
Council on Medical Education.
The number of refresher courses has increased by
more than 50 per cent in the past five years. More
than 71,000 physicians were registered in only half
of the total number of courses offered last year, com-
pared to about 18,000 in the 1954-1955 season.
The constant pace to study, to know, to keep up
with the changing pace in clinical experience, in re-
search, in development of drugs and equipment, is
only one facet of professional life. It is a facet that
will and does color the public "doctor image.”
In this issue of The Journal are details on a num-
ber of Fall postgraduate programs being offered in
Ohio. The AMA listing in a recent issue of JAMA
gives some 1,641 postgraduate courses throughout
the country, many of them in Ohio.
There is no other field, whether profession, craft
or art, in which the individual constantly strives to
equip himself for better service. It should be com-
fort to the American people to know that good
doctors never stop studying, and today’s physicians
are studying more than ever.
EMOTIONAL PROBLEMS RELATED TO
HEALTH OF SCHOOL CHILDREN
Emotional problems comprise the largest single
group of health problems in the schools, according
to a resolution on "Guidance and Health” adopted
by the Joint Committee on Health Problems in Edu-
cation of the National Education Association and the
American Medical Association.
Observing further that such problems are frequently
multiple in origin as well as in manifestation, the
committee’s resolution states that medical aspects of
such problems must not be overlooked.
The resolution concludes with the recommendation,
"That schools establish policies and protocol to insure
that each member of the team — such as teachers,
psychiatrists, guidance personnel, psychologists, social
workers, and physicians — function according to his
ability and qualification, and that medical consultation
always be available and utilized in the approach to
these problems . . . That personnel responsible for
guidance have adequate preparation in the area of
health.”
These are points well taken by the joint committee
and deal with matters that need serious consideration
in liaison between local County Medical Societies and
school authorities.
for April, 1966
383
• • •
OMPAC Membership Hits 2,610
About 26% of Members Have Affiliated; Crawford
County and the Tenth District Lead in Percentage
MEMBERSHIP in the Ohio Medical Political
Action Committee stood at 2,6 10 on March
*■ 15. Membership cards have been mailed to
approximately 2,000 physicians. Cards are mailed
periodically. An effort is made to keep a steady
flow of cards in the mail.
As of March 15, almost 26 per cent of the mem-
bership of the Ohio State Medical Association
(10,042) had affiliated with OMPAC.
The Tenth and Second Councilor Districts were
running neck and neck for OMPAC membership
honors on a percentage basis. On March 15, the
Tenth District had 428 OMPAC members. Its
OSMA membership is 1103, giving it an OMPAC
percentage membership of 39-3 per cent. The Second
District with 892 OSMA members has 349 OMPAC
members or 39.1 per cent.
Crawford County with 39 Ohio State Medical As-
sociation members was way ahead of the field with
35 OMPAC members or 89.7 per cent of its mem-
bers affiliated with OMPAC.
A number of Woman’s Auxiliary members have
joined OMPAC during the past month, dues having
been paid directly to OMPAC at P. O. Box 5617,
Columbus, Ohio 43221.
Key Elections in Ohio
Widespread interest in the Ohio Medical Political
Action Committee is picking up. In all probability
this has been stimulated by a realization that Ohio
will be one of the major battle grounds in the Con-
gressional elections on next November 8. Hot con-
tests are being anticipated in five or six of the Ohio
Congressional districts. The results in these districts
could make a substantial change in the make-up of
Ohio’s Congressional delegation. Physicians are be-
ginning to realize that and they are getting anxious
to get into the fray with help for their favorite
candidates.
Physicians in most counties may acquire member-
ship in OMPAC by paying the $25.00 OMPAC an-
nual dues to the secretary-treasurer of their County
Medical Society. In counties where collections are not
being carried on in this manner, physicians may af-
filiate by sending dues directly to OMPAC, Post
Office Box 5617, Columbus, Ohio 43221.
OMPAC Membership By Counties
Following is a tabulation showing the OSMA mem-
bership on last December 31 in the various counties,
arranged by districts; the Ohio Medical Political Ac-
tion Committee membership as of March 15, 1966;
and the percentage of OMPAC members per district:
First District
Adams
Brown
Butler
Clermont
Clinton
Hamilton
Highland
Warren
OSMA
Membership
14
15
174
28
22
1243
19
16
OMPAC
Membership
to date
1
6
71
4
5
409
0
0
% OMPAC
Membership
1531
496
32.4
Second District
Champaign
17
0
Clark
128
54
Darke
24
7
Greene
49
19
Miami
62
37
Montgomery
579
217
Preble
11
0
Shelby
22
15
892
349
39.1
Third District
Allen
124
70
Auglaize
16
2
Crawford
39
35
Hancock
47
3
Hardin
26
0
Logan
18
0
Marion
66
13
Mercer
21
2
Seneca
45
22
Van Wert
20
0
Wyandot
11
3
433
150
34.6
Fourth District
Defiance
21
4
Fulton
17
3
Henry .
15
7
Lucas
613
13
Ottawa
23
7
Paulding
7
1
Putnam ...
12
0
Sandusky
46
13
Williams
18
0
Wood —
42
2
815 50 06.1
( Continued on Next Page )
384
The Ohio State Medical Journal
OMPAC Membership
( Contd.)
OSMA
OMPAC
% OMPAC
Membership
Membership
Membership
Fifth District
to date
Ashtabula
59
17
Cuyahoga
2315
384
Geauga
24
10
Lake
108
57
2506
468
18.6
Sixth District
Columbiana
67
5
Mahoning
336
85
Portage
55
26
Stark
354
172
Summit
572
0
Trumbull
134
52
1518
340
22.4
•
Seventh District
Belmont
55
18
Carroll
10
6
Coshocton ____
25
1
Harrison
7
6
Jefferson
63
2
Monroe
3
0
Tuscarawas
51
26
214
59
27.5
Eighth District
Athens
37
13
Fairfield
53
34
Guernsey
29
4
Licking
69
1
Morgan ___
3
0
Muskingum
73
26
Noble
2
1
Perry
10
3
Washington
30
0
306
82
26.7
Ninth District
Gallia
33
3
Hocking
9
1
Jackson
16
0
Lawrence
22
15
Meigs
6
0
Pike
11
0
Scioto
68
33
Vinton
1
0
166
52
31.3
Tenth District
Delaware
27
7
Fayette
16
12
Franklin
928
357
Knox
36
25
Madison
14
2
Morrow ...
8
2
Pickaway
17
6
Ross
39
21
Union
18
2
1103
434
39.3
Eleventh District
Ashland
25
6
Erie „
67
0
Holmes
10
6
Huron
28
13
Lorain ___
193
58
Medina
57
18
Richland
119
1
Wayne
60
28
559 130 23.2
Methodist Hospital Graduate Medical Center
Indianapolis, Indiana
Invites Practicing Physicians
To
Attend a Graduate Course on
ALLERGIC DISEASE AND
IMMUNE MECHANISM
May 20, 21 and 22, 1966
This course will cover the field of allergy from a
practical viewpoint. Demonstrations of proper skin
testing techniques and methods of treatment will be
included.
The registration fee ($35.00) will include a book
which will cover the practical care of allergic disease.
The entire course is geared to help the practicing
physician better care for the allergic patient. The
book will contain all the lectures in detail, as well as
aspects which cannot be completely covered within
a few days.
The lectures will be supplemented by Koda-
chrome studies and round table discussions with ques-
tion and answer periods.
The program is approved for 15 hours credit in
Category I by the American Academy of General
Practice.
For further information write:
Department of Medical Education
Methodist Hospital Graduate Medical Center
Indianapolis, Indiana 46207
THE WENDT-BRISTOL COMPANY
GENERAL OFFICES
AND DISPLAY ROOM
1159 Dublin Road — Columbus 12, Ohio
HU 6-9411
PLENTY OF PARKING SPACE
A Complete Source of Supply
EVERYTHING FOR THE DOCTOR
and HOSPITAL
Surgical Instruments
Office & Treatment Room Furniture
X-ray and X-ray Supplies
Sterilizing, EKG and Anesthesia Equipment
Pharmaceuticals
EVERYTHING FOR THE PATIENT
Drive-in Prescription & Retail Store
Sickroom Supplies
Hospital Beds (Rental or Sale)
Wheelchairs (Rental or Sale)
Surgical Garments fitted by
Trained Male and Female Fitters
Columbus Branch Stores
BUTTLES UNIVERSITY
721 N. High Street 1660 Neil Ave.
CA 1-3153 AX 1-7048
DOWNTOWN
26 S. Third Street
(Next door to the Dispatch )
CA 1-5105
Worthington Branch
(Serving North Columbus and Worthington Areas)
1000 High Street Worthington, Ohio
Phone 885-4079
for April, 1966
385
Obituaries
Ad Astra
Helen Jackson Alexander, M. D., Cincinnati; Uni-
versity of Cincinnati College of Medicine, 1933;
aged 55; died February 6; member of the Ohio State
Medical Association. A physician in the Cincinnati
area, Dr. Alexander practiced under her maiden name
of Helen Jackson. Her specialty was in the field
of anesthesia. Survivors include her husband, Clar-
ence Alexander, a son, a daughter, her father and a
brother.
William F. Ashe, Jr., M. D., Columbus; Western
Reserve University School of Medicine, 1936; aged
56; died February 27; member of the Ohio State
Medical Association, the American Medical Associa-
tion, American Academy of Occupational Medicine,
Industrial Medical Association, American College of
Preventive Medicine, and the Aerospace Medical As-
sociation; Fellow of the American College of Physi-
cians. A former practicing physician in Gallipolis,
Dr. Ashe in recent years was chairman of the Depart-
ment of Preventive Medicine at Ohio State Univer-
sity College of Medicine. He retired last year and
was named emeritus professor of preventive medi-
cine. Before joining the OSU faculty, Dr. Ashe
served a tour in India as consultant in thermal and
environmental health, and in 1964 was vice-president
of the American College of Preventive Medicine. He
served from 1953 to 1958 on the OSMA Committee
on Scientific Work. Surviving are his widow, four
daughters, a son, four brothers and a sister.
Olen Dighton Ball, M. D., New Lexington; Ohio
State University College of Medicine, 1935; aged
60; died February 16; member of the Ohio State
Medical Association, the American Medical Associa-
tion, and the American Academy of General Practice;
past president of the Perry County Medical Society;
former delegate and alternate delegate to the OSMA
House of Delegates. A practicing physician of long
standing in New Lexington, Dr. Ball established the
Ball Clinic there in 1935. He was active in local
affairs; served in all offices of the local Medical So-
ciety and on numerous of its committees. He also
was Perry County coroner; was a veteran of World
War II, and belonged to the Methodist Church, and
the Masonic, Elks and Eagles Lodges. Surviving are
his widow, two daughters, three sons, his father and a
sister.
Alletta Maribel Bare, M. D., Cincinnati; Univer-
sity of Cincinnati College of Medicine, I960; aged 34;
died February 8 as the result of accidental gas poison-
ing; member of the Ohio State Medical Association
and the American Medical Association. After receiving
her medical degree, Dr. Bare took advanced training
at the University of Nebraska and at Cincinnati
General Hospital. Her practice was in the field of
internal medicine. Born in China, the daughter of
medical missionaries, she is survived by her mother
who now lives in Portsmouth.
Irwin Henry Boesel, M. D., Springfield; Univer-
sity of Michigan Homeopathic Medical School, 1909;
aged 79; died February 24; member of the Ohio State
Medical Association, and the American Medical As-
sociation. A general practitioner in the Springfield
area for some 42 years, Dr. Boesel was a veteran of
World War I, during which he served in the Army
Medical Corps. Affiliations included memberships in
several Masonic bodies and in the Church of God.
His widow, a son, two sisters, and a brother survive.
George S. Buttemiller, Sr., M. D., Cincinnati;
Medical College of Ohio, Cincinnati, 1901; aged 87;
died February 3; member of the Ohio State Medical
Association and the American Medical Association.
Dr. Buttemiller was retired after practicing for many
years in the Cincinnati area where he specialized in
obstetrics and gynecology. Survivors include his
widow and a son, Dr. George S. Buttemiller, Jr.
Lawrence I. Clark, M. D., Toledo; St. Louis Uni-
versity School of Medicine, 1923; aged 68; died
February 8; member of the Ohio State Medical Asso-
ciation, the American Medical Association, and the
American Academy of Pediatrics; diplomate of the
American Board of Pediatrics. A native of Toledo,
Dr. Clark served most of his professional career
there, specializing in pediatrics. Among special in-
terests, he was director of pediatrics at Opportunity
Home and the Convalescent Home for Crippled Chil-
dren. He was a member of the Catholic Church and
the Holy Name Society. Surviving are his widow,
two sons and a daughter.
Paul Josef Collander, M. D., Ashtabula; medical
degree from Helsingfors University, Helsinki, Fin-
land, 1903; aged 91; died February 10; member of
the Ohio State Medical Association and the American
Medical Association; diplomate of the American
Board of Radiology. A native of Finland, Dr. Col-
lander came to this country early in his career and
began parctice in Ashtabula in 1910. For many
years he was the Finnish vice-consul, and during
World War I served in the Medical Corps. He was
a member of the Elks Lodge, the Exchange Club,
Chamber of Commerce, and the Congregational
Church. A son and a daughter survive.
George Thomas Day, M. D., Cleveland; Stritch
School of Medicine of Loyola University, 1934; aged
386
The Ohio State Medical Journal
The Ohio State Surgical Association presents . . .
MEDICARE:
Another
Viewpoint”
by THOMAS L. DWYER, M.D
Mexico, Missouri
President
Association of American
Physicians and Surgeons
THURSDAY, MAY 26th
CLEVELAND
Dr. Dwyer will speak at a banquet in the Cleveland Room of the Sheraton Cleveland Hotel which
is open to non-members of OSSA by pre-registration. Dr. Dwyer’s appearance is the Association's
contribution to the combined medical meeting idea actively sought by OSMA. We regret that Dr.
James Z. Appel, President of the American Medical Association, could not appear on the program
with Dr. Dwyer, but we have announced to our membership that the earlier talk by Dr. Charles L.
Hudson, President-Elect of the AMA, on “Medicare’s Rules and Regulations and Their Effect on
the Practice of Medicine,” as well as the Friday speech by Dr. Edward R. Annis, Past President of
AMA, on “Care of the Patient, 1966," should be considered a part of our Association’s total pro-
gram. From these three offerings on the Medicare program, it is hoped that our membership can
obtain the information they need to arrive at an individual decision on the matter of Medicare
participation or non-participation. The Association itself has not taken a stand. Please com-
plete and mail the form below if you wish to attend the banquet at which Dr. Dwyer will speak.
ROBERT G. SMITH, M. D.
President
.tickets at $10.00 each for the Ohio State Surgical Association reception and banquet at which Dr.
Please reserve
Thomas L. Dwyer, President of the Association of American Physicians and Surgeons, will speak.
Enclosed is my check for
reception hour preceding the banquet.
I will pay upon arrival.
Thank you.
_. I understand that there will be no additional charges during the
name (please print or use stamp)
address
member
non-member
Mail to: Ohio State Surgical Association
526 E. Dunedin Rd.
Columbus, Ohio 43214
59; died February 20; member of the Ohio State
Medical Association, the American Medical Associa-
tion, and the American Academy of General Practice.
Dr. Day’s practice in the Cleveland area extended
over approximately 30 years. During World War II,
he served in the Medical Corps of the Navy and at-
tained the rank of lieutenant commander. A member
of the Catholic Church and the Holy Name Society,
he is survived by his widow, a son and four daughters.
J. Gordon Griffin, M. D., Akron; Western Re-
serve University School of Medicine, 1905; aged 86;
died February 24; former member of the Ohio State
Medical Association. Dr. Griffin moved to Akron
in 1914 and practiced there until his retirement in
1957. He previously practiced in Lorain and on
Kelley’s Island. Among affiliations, he was a mem-
ber of the Elks Lodge. A daughter survives.
William C. Gutermuth, M. D., Versailles; Hos-
pital College of Medicine, Louisville, 1893; aged 93;
died February 22; member of the Ohio State Medi-
cal Association and the American Medical Associa-
tion. Dr. Gutermuth’s practice in the Versailles area
extended from 1894 until his retirement in 1949.
Among affiliations, he was a member of the Lutheran
Church, a past master of the Masonic Lodge and
belonged to other Masonic orders. Survivors include
three sons, a daughter, a brother, and three sisters.
Harold K. Harris, M. D., Columbus; Ohio State
University College of Medicine, 1925; aged 65; died
February 11; member of the Ohio State Medical
Association and the American Medical Association.
A practicing physician of long standing in Colum-
bus, Dr. Harris was one of the founders of Lincoln
Memorial Hospital. Among affiliations, he held
memberships in several Masonic bodies. Three step-
daughters and a step-son survive.
Lothar Z. Hoffer, M. D., Lorain; Medical Faculty
of the University of Hamburg, 1923; aged 70; died
February 11; member of the Ohio State Medical As-
sociation, the American Medical Association and the
American Academy of General Practice. A native of
Germany and former practitioner in Hamburg, Dr.
Hoffer came to this country in 1938 and began prac-
tice in Lorain in 1940. He was a member of the
Temple, the Zionist Organization, and B’nai B’rith.
Among survivors are his widow, a son, and a brother.
Ralph W. Holmes, M. D., Chillicothe; Ohio Medi-
cal University, Columbus, 1901; aged 89; died Feb-
ruary 1; member of the Ohio State Medical Associa-
tion, the American Medical Association, American
Roentgen Ray Society, Radiological Society of North
America; diplomate of the American Board of Radi-
ology; past president of the Ross County Academy
of Medicine. A practitioner of long standing in
Chillicothe, Dr. Holmes pioneered in radiology. For
many years he was radiologist for the Chillicothe
Hospital and was also consultant to the VA Hospital
and Federal Reformatory Hospital. In addition to
numerous local activities, he was a member of the
board of directors and past president of the Ohio
Society for Crippled Children and Adults, and past
president of the Ohio State Radiological Society; also
a member of the Silicosis Board of the Ohio Indus-
trial Commission. A veteran of World War I, he
was a member of the Rotary Club, the Sunset Club,
and the Elks Lodge. Surviving are his widow and
two sons, one of whom is Dr. Nicholas H. Holmes,
also of Chillicothe.
Edward J. Keefe, M. D., East Cleveland; Western
Reserve University School of Medicine, 1930; aged
62; died February 26; member of the Ohio State
Medical Association and the American Medical As-
sociation. After completing his internship at St.
Vincent Charity Hospital, Dr. Keefe established his
practice in East Cleveland 35 years ago. His field
was general practice and general surgery. Among
affiliations, he was a member of the Catholic Church
and the Holy Name Society. Surviving are his
widow, three daughters, four sons, his mother, two
sisters and two brothers.
Richard S. Knowlton, M. D., Cleveland; Univer-
sity of Rochester School of Medicine, 1933; aged 58;
died February 18; member of the Ohio State Medical
Association and the American Medical Association.
A native of Mantau, Dr. Knowlton practiced for
three decades in Cleveland. He also maintained a
home in Ashtabula and did some practice there. He
was a veteran of World War II, during which he
served in the Army Medical Corps, and was a 32nd
Degree Mason. Survivors include his widow and a
brother, Dr. Edward A. Knowlton, of Mantau.
Jorge Anibal Leon, M. D., Columbus; medical
degree from the University at Quito, Ecuador; aged
40; died February 14; member of the Ohio State
Medical Association, the American Medical Associa-
tion, and the American Thoracic Society. Dr. Leon
was taking residency training in chest diseases as a
member of the staff of Benjamin Franklin Hospital.
He had previously engaged in the practice of internal
medicine in Columbus. Survivors include his widow,
three sons, his mother, and several brothers and
sisters.
Edgar James March II, M. D., Canton; University
of Rochester School of Medicine, 1941; aged 54; died
February 20; member of the Ohio State Medical As-
sociation. A life resident of Canton, Dr. March
began practice there in 1945. He was a veteran of
World War II, during which he served in the Army
Medical Corps. Affiliations included memberships
in the Masonic Lodge and the Baptist Church. Sur-
viving are his widow, three daughters and five sons.
Lester William McDevitt, M. D., Cincinnati; Har-
vard Medical School, 1921; aged 71; died February 3;
former member of the Ohio State Medical Associa-
tion and the American Medical Association; Fellow
of the American College of Surgeons. A physician
388
The Ohio State Medical journal
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for April, 1966
389
and surgeon of long standing in Cincinnati, Dr. Mc-
Devitt’s specialty was obstetrics and gynecology. He
was a veteran of World War I, having volunteered
as a fighter pilot with the British forces. Survivors
include a daughter, a son, and a sister.
Isidora Baldovino Nonato, M. D., Cleveland; Col-
lege of Medicine Southwestern University, the Philip-
pines, 1963; aged 36; died February 14. Dr.
Nonato came to Cleveland for advanced training after
receiving her medical degree in the Philippines. She
had only recently joined the staff of Evangelical Dea-
coness Hospital as an intern. She was married to
Dr. Jose C. Nonato, a Manila physician who also
was studying in Cleveland. He survives with an
infant son.
John Dexter Osmond, Sr., M. D., Lyndhurst-May-
field; Western Reserve University School of Medicine,
1909; aged 84; died February 17; member of the
Ohio State Medical Association, the American Medi-
cal Association, American Roentgen Ray Society, Radi-
ological Society of North America; diplomate of the
American Board of Radiology. A practitioner of long
standing in the Cleveland area, Dr. Osmond special-
ized in radiology, and was one of the few specialists
in this field who served overseas in the Army Medical
Corps during World War II. He was a charter
member of the Cleveland Radiological Society and a
former director of the Academy of Medicine of Cleve-
land. He was a past president of the Lions Club,
past commander of the local American Legion post,
a 32nd Degree Mason, and an elder in the Presby-
terian Church. Survivors include a daughter and a
son, Dr. John D. Osmond, Jr.
Alexander Poliak, M. D., Cleveland; medical de-
gree from the university in Prague, 1923; aged 66;
died February 9; former member of the Ohio State
Medical Association and the American Medical Asso-
ciation. A former practitioner in Czechoslovakia, Dr.
Poliak endured imprisonment in the Dachau Concen-
tration Camp during World War II before he came
to this country. His practice in Cleveland was in the
field of general practice and internal medicine. His
widow and a daughter survive.
Harry William Reck, M. D., Dayton; Ohio State
University College of Medicine, 1917; aged 69; died
February 19; member of the Ohio State Medical As-
sociation and former member of the American Medi-
cal Association. Dr. Reck interned at St. Elizabeth
Hospital then went into service with the Army dur-
ing World War I. He returned to Dayton after the
war and practiced there until last year. In addition
to his private practice, he was school physician for
many years. A member of the American Legion and
several Masonic bodies, he is survived by his widow
and two daughters.
Carl Walker Sawyer, M. D., Marion; Rush Medi-
cal College, 1906; aged 84; died February 22; mem-
ber of the Ohio State Medical Association, the Ameri-
can Medical Association, American Psychiatric Asso-
ciation, Central Neuropsychiatric Association; Fellow
of the American College of Physicians; diplomate of
the American Board of Psychiatry and Neurology. A
physician of long standing in the Marion area, Dr.
Sawyer was the son of the late Dr. Charles E. Sawyer,
physician to President Warren G. Harding and foun-
der of the Sawyer Sanatorium. Dr. Carl Sawyer’s
practice was largely associated with the sanatorium,
but in addition to his professional associations, he
was known as a writer, lecturer and historian. One
of his most dedicated services in the community was
that as president of the Harding Memorial Associa-
tion. Closely associated in the practice and other
activities of Dr. Sawyer is his surviving son, Dr.
Warren C. Sawyer.
Edward Joseph Smyka, M. D., Lyons; St. Louis
University School of Medicine, 1939; aged 52; died
February 19. Dr. Smyka had opened an office in the
Lyons community only a few months ago, after mov-
ing there from Detroit. He is survived by his widow
and two children.
Chester Paul Widmeyer, M. D., Akron; Ohio
State University College of Medicine, 1941; aged 59;
died December 30; member of the Ohio State Medical
Association and the American Academy of General
Practice; former member of the American Medical
Association. A general practitioner in Akron, Dr.
Widmeyer began practice there after serving in the
Army Medical Corps during World War II.
James Rucker Williams, M. D., Pueblo, Colorado;
University of Cincinnati College of Medicine, 1947;
aged 41; died February 14. A former resident of
Cincinnati, Dr. Williams left the state after receiv-
ing his medical degree. His specialty field was neuro-
surgery. His widow, three children, his parents, and
a sister survive.
OSU School of Nursing Is Given
Federal Grant for Building
The Ohio State University School of Nursing has
received a $1,165,000 construction grant from the
U. S. Public Health Service to help finance a new
building.
Total cost for the building is estimated at $2,-
170,000 with $1,000,000 already earmarked for the
project from the 1963 bond issue approved by Ohio
voters.
The building will be located on Neil Avenue
between 9th and 10th Avenues. It will be a three-
story structure, with the basement used for lockers, a
student lounge and service areas.
The new building will permit the School of Nursing
to increase student capacity from 231 to 308 students
for the entering class.
Construction will begin in 1966, with occupancy
planned for 1967.
390
The Ohio State Medical Journal
Frank E. Foss, M. D., Toledo, left, and Nicholas H. Holmes, M. D., Chillicothe, center, discuss plans for the Ohio
State Surgical Association annual meeting in Cleveland Thursday and Friday, May 26th and 27th, with Robert G. Smith,
M. D., Circleville, President. This is the second year the surgical group has met in conjunction with OSMA. OSSA
is sponsoring the appearance of Thomas L. Dwyer, Mexico, Mo., president of the Association of American Physicians
and Surgeons, at a banquet in Cleveland Room of the Sheraton Cleveland Hotel on Thursday evening which is open
to non-members by preregistration. A registration form appears elsewhere in this issue.
Heart Association Luncheon Speaker
Will Be Noted Cardiologist
Lewis E. January, M. D., president-elect of the
American Heart Association and professor of internal
medicine (cardiology), University of Iowa, will be
the luncheon speaker at the Annual Meeting of the
Ohio State Heart Association to be held Wednesday,
May 25, at the Pick-Carter Hotel in Cleveland.
The theme of the all-day meeting for heart volun-
teers throughout the state will be "Heart Attack and
Stroke Risk Reduction.”
All interested physicians are invited to hear Dr.
January at the luncheon session and can get further
information on this meeting by contacting the Ohio
State Heart Association, 10 East Town Street, Colum-
bus, Ohio 43215.
Caribbean Territories Sales Group
Gets Cease and Desist Order
The Division of Securities, Department of Com-
merce of the State of Ohio, has issued a cease and
desist order in the matter of the solicitation for sale
of unregistered interest in foreign real estate located
in the Caribbean Territories and the Bahamas to Ohio
residents in Ohio by Trans Caribbean Research Corp.,
4333 St. Catherine Street West, Montreal, Quebec.
Fellowships in Immunology-Allergy
Announced at Cincinnati U
A New Fellowship training program in Immunol-
ogy and Allergic Diseases will begin July 1, 1966,
under the auspices of the Division of Immunology of
the Department of Medicine, College of Medicine
of the University of Cincinnati. The program is a
combined clinical and research training experience
for a minimum of two years. Prospective applicants
may choose a two-year training program in allergic
diseases or a two-year training program in rheumatol-
ogy. Applicants should have a minimum of two
years’ training in either internal medicine or pediatrics.
The Fellowship is part of a National Institutes of
Health training award and the annual stipend begins
at $6 000.00 per year. Further information may be
obtained by writing to Dr. I. Leonard Bernstein, 19
Garfield Place, Cincinnati, Ohio 45202 (Allergy
Program) , or to Dr. Evelyn Hess, Cincinnati General
Hospital, Cincinnati, Ohio 45229 (Rheumatology
Program) .
Health insurance policies cover about 78 per cent
of the U. S. population. Benefits paid on these poli-
cies reached $8.6 billion in 1964. Government
programs in 1964 paid about $1.2 billion in health
aid to the vendors of health sendees.
for April, 1966
391
C-14 AS MICROGRAMS NICOTINIC ACID PER LITER OF PLASMA
Sustained circulatory, respirator
and cerebral stimulation for th
500
400
300
200
100
(fewer absent doses by
absent-minded patients)
mindedness or senile confusion. Therapy can be con-
tinuous on a daily dose of only one Geroniazol TT tab-
let every 12 hours.
The gradual release of nicotinic acid in Geroniazoi |
TT will provide the well-known peripheral vasodilata-
tion needed in patients with deficient circulation and
with a minimum amount (if any) of “flushing.” Also, ,
cerebrovascular circulation is complemented by pen-
tylenetetrazol, long-established as a cerebral and res-
piratory stimulant.
Geroniazol TT improves the typical, unfortunate.'
signs of senile confusion. Patients become more alert,
Human volunteer subjects were administered Geroni-
azol TT tablets with the nicotinic acid component
made radioactive with C-14. Plasma and urine sam-
ples were analyzed. (See Figures I and II) The radio-
active tracer study substantiated the previous clinical
evidence that the release of nicotinic acid from the
Geroniazol TT tablet produced a gradual rise in
plasma levels to a plateau for a total of 12 hours and
more.
Such proven sustained activity makes the manage-
ment of geriatric patients much easier by minimizing
the possibility of neglected doses through absent-
TIME AFTER ADMINISTRATION (Hours)
ged and debilitated
less confused and moody. Personal care, memory,
emotional stability, social attention improve. Fatigue,
apathy and irritability are reduced.
A prescription for 100 tablets of Geroniazol TT will
permit your patients to enjoy the benefits of time-
prolonged nicotinic acid/pentylenetetrazol therapy,
at an economical price. Dosage is only one tablet every
12 hours.
Contraindications: There are no known contraindica-
tions.
Precautions : Exercise caution when treating patients
with a low convulsive threshold.
Side Effects: Side effects are rarely encountered, how-
ever due to the vasodilatation effect of nicotinic acid,
transitory mild nausea, flushing, tingling and pru-
ritus are possible.
Dosage: One tablet every 12 hours.
Supplied: Prescribe bottles of 100 tablets, to take ad-
vantage of recent price reduction.
References : 1. Report by Nuclear Science & Engi-
neering Corp., Pittsburgh, Pa., in files of Philips
Roxane Laboratories. 2. Connolly, R. : W. Virginia Med.
J. 56: 263 (Aug.) 1960. 3. Curran, T. R., and Phelps,
D. K. : Am. Pract. & Digest Treat. 11 :617 (July) 1960.
“First with the Retro-Steroids”
PHILIPS ROXANE LABORATORIES
Division of Philips Roxane, Inc., Columbus, Ohio
A Subsidiary of Philips Electronics and
Pharmaceutical Industries Corp.
GeroniazolTT
nicotinic acid 150 mg., pentylenetetrazol 300 mg.
Tempotrol® Time Controlled Tablet
• • •
Activities of County Societies
First District
(COUNCILOR : ROBERT E. HOWARD, M. D„ CINCINNATI)
CLERMONT
An overall determination of all Clermont County
Health needs has been undertaken by the Clermont
County Medical Society.
Dr. Albert W. VanSickle, Clermont County Health
Commissioner, has been named chairman of a com-
mittee of four doctors who have been assigned the
job of obtaining the extensive health survey. Serv-
ing with him are Dr. Phillips Greene; Dr. Kirby
Lancaster, who is a member of the County Board of
Health; and Dr. Lee Davidson. — The Clermont Sun.
HAMILTON
"Non-Cardiac Chest Pain" was the topic of a
panel discussion for the February 15 meeting of the
Academy of Medicine of Cincinnati.
Guest participants were Dr. Edmund Pellegrino,
professor and chairman of the Department of Medi-
cine, University of Kentucky School of Medicine,
moderator;
Dr. Philip Tumulty, professor of medicine, Johns
Hopkins University School of Medicine; and
Dr. Morton Bogdonoff, professor of medicine,
Duke University School of Medicine.
H? sfc % %
A joint meeting of the Academy and the Cincin-
nati Bar Association was held on February 22 at
the Netherland Hilton Hotel. The meeting followed
a social hour and dinner.
Topic for discussion was "The Doctor’s Patients
Are the Lawyer’s Clients.” Principal speaker was
the honorable Felix Forte, senior member of the
Appellate Division of the Superior Court of Mas-
sachusetts, and Professor Emeritus, Boston Univer-
sity School of Law.
Second District
(COUNCILOR: THEODORE L. LIGHT, M. D., DAYTON)
CLARK
A vigorous campaign to combat the growing rate
of venereal disease in Clark County was launched
by the Clark County Medical Society in conjunction
with an official proclamation from Mayor Robert C.
Henry.
The mayor designated a week in February as
"Venereal Disease Week” to add emphasis to the
campaign.
The proclamation stated venereal diseases are the
nation’s leading communicable disease, and are in-
creasing in scope with a reported 23,250 cases through-
out the nation during 1965.
Plans have been made locally by the Clark County
Medical Society, Jaycees and other interested per-
sons to eliminate the ignorance surrounding the dis-
eases.— Adopted from the Springfield News-Sun.
* * *
The Executive Director of the American College of
Physicians, Dr. Edward C. Rosenow, Jr., Philadel-
phia, Pa., was guest speaker at the February 21
meeting of the Clark County Medical Society. The
dinner meeting was held in the Shawnee Hotel,
Springfield. His topic was "Medical Communications.”
GREENE
Dr. John Matre, chief of gastroenterology at the
Veterans Administration Hospital, Dayton, presented
a lecture on liver biopsy to members of the Greene
Accredited by The Joint Commission on Accreditation of Hospitals.
WINDSOR HOSPITAL
A NONPROFIT CORPORATION
— ESTABLISHED 7 8 9 8 —
Chagrin Falls, Ohio 44022
247-5300 (Area Code 216)
A hospital for the treatment
of Psychiatric Disorders
Booklet available on request.
JOHN H. NICHOLS, M. D., Medical Director G. PAULINE WELLS, R. N., Admin. Director HERBERT A. SIHLER, Jr., Pres.
MEMBER: American Hospital Association — National Association of Private Psychiatric Hospitals — Ohio Hospital Association
39 4
The Ohio State Medical Journal
County Medical Society Thursday morning (Feb. 10)
in the Greene Memorial Hospital Auditorium.
County Commissioners James Ford, Ray Durn-
baugh and Ralph Mitman, and Fred Tartaglia, hospi-
tal administrator, were special guests.
Discussion was held on a radio program which
the society is sponsoring. Entitled "Know Your Doc-
tor,” presented over Radio Station WGIC the third
Thursday of each month from 9:30 to 10 a. m. —
Xenia Daily Gazette.
Fourth District
(COUNCILOR: ROBERT N. SMITH. M. D., TOLEDO)
WOOD
A report on the most recent methods of handling
tuberculosis was given by Dr. Robert Markey at the
Wood County Medical Society meeting Thursday
night (February 17).
Dr. Markey stated that the number of new cases
in Wood County is very low.
New drugs have shortened hospital stays and im-
proved cure rates in tuberculosis treatment.
Dr. Marjorie Conrad was introduced to the mem-
bership of the Wood County Medical Society. —
Daily Sentinel Tribune , Bowling Green.
Sixth District
(COUNCILOR: EDWIN R. WESTBROOK, M. D„ WARREN)
MAHONING
The Mahoning County Medical Society recently
presented copies of Todays Health Guide, to the
libraries of 26 schools, which included ever}' high
school in Mahoning County, Youngstown University,
and three nearby schools in Trumbull County.
Arrangements for the gift were made by the So-
ciety’s public relations committee. Dr. Robert L.
Jenkins, committee member, made the presentation.
The books were formally accepted in a brief cere-
mony by representatives of the Mahoning County and
Youngstown Boards of Education, the Youngstown
Diocese, and Youngstown University.
The Mahoning County Medical Society has also
ordered an additional six copies of the book to be
given as prizes in the tri-county spelling bee con-
ducted by the Youngstown Vindicator.
Each book carried a special book-plate marking it
as a presentation from the Medical Society.
The annual banquet of the Mahoning County
Medical Society was held on January 25 to honor
retiring president, Dr. John J. McDonough. He was
presented an appreciation plaque. New officers in-
stalled at the dinner-dance were: Dr. F. A. Resch,
president; Dr. H. J. Reese, president-elect, Dr. C.
K. Walter, secretary; and Dr. M. C. Raupple, treas-
urer. Dr. Edwin R. Westbrook, Sixth District Coun-
cilor, presented the OSMA fifty-year certificate and
pin to Dr. W. K. Allsop. Special guests were mem-
bers of the Corydon Palmer Dental Society and their
wives. Dr. Henry L. Shorr was program chairman.
The benefits and responsibilities of Social Security
were explained at the February 15 meeting of the
Mahoning County Medical Society. Speaker was
William J. McCauley, district manager of the
Youngstown Social Security office. Arrangements
were made by Dr. Jack Schrieber, program chairman.
STARK
Dr. A. Dixon Weatherhead, chief of the Cleveland
Clinic’s Department of Psychiatry, was speaker for
the Stark County Medical Society meeting on February
10 at Mergus Restaurant, Canton. His topic was
"The Management and Treatment of Depression. "
SUMMIT
The second annual Northeast Ohio Sports Injuries
Conference will be held in Akron on Saturday,
April 16.
Sponsors of the meeting are Summit County Medi-
cal Society and the American Academy of Orthopedic
Surgeons. The University of Akron will be host
for the gathering to which physicians and the coach-
ing, training and athletic teaching personnel of high
schools have been invited.
The all day series of lectures, panels, exhibits and
discussions will be aimed at the problem of injuries
to particularly the participant in intramural and re-
quired athletics as well as at those of the varsity ath-
Protect Your Family — Now — With the OSMA-PLAN
of comprehensive group major medical insurance sponsored by the
Ohio State Medical Association for its members and their families
NEW —
Also available to Ohio Physicians:
up to $100,000
DISABILITY
PRACTICE
ACCIDENTAL
OVERHEAD
DEATH AND
and INCOME and
EXPENSE
DISABILITY
PROTECTION
INSURANCE
INSURANCE
(All three at low group rates)
Call or write : DANIELS-HEAD & ASSOCIATES, INC.
Daniels-Head Building, Portsmouth, Ohio 45662 Tel. 353-3124
for April, 1966
395
lete. — Adapted from Evening Independent, Mas-
sillon.
Seventh District
(COUNCILOR: BENJAMIN C. DIEFENBACH, M. D.,
MARTINS FERRY)
TUSCARAWAS
Dr. Robert Hopkins, Cleveland, spoke on the topic,
"Pulmonary Embolism — Its Diagnosis and Treat-
ment,” during the February meeting of the Tuscara-
was County Medical Society at Bonvechio’s in Wain-
wright.
Eighth District
(COUNCILOR: ROBERT C. BEARDSLEY, M. D.,
ZANESVILLE)
WASHINGTON
Dr. Karl P. Klassen, president and trustee of Cen-
tral Ohio Heart Association, professor of surgery and
director of the Division of Thoracic Surgery at Ohio
State College of Medicine, spoke on the diagnosis and
surgical treatment of coronary artery disease at the
monthly meeting of Washington County Medical
Society.
Dr. W. F. Rogers and Dr. Robert Biddle of Park-
ersburg were guests at the meeting which was at-
tended by 19 members. Dr. Mary Whitacre Owen,
president of the Washington County Society, presided.
The program was sponsored by the Central Ohio
Heart Association as part of heart month. — Marietta
Daily Times.
Eleventh District
(COUNCILOR: WILLIAM R. SCHULTZ, M. D., WOOSTER)
HOLMES
Dr. Charles H. Hart, president of the Holmes
County Medical Society, announced that annual
awards of $50 each will be given to an outstanding
senior member of the Future Nurses Clubs at Hiland
and West Holmes High Schools.
It is the hope of the medical society that these
annual awards may encourage students, both boys and
girls, to join the Future Nurses Clubs and to make
application for training in nursing.
To qualify for the award, a student must have
made application for nurse’s training, but need not
have already been accepted by a school of nursing.
The winners of the awards will be announced during
the high school graduation ceremonies, Dr. Hart said.
— News-Journal, Mansfield.
LORAIN
A record attendance marked the regular meeting
of Lorain County Medical Society on Tuesday eve-
ning, March 8, when members and their wives met to
hear the featured speaker of the evening, Charles L.
Hudson, M. D., of Cleveland, President-Elect of the
American Medical Association. Among guests pre-
sent were Mrs. Hudson, William R. Schultz, M. D.,
of Wooster — Eleventh District Councilor — and
Mrs. Schultz, and H. T. Pease, M. D., of Wadsworth,
who had previously served as Councilor.
The dinner was preceded by a social hour, and
following a brief business session and reports, Presi-
dent Joseph A. Cicerrella, M. D., introduced Dr.
Hudson. In welcoming the speaker, Dr. Cicerrella
recalled the fact that this was not the first occasion
on which Dr. Hudson had addressed the Lorain
County Medical Society. While President of Ohio
State Medical Association, Dr. Hudson had spoken
to the group in September 1955, and his subject
then was "The Changing Picture of the Practice of
Medicine.”
His present topic outlined the effect of the 1965
Social Security Amendments on Medical Practice.
Advances in the mechanism used to provide payment
for medical care challenges the future of the Ameri-
can system, and in accepting the challenge, the indi-
vidual physician should establish and hold fast to
the principle that the Government should provide
assistance only for the needy.
In a cordial vote of thanks, Dr. Cicerrella expressed
the members’ pleasure in welcoming Dr. and Mrs.
Hudson. This was a "first” for the Society, in that
it was the first occasion a President-Elect of the
American Medical Association had addressed the
group. The local press was well represented at the
meeting.
GROUP LIFE INSURANCE
Initiated and Sponsored by
Your OHIO STATE MEDICAL ASSOCIATION
For Information, Call Or Write
TURNER & SHEPARD, inc.
insurance
20 SOUTH THIRD STREET COLUMBUS, OHIO 43215 PHONE 228-6115 CODE 614
396
The Ohio State Medical Journal
• • •
Woman’s Auxiliary Highlights
By MRS. S. L. MELTZER, Publicity Committee
Chairman, 2442 Dorman Dr., Portsmouth 45662
I AST YEAR, the Woman’s Auxiliary to the Ohio
State Medical Association celebrated its twen-
ty-fifth anniversary. It was a momentous oc-
casion. But this year — our twenty-sixth — is equally
so. Because our parent organization has seen fit to
honor us with a coveted invitation — the privilege of
attending OSMA’s General Sessions on Wednesday,
Thursday and Friday afternoons of convention week
— May 24 through 27 at the Sheraton-Cleveland
Hotel.
How to put into words what such a magnificent
gesture means? Always, to be sure, the doctors have
given us outstanding cooperation, significant under-
standing and unlimited help. That, now, they should
want us, as a body, to attend three of their very
important General Sessions would indicate (at least
so it appears to this reporter) that there is an ever-
growing awareness of the tremendous potential of the
Woman’s Auxiliary7 yet to be tapped. Certainly there
is no end to what we are willing, eager and happy
to do. For us, it is a privilege to serve the medical
profession in any way we can. We thank the doctors
of Ohio for permitting us that privilege.
What are those three sessions I’ve been dangling
so temptingly? The first is Wednesday, May 25:
"Problems in Marriage,” sponsored by the Section on
Psychiatry and Neurology, the Ohio Psychiatric As-
sociation and cosponsored by the OSMA Commit-
tee on Medicine and Religion. The second session
is on Thursday, May 26, with Dr. Charles F. Hudson,
President-Elect of the American Medical Association,
as the featured speaker. He will present detailed in-
formation regarding the rules and regulations of Pub-
lic Faw 89-97, which becomes effective July 1, 1966.
Dr. Hudson has participated in the activities of the
AMA’s Task Force in its consultations with the Fed-
eral Government on the development of these rules
and regulations. He will answer questions from the
audience following his formal presentation.
The third session is on Friday, May 27, and the
provocative theme "Care of the Patient: 1966” will
be discussed by the well-known Dr. Edward R. Annis,
Past President of the American Medical Association.
He will take a look at the future of patient care and
the effect of the various pieces of Federal legislation
upon the traditional physician-patient relationship. A
question and answer period will follow Dr. Annis’
formal presentation.
All three sessions will begin promptly at 1:30
P. M. and it should go without saying (except that
I feel I must say it!) that our Auxiliary members
honor the request of the doctors that we be in our
seats at the appointed time.
Busy Women and Events
A salute to two busier-than-bees Cuyahoga County
women — Mrs. Burdette Wylie and Mrs. Roscoe
Kennedy. They are chairman and cochairman re-
spectively of this twenty-sixth annual meeting. Can
you begin even to imagine the amount of work such
a meeting entails? (It leaves me weak, just think-
ing about it!)
The detailed program for our convention is on
page 372, but I should like to highlight a few of
the "Newer Looks” that will be yours, if you come
to Cleveland in May. A Buffet Breakfast for the
doctors and their wives will be given on Friday, May
27, from 7:30 a. m. to 8:45 a. m. (Because of our
participation in the men’s General Sessions program,
our luncheon hours have necessarily been shortened
and revamped, as have certain other procedures of
the past) . But to get back to THAT Breakfast —
Higbee’s will present a Fashion Show and this you’ll
hardly believe : Local doctors will be the models !
I’m told further that Chairmen Mrs. Joseph Corsaro,
Mrs. Leonard Backiel, and Mrs. T. L. Manning will
appear in chefs’ outfits and that it will all be a
"fun affair.”
Ever heard of Hixon’s Barn? As fascinating as
anything this side of the Rockies ! It is a unique shop
and display room and features an old-fashioned Ice
Cream Parlor (in operation), an old-fashioned Gro-
cer)7 Store, antiques, floral arrangements, hand-
dipped candles, handmade candies — come on in and
see for yourselves. You can purchase or you can just
observe. Transportation to the Barn will be made
available from 5:30 p. m. to 7.30 p. m. on Wednes-
day and Thursday, May 25 and 26. Interested per-
sons (the men are equally welcome) should contact
Information Chairman Mrs. Frederick Rittinger. Mrs.
John Sanders is general chairman of the Hixon’s
Barn project — something you just won’t want to miss.
Lunch-a-la-cart?
On Friday, May 27, at 12:00 Noon, immediately
following the installation of officers, "French Maids”
for April, 1966
397
(so says my copy) will serve "Happy Time” punch
from carts. Another first in luncheons that day —
"Lunch-On-A-Cart” will honor the new officers, mem-
bers and honored guests. I’m just as curious as you.
But it is something to look forward to, don’t you
think? Mrs. Edward F. Kieger is chairman and Mrs.
John Budd cochairman of that New Look in lunch-
eons. On Thursday, May 26, also at 12:00 Noon,
the Lake County Auxiliary will hostess a luncheon,
honoring our past state presidents and incumbent
county presidents. Mrs. Frederick W. Wachter is
chairman and Mrs. Lloyd E. Johnson cochairman of
that special event.
Mrs. Reuben R. Gould, convention publicity chair-
man, advises me that all corsages and center pieces
are being handmade and that the money usually al-
lotted for this expense will be donated to AMA-ERF.
Mrs. Kenneth Potter is chairman of this interesting
project and Mrs. R. H. McDonald cochairman. And
to add to all that — some 1 5 women are involved in
a French Reading Class to make boutonnieres that
will serve as favors for special guests. Cochairmen
for that unusual activity are Mrs. John B. Hazard and
Mrs. Joseph Corsaro.
Counties on Display
A huge display area is being reserved in a section
of the Main Exhibit Hall for local county exhibits.
You may have an outstanding project to feature —
or maybe even more than one. And these invalu-
able scrapbooks ! What a wonderful opportunity to
show what you have all been doing — and at the same
time to observe, get ideas and learn from others.
Exhibitors are asked to contact Mrs. Charles A.
Swan, 2680 North Moreland Boulevard, Cleveland
44120, as to how much space you would like reserved
for your county. Another point of emphasis: once
again the annual meeting will feature the county
reports. This year, the session will be on Wednes-
day, May 25, from 3:00 to 5:00 P. M. Every county
president should consider it a privilege to be able to
present a view of her group’s activities. Set in
proper focus, it can tell a most meaningful story.
Auxiliary headquarters will be at the Sheraton-
Cleveland and if you haven’t already done so, you’d
better make that hotel reservation on the double. The
Statler-Hilton and the Pick-Carter are two other
Cleveland hotels and there are a number of motor
hotels: Lake Erie Motel, Sahara Motor Hotel and
the Versailles Motor Inn. (This list isn’t complete
by any means.)
My Apologies
Convention news has had to take precedence over
local auxiliary news this month. I promise to make
up for it in the next issue. So keep those clippings
coming in to me, because I DO want them and I
WILL use them.
CREDIT JUDGMENT
would be easy if you
knew all about
everyone
Even in small towns, acquaint-
anceship just won’t do in credit
judging today. Credit buying is
done too quickly . . . there’s so
much more of it . . . the auto
takes families to neighboring
cities for credit buying.
So how can you hope to know
all the credit facts about every-
one— car loans, home loans,
medical bills, out-of-town time
purchases? You can know
through your local credit bu-
reau. And by knowing, you can
save hours of credit pondering,
save time and expense of trying
to collect poor risks, save losses.
Your local credit bureau’s up-to-
the-minute family credit rec-
ords are augmented by those of
eighty-six Ohio member bu-
reaus, and by the records of
over two-thousand such bu-
reaus in the U.S. We will gladly
direct you to that bureau.
ASSOCIATED
CREDIT BUREAUS
OF OHIO
P. 0. Bo* 1114, Lima, Ohio 45802
398
The Ohio State Medical journal
State Association Officers and Committeemen
Headquarters Office: Room 1005, 79 East State Street, Columbus 43215. Telephone 221-7715
Henry A. Crawford, President
1058 Hanna Bldg., Cleveland 44115
Lawrence C. Meredith, President-Elect Robert E. Tschantz, Past-President
205 Elyria Block, Elyria 44035 515 Third Street, N.W., Canton 44703
Philip B. Hardymon, Treasurer
350 East Broad St., Columbus 43215
Mr. Hart F. Page, Executive Secretary
Mr. W. Michael Traphagan, Administrative Assistant
Perry R. Ayres, Editor
THE COUNCIL
Mr. Charles W. Edgar, Director of Public Relations
and Assistant Executive Secretary
Mr. Herbert E. Gillen, Administrative Assistant
Mr. R. Gordon Moore, Executive Editor
First District, Robert E. Howard, 2600 Union Central Bldg., Cincinnati 45202 ; Second District, Theodore L. Light, 2670 Salem Ave.,
Dayton 45406 ; Third District, Frederick T. Merchant, 1051 Harding Memorial Pky., Marion 43305 ; Fourth District, Robert N. Smith,
3939 Monroe St., Toledo 43606 ; Fifth District, P. John Robechek, 10525 Carnegie Ave., Cleveland 44106 ; Sixth District, Edwin R.
Westbrook, 438 North Park Ave., Warren; Seventh District, Benj. C. Diefenbach, 30 S. 4th St., Martins Ferry; Eighth District, Robert
C. Beardsley, 2236 Maple Ave., Zanesville ; Ninth District, George N. Spears, 2213 So. Ninth St., Ironton ; Tenth District, Richard
L. Fulton, 1211 Dublin Rd., Columbus 43212 ; Eleventh District, William R. Schultz, 1749 Cleveland Rd., Wooster 44691.
COMMITTEES
Committee on Education — Thomas E. Rardin, Columbus, Chair-
man (1966) ; Clyde W. Muter, Warren (1970) ; Thomas S. Brow-
nell, Akron (1969) ; John G. Sholl, Cleveland (1968) ; Elmer R.
Maurer, Cincinnati (1967).
Judicial and Professional Relations Committee — Frank F. A.
Rawling, Toledo, Chairman (1968) ; Homer A. Anderson, Colum-
bus (1970) ; Chester H. Allen, Portsmouth (1969) ; David Fish-
man, Cleveland (1967) ; Paul A. Mielcarek, Cleveland (1966).
Committee on Public Relations and Economics — Frederick P.
Osgood, Toledo, Chairman (1969) ; Luther W. High, Millers-
burgh (1970) ; John H. Budd, Cleveland (1968) ; John J. Cranley,
Cincinnati (1967); Horace B. Davidson, Columbus (1966).
Committee on Scientific Work — Samuel Saslaw, Columbus,
Chairman (1968) ; Jack Schreiber, Canfield (1970) ; Walter J.
Zeiter, Cleveland (1970); John D. Battle, Jr., (1969); Harold
J. Schneider, Cincinnati (1969) ; Isador Miller, Urbana (1968) ;
William Hamelberg, Columbus (1967) ; F. A. Simeone, Cleveland
(1967) ; Ralph K. Ramsayer, Canton (1966) ; G. Douglas Talbott,
Dayton (1966).
Committee on Care of the Aging — Charles W. Stertzbach,
Youngstown, Chairman; James O. Barr, Chagrin Falls; Dwight
L. Becker, Lima; Robert A. Borden, Fremont; Edwin W.
Rurnes, Van Wert; Philip T. Doughten, New Philadelphia;
Robert B. Elliott, Ada ; George T. Harding, Sr., Worthington ;
Roger E. Heering, Columbus; M. Robert Huston, Millersburg ;
John S. Kozy, Toledo; Francis M. Lenhart, Defiance; Harold
E. McDonald, Elyria; H. W. Porterfield, Columbus; Elliot W.
Schilke, Springfield ; Bernard A. Schwartz, Cincinnati ; Clar-
ence V. Smith, Canton; Joseph B. Stocklen, Cleveland; Don P.
VanDyke, Kent ; William M. Wells, Newark ; Roger Williams,
Columbus.
Committee on Cancer — Arthur G. James, Columbus, Chairman ;
Thomas D. Allison, Lima; Andrew M. Barone, Lima; William
F. Boukalik, Cleveland; William J. Flynn, Youngstown; Douglas
P. Graf, Cincinnati; Stanley O. Hoerr, Cleveland; William A.
Newton, Jr., Columbus; W. D. Nusbaum, Lancaster; Arthur E.
Rappoport, Youngstown ; Carl A. Wilzbach, Cincinnati.
Committee on Eye Care — Arthur D. Collins, Cleveland, Chair-
man ; Martin J. Cook, Springfield ; Thomas L. Edwards, Lima ;
Robert H. Magnuson, Columbus ; Russell J. Nicholl, Cleveland ;
Claude S. Perry, Columbus ; Norman W. Pinschmidt, Gallipolis ;
Barnet R. Sakler, Cincinnati ; Robert L. Willard, Toledo.
Committee on Hospital Relations — William R. Schultz, Woo-
ster, Chairman ; L. A. Black, Kenton ; L. Fred Bissell, Aurora ;
Oscar W. Clarke, Gallipolis ; Robert M. Craig, Dayton ; John
V. Emery, Willard ; Harvey C. Gunderson, Toledo ; Philip B.
Hardymon, Columbus ; Middleton H. Lambright, Cleveland ;
Lloyd E. Larrick, Cincinnati; Joseph S. Lichty, Akron; James
C. McLarnan, Mt. Vernon ; Ben V. Myers, Elyria ; Robert A.
Tennant, Middletown ; V. William Wagner, Port Clinton ; Wil-
liam A. White, Canton.
Committee on Insurance — David A. Chambers, Cleveland,
Chairman ; William F. Bradley, Columbus ; Walter A. Daniel,
Tiffin; Chester R. Jablonoski, Cleveland; William A. Knapp,
Zanesville; Marvin R. McClellan, Cincinnati; William Neal,
Archbold ; Oliver Todd. Toledo ; Robert E. Tschantz, Canton ;
Allan L. Wasserman, Dayton; John W. Wherry, Elyria; Wil-
liam A. White, Canton.
Committee on Laboratory Medicine — Horace B. Davidson, Co-
lumbus, Chairman ; William H. Benham, Columbus ; John B.
Hazard, Cleveland ; Melvin Oosting, Dayton ; Arthur E. Rap-
poport, Youngstown; William Sinclair, Cleveland; Gilbert B.
Stansell, Toledo; Philip B. Wasserman, Cincinnati.
Committee on Legislation — James T. Stephens, Oberlin, Chair-
man; Donald R. Brumley, Findlay; George D. J. Griffin, Cin-
cinnati: Jack L. Kraker, Lancaster; Maurice F. Lieber, Canton;
Ralph F. Massie, Ironton ; James C. McLarnan, Mt. Vernon ;
Robert E. Rinderknecht, Dover; John H. Sanders, Cleveland;
Carl R. Swanbeck, Sandusky; William W. Trostel, Piqua.
Committee on Maternal Health — Anthony Ruppersberg, Co-
lumbus, Chairman ; Otis G. Austin, Medina ; Raymond E. Bar-
ker, Columbus ; William D. Beasley, Springfield ; Keith R.
Brandeberry, Gallipolis ; Thomas E. Byrne, Mentor ; C. Ray-
mond Crawley, Dover ; Mel A. Davis, Columbus ; Marion F.
Detrick, Jr., Findlay; John P. Garvin, Columbus; Richard P.
Glove, Cleveland ; Robert A. Heilman, Columbus ; John F. Hil-
labrand, Toledo ; Robert E. Johnstone, Cincinnati ; Albert A.
Kunnen, Dayton; James F. Morton, Zanesville; Ralph K. Ram-
sayer, Canton; Robert E. Swank, Chillicothe ; Densmore Thomas.
Wai-ren ; Robert S. VanDervort, Elyria.
Committee on Medicine and Religion — George W. Petznick,
Cleveland, Chairman; John D. Albertson, Lima; Eugene F.
Damstra, Dayton; Francis M. Lenhart, Defiance; Ralph W.
Lewis, Portsmouth ; J. Kenneth Potter, Cleveland ; Charles A.
Sebastian, Cincinnati ; John R. Seesholtz, Canton ; William B.
Smith, Zanesville; James T. Stephens, Oberlin; Donald J. Vin-
cent, Columbus ; Don G. Warren, West Lafayette.
Committee on Mental Health — Wendell A. Butcher, Columbus,
Chairman; Homer A. Anderson, Columbus; Max D. Graves,
Springfield; Charles W. Harding, Worthington; Warren G.
Harding, II, Columbus ; Henry L. Hartman, Toledo ; J. Robert
Hawkins, Cincinnati; William H. Holloway, Akron; Nathan
B. Kalb, Lima ; Thomas E. Rardin, Columbus ; Philip C. Rond,
Columbus; Victor M. Victoroff, Cleveland; John A. Whieldon,
Columbus.
Committee on Disaster Medical Care — Thomas D. Allison,
Lima, Chairman; Thomas P. Bowlus, Toledo; Nino M. Cam-
ardese, Norwalk; Drew L. Davies, Columbus; John H. Davis,
Cleveland; Gregory G. Floridis, Dayton; Robert D. Gillette,
Huron; Robert S. Heidt, Cincinnati; N. J. M. Klotz, Wads-
worth ; Thomas W. Morgan, Gallipolis : Sterling W. Obenour,
Jr., Zanesville; Vol K. Philips, Columbus; Elden C. Weckesser,
Cleveland; (Liaison with the American Medical Association)
Wendell A. Butcher, Columbus.
Military Advisory Committee — Drew L. Davies, Columbus,
Chairman ; A. A. Brindley, Maumee ; Ralph G. Carothers, Cin-
cinnati; Homer D. Cassel, Dayton; Henry A. Crawford, Cleve-
land; Walter L. Cruise, Zanesville; Charles R. Keller, Mans-
field ; Ralph W. Lewis, Portsmouth ; Edward L. Montgomery,
Circleville ; Frank T. Moore, Akron; Earl Rosenblum, Steuben-
ville.
Committee on Occupational Health — Rex H. Wilson, Akron,
Chairman; Drew J. Arnold, Columbus; William W. Davis, Co-
lumbus ; Winfred M. Dowlin, Canton ; Harold M. James, Day-
ton ; H. W. Lawrence, Middletown ; Daniel M. Murphy, Marion ;
Anthony M. Puleo, Cleveland; George W. Wright, Cleveland;
H. P. Worstell, Columbus.
Committee on Poison Control — John A. Norman, Akron,
Chairman; William G. Gilger, Cleveland; Mason S. Jones, Day-
ton; James H. Bahrenburg, Canton; Edward V. Turner, Co-
lumbus; William M. Wallace, Cleveland; Hugh Wellmeier,
Piqua ; John A. Williams, Cincinnati.
Committee on Radiation — Charles M. Barrett, Cincinnati,
Chairman; Eldred B. Heisel, Columbus: George F. Jones, Lan-
caster; Carey B. Paul, Jr., Columbus; Thomas C. Pomeroy, Co-
lumbus ; Denis A. Radefeld, Lorain ; Eugene L. Saenger, Cin-
cinnati; Robert E. Schulz, Wooster; John P. Storaasli, Cleve-
land; Robert P. Ulrich, Troy; Robert L. Wall, Columbus; John
Robert Yoder, Toledo; James G. Kereiakes, Ph. D. (Advisory
Member, Special Consultant), Cincinnati.
for April, 1966
399
State Association Officers and Committeemen (Continued)
Committee on Rural Health — Robert E. Reiheld, Orrville,
Chairman ; Chester J. Brian, Eaton ; J. Martin Byers, Green-
field; Walter A. Campbell, Coshocton; E. Joel Davis, East Can-
ton ; Victor R. Frederick, Urbana ; Benjamin W. Gilliotte, Zanes-
ville; Jerry L. Hammon, West Milton; Jasper M. Hedges, Circle-
ville ; Luther W. High, Millersburg ; E. D. Mattmiller, Athens;
John R. Polsley, North Lewisburg ; Leonard S. Pritchard, Co-
lumbiana ; Harold C. Smith, Van Wert ; Kenneth W. Taylor.
Pickerington ; Edmond K. Yantes, Wilmington.
Committee on Scientific and Educational Exhibit — Charles V.
Meckstroth, Columbus, Chairman ; Harvey C. Knowles. Jr., Cin-
cinnati ; W. Arnold McAlpine, Toledo ; Arthur E. Rappoport,
Youngstown ; Arnold M. Weissler, Columbus ; Walter J. Zeiter,
Cleveland ; Robert E. Zipf, Dayton.
Committee on School Health — Charles H. McMullen, Loudon-
ville. Chairman; Walter Felson, Greenfield; Paul D. Hahn, New
Philadelphia; Howard H. Hopwood, Cleveland; Dale A. Hudson,
Piqua ; Howard J. Ickes, Canton ; Charles L. Kagay, Dayton ;
Lawrence L. Maggiano, Warren; Robert C. Markey, Bowling
Green; Robert J. Murphy, Columbus; Carey B. Paul, Jr., Colum-
bus; Carl L. Petersilge, Newark; William H. Rower, Ashland;
Thomas E. Shaffer, Columbus ; Aubrey L. Sparks. Warren ;
Albert E. Thielen, Cincinnati ; Homer B. Thomas, Gallipolis.
Committee on Traffic Safety — N. J. Giannestras, Cincinnati,
Chairman; Howard W. Brettell, Steubenville; Drew L. Davies.
Columbus; Clark M. Dougherty, New Philadelphia; Wesley L.
Furste, Columbus; Thomas W. Morgan, Gallipolis; Lester G.
Parker, Sandusky; Thomas N. Quilter, Marion; Stewart M.
Rose, Columbus; John F. Tillotson, Lima; Robert C. Waltz,
Cleveland; Paul L. Weygandt, Akron; Robert E. Zipf, Dayton.
Committee on Workmen’s Compensation — H. P. Worstell, Co-
lumbus, Chairman; A. L. Berndt, Portsmouth; Thomas H.
Brown, Jr., Toledo; Charles A. Browning, Jr., Bellefontaine ;
Oscar W. Clarke, Gallipolis ; Frederick A. Flory, Columbus ;
Lawrence T. Hadbavny, Cleveland ; Clyde O. Hurst, Portsmouth ;
Edmund F. Ley, Tiffin ; Joseph Lindner, Sr., Cincinnati ; John
D. Osmond, Jr., Cleveland; James G. Roberts, Akron; George
L. Sackett, Sr., Painesville ; Joseph H. Shepard, Columbus;
William V. Trowbridge, Cleveland; Rex H. Wilson, Akron;
Frederick A. Wolf, Cincinnati; James N. Wychgel, Cleveland.
OSMA Members of the Joint Advisory Committee on Athletic
Injuries — Robert J. Murphy, Columbus; John R. Jones, Toledo;
Sol Maggied, West Jefferson; Charles H. McMullen, Loudonville :
Carey B. Paul, Jr., Columbus; Thomas E. Shaffer, Columbus;
Don A. Kelly, Cleveland ; Marvin R. McClellan, Cincinnati ;
Walter A. Hoyt, Jr., Akron.
OSMA Members of the Joint Committee on School Bus Driver
Examinations — Carey B. Paul, Jr., Columbus ; Thomas N. Quil-
ter, Marion ; Stewart M. Rose, Columbus.
DELEGATES AND ALTERNATES
Delegates and Alternates to the American Medical Association
— George W. Petznick, Cleveland; H. T. Pease, Wadsworth, alter-
nate ; Carl A. Lincke, Carrollton ; Robert S. Martin, Zanesville,
alternate; Theodore L. Light, Dayton; Kenneth D. Arn, Dayton,
alternate; Edmond K. Yantes, Wilmington; Harry K. Hines,
Cincinnati, alternate; John H. Budd, Cleveland; P. John Robe-
chek, Cleveland, alternate; Richard L. Meiling, Columbus; Rob-
ert E. Tschantz, Canton, alternate; Frederick F. Osgood, Toledo;
Robert N. Smith, Toledo, alternate ; Charles A. Sebastian, Cin-
cinnati ; J. Robert Hudson, Cincinnati, alternate ; Edwin H.
Artman, Chillicothe ; Philip B. Hardymon, Columbus, alternate.
County Societies’ Officers and Meeting Dates
First District
Councilor: Robert E. Howard, Cincinnati 45202
2600 Union Central Bldg.
ADAMS — Gary J. Greenlee, President, Manchester 45144 ; Stan-
ley H. Title, Secretary, Manchester 45144.
BROWN — Charles H. Maly, President, Sardinia 45171 ; Charles
W. Hannah, Secretary, Sardinia 45171. 1st Monday monthly.
BUTLER — Robert Johnson, President, 500 S. Breiel Boulevard,
Middletown 45042 ; Mr. Charles G. Greig, Executive Secretary.
110 North Third Street, Hamilton 45011. 4th Wednesday
monthly.
CLERMONT — Cecil F. Barber, President, State Route 133, Feli-
city 45120 ; Phillips F. Greene, Secretary, Route 1, Box 509.
New Richmond 45157. 3rd Wednesday monthly, except July
and August.
CLINTON — Richard R. Buchanan, President, 115 West Main,
Wilmington 45177 ; Mary Ranz Boyd, Secretary, Box 629,
Wilmington 45177. 4th Tuesday monthly.
HAMILTON — Robert M. Woolford, President, 320 Broadway,
Cincinnati 45202 ; Mr. Edward F. Willenborg, Executive
Secretary, 320 Broadway, Cincinnati 45202. Monthly meet-
ing dates, 1st Tuesday; Academy, 3rd Tuesday, except June,
July and August.
HIGHLAND — Thomas L. Jones, President, 528 South St., Green-
field 45123 ; Walter Felson, Secretary, 357 South St., Greenfield
45123. 3rd Tuesday bimonthly.
WARREN — O. Williard Hoffman, President, 20 East Fourth
Street, Franklin 45005 ; Ray E. Simendinger, Secretary, 901
North Broadway Street, Lebanon 45036. 2nd Tuesday monthly.
Second District
Councilor: Theodore L. Light, Dayton 45406
2670 Salem Ave.
CHAMPAIGN — Myron J. Towle, President, 848 Scioto Street,
Urbana 43078 ; Fred R. Denkewalter, Secretary, 848 Scioto
Street, Urbana 43078. 2nd Wednesday monthly.
CLARK — Henry M. Tardif, President, 2608 E. High Street,
Springfield 45505 ; Mrs. Marion L. Wilcoxson, Executive
Secretary, Hotel Shawnee, Room 207, Springfield 44501. 3rd
Monday monthly, except June, July and August.
DARKE— William A. Browne, President, 722 Sweitzer St.,
Greenville 45331 ; Delbert D. Blickenstaff, Secretary, 552 S-
West St., Versailles 45380. 3rd Tuesday monthly.
GREENE — Clement G. Austria, President, 1142 North Monroe
Drive, Xenia 45385 ; Mrs. C. K. Elliott, Executive Secretary,
225 Pleasant Street, Xenia 45385. 2nd Thursday monthly
except July and August.
MIAMI — David Brown, President, 1060 North Market Street,
Troy 45373 ; Jack P. Steinhilber, Secretary, 145 Sunset Drive,
Piqua 45356. 1st Tuesday monthly.
MONTGOMERY — Charles E. O’Brien, President, 600 Fidelity
Building, Dayton 45402 ; Mr. Robert F. Freeman, Executive
Secretary, 280 Fidelity Medical Building, Dayton 45402. 1st
Friday monthly October through May — 1st Wednesday June.
PREBLE — John D. Darrow, President, 228 N. Barron St., Eaton
45320 ; Willard C. Clark, Jr., Secretary, 228 N. Barron, Eaton
45320. Irregular meetings.
SHELBY — George J. Schroer, President, 322 Second Ave., Sidney
45365 ; Alfonsas Kisielius, Secretary, Ohio Bldg., Sidney 45365.
Third District
Council : Frederick T. Merchant, Marion 43305
1051 Harding Memorial Pky.
ALLEN — Carl H. Zinsmeister, President, 729 W. Market Street,
Lima 45801 ; Thomas D. Allison, Secretary, 401 Metropolitan
Bank Building, Lima 45801. 3rd Tuesday monthly.
AUGLAIZE — Robert Sobocinski, President, 75 Blackhoof Street,
Wapakoneta 45895 ; J. F. Bowling, Secretary, 319 West Spring
Street, St. Marys 45885. 1st Thursday monthly except July.
CRAWFORD — Don E. Ingham, President, 201 N. Market Street,
Galion 44833 ; Johnson H. Chow, Secretary, 1040 Devonwood
Drive, Galion 44833. Called meetings.
HANCOCK — Raymond J. Tille, President, 801 S. Main St., Find-
lay 45840 ; Herbert L. Queen, Secretary, 828 Woodworth Dr.,
Findlay 45840.
HARDIN — William D. Dewar, President, 405 North Main Street,
Kenton 43326 ; John J. Roget, Secretary, Belle Center 43310.
2nd Tuesday monthly.
LOGAN — Thomas Seitz, President, 223 E. Columbus Street,
Bellefontaine 43311 ; Glen Miller, Secretary, R. D. 2, West
Liberty 43357. 1st Friday monthly.
MARION — Ransome Williams, President. 1035 Harding Me-
morial Parkway, Marion 43302 ; Alice Fisher, Secretary, 1040
Delaware Avenue, Marion 43302. 1st Tuesday monthly.
MERCER — R. Duane Bradrick, President, Rockford 45882 ; R. L.
Dobbins, Secretary, 5402 State Route 29 East, Celina. 3rd
Thursday, monthly.
SENECA — Olgierd C. Garlo, President, 53 Clay Street, Tiffin
44883 ; Leonard M. Gaydos, Secretary, 233 South Monroe
Street, Tiffin 44883. 3rd Tuesday monthly.
VAN WERT — Norman L. Marxen, President, Medical Arts Bldg.,
Fox Road, Van Wert 45891 ; W. L. Iler, Secretary, Medical
Arts Bldg., Fox Road, Van Wert 45891. 4th Friday monthly.
WYANDOT — Herschel A. Rhodes, President, 777 N. Sandusky
Ave., Upper Sandusky 43351 ; J. J. Browne, Secretary, 777 N.
Sandusky Ave., Upper Sandusky 43351. 2nd Tuesday monthly.
Fourth District
Councilor: Robert N. Smith, Toledo 43606
3939 Monroe St.
DEFIANCE — L. F. Berry, Jr., President, 1400 East Second
Street, Defiance 43512 ; W. S. Busteed, Secretary, Box 218,
Defiance 43512.
FULTON — B. H. Reed, Jr., President, Delta 43515 ; R. L. Davis,
Secretary, Wauseon 43567. 2nd Tuesday quarterly March,
June, September, December.
HENRY — J. J. Harrison, President, 113 East Clinton Street,
Napoleon 43545 ; Gamble S. Hall, Secretary, 834 Strong
Street, Napoleon 43545. 1st Tuesday monthly.
LUCAS — E. L. Doermann, President, 2001 Collingwood Blvd.,
Toledo 43620 : Mr. Robert W. Elwell, Executive Secretary, 3101
Collingwood Blvd., Toledo 43610. 3rd Tuesday monthly except
July and August.
OTTAWA — V. Wm. Wagner, President, 122 East Perry, Port
Clinton 43452 ; William Coon, Secretary, 120 East Perry, Port
Clinton 43452. 2nd Thursday monthly.
PAULDING — Roy R. Miller, President, 220 W. Perry, Paulding
45879 ; D. Paul Ward, Secretary, Box 416, Oakwood 45873.
Meetings called.
PUTNAM — Arthur P. Daniel, President, 144 N. Walnut, Ottawa
45875 ; Oliver N. Lugibihl, Secretary, Pandora 45877. 1st
Tuesday monthly.
400
The Ohio State Medical Journal
SANDUSKY — J. L. Zimmerman, President, Memorial Hospital
of Sandusky County, Fremont 43420 ; Mrs. Patsy J. Askins.
Executive Secretary, Memorial Hospital of Sandusky County,
Fremont 43420. 3rd Wednesday monthly.
WILLIAMS — John E. Moats, President, Central Drive, Bryan
43506; Neil T. Levenson, Secretary, 907 Noble Drive, Bryan
43506. 2nd Tuesday monthly.
WOOD — Roger A. Peatee, President, 140 S. Prospect Street,
Bowling Green 43402 ; William B. Elderbrock, Secretary,
Health Service, Bowling Green State University, Bowling
Green 43402. 3rd Thursday monthly.
Fifth District
Councilor: P. John Robechek, Cleveland 44106
10525 Carnegie Ave.
ASHTABULA — J. R. Nolan, President, 2736 Lake Avenue, Ash-
tabula 44004; Richard Millberg, Secretary, 430 West 25th
Street, Ashtabula 44004. 2nd Tuesday monthly.
CUYAHOGA — William F. Boukalik, President, 20030 Scottsdale
Boulevard, Cleveland 44122 ; Mr. Robert A. Lang, Executive
Secretary, 10525 Carnegie Avenue, Cleveland 44106.
GEAUGA — Bruce F. Andreas, President, 400 Downing Drive,
Chardon 44024 ; Arturo J. Dimaculangan, Secretary, 8400 May-
field Road, P. O. Box 277, Chesterland 44026. 2nd Friday
monthly.
LAKE — Robert W. Colopy, President, 89 E. High Street, Paines-
ville 44077 ; Mrs. Owen A. McLaren, Executive Secretary,
7408 Cadle Avenue, Mentor 44060. 4th Wednesday evening
monthly, January, May, March, September and November
unless otherwise ordered by Council.
Sixth District
Councilor: Edwin R. Westbrook, Warren 44481
438 North Park Ave.
COLUMBIANA — Edith S. Gilmore, President, 432 W. 5th St.,
E. Liverpool 43920 ; Fraser Jackson, Secretary, 205 W. 6th
St. 3rd Tuesday monthly.
MAHONING — F. A. Resch, President, Doctors Park, Canfield
44406 ; Mr. Howard C. Rempes, Jr., Executive Secretary, 245
Bel-Park Building, 1005 Belmont Avenue, Youngstown 44504.
3rd Tuesday monthly except July and August.
PORTAGE — David Palmstrom, President, 124 North Prospect
Street, Ravenna 44266 ; William R. Brinker, Secretary, 141
East Main Street, Kent 44240. 3rd Tuesday monthly.
STARK — A. R. Furnas, Jr., President, 420 Lake Avenue, N. E.,
Massillon 44646 ; Mr. John H. Austin, Executive Secretary,
405 4th Street, N. W., Canton 44702. 2nd Thursday monthly.
SUMMIT — James G. Roberts, President, 655 West Market Street,
Akron 44303 ; Mr. Sidney H. Mountcastle, Executive Secretary,
437 Second National Building, 159 South Main Street, Akron
44308. 1st Tuesday monthly.
TRUMBULL — John F. McGreevey, President, 297 Hawthorne
Lane N. E., Warren 44484 ; Mrs. Kay Ticknor, Executive
Secretary, 280 North Park Avenue, Warren 44481. 3rd
Wednesday monthly September through May.
Seventh District
Councilor: Benj. C. Diefenbach, Martins Ferry 43935
30 S. 4th St.
BELMONT — James Sutherland, President, 9 North 4th Street,
Martins Ferry 43935 ; Bertha M. Joseph, Secretary, 100 South
4th Street, Martins Ferry 43935. 3rd Thursday of February,
March, April, June, September, October, November and
December.
CARROLL— Glen C. Dowell, President, 207 West Main, Car-
rollton 44615 ; Thomas J. Atchison, Secretary, 292 East
Main, Carrollton 44615. 1st Thursday monthly.
COSHOCTON — Don Warren, President, 600 East Main Street,
West Lafayette 43845 ; Harold Lear, Secretary, 133 South
Fourth Street, Coshocton 43812. 2nd Tuesday monthly.
HARRISON — Charles D. Evans, President, 159 South Main
Street, Cadiz 43907 ; G. E. Vorhies, Secretax-y, Scio 43988,
Quarterly.
JEFFERSON — Jacob R. Cohen, President, 341 Market Street,
Steubenville 43952 ; Irving Dreyer, Secretary, Ohio Valley
Hospital, Steubenville 43952. 4th Tuesday monthly except
December, January, February.
MONROE — Byron Gillespie, Secretary, Woodsfield 43793.
TUSCARAWAS — Robert J. Kuba, President, 319 Grant St., Den-
nison 44621 ; Thomas E. Ogden, Secretary, 138 E. Main St.,
Gnadenhutten. 2nd Thursday monthly.
Eighth District
Councilor: Robert C. Beardsley, Zanesville 43705
2236 Maple Ave.
ATHENS — D. R. Johnson, President, 52 West Washington
Street, Nelsonville 45764; L. A. Hamilton, Secretary, 400 East
State Street, Athens 45701. 2nd Tuesday monthly except July
and August.
FAIRFIELD — George W. LeSar, President, 216 Harmon Avenue,
Lancaster 43130 ; Stephen R. Hodsden, Secretary, 1423 West
Market Street, Baltimore 43105. 2nd Tuesday monthly.
GUERNSEY — A. C. Smith, President, 1115 Clark Street, Cam-
bridge 43725; Dayle O. Snyder, Secretary, 840 Wheeling
Avenue, Cambridge 43725. 1st Tuesday monthly.
LICKING— Carl L. Petersilge, President, 104 Hudson Avenue,
Newark 43055 : Robert P. Raker, Secretary, 317 N. Granger
Street, Granville 43023. 4th Tuesday monthly.
MORGAN — A. H. Whitacre, President, Chestei-hill 43728 ; Henry
Bachman, Secretary, Box 199, Malta 43758.
MUSKINGUM — Paul A. Jones, President, 838 Market Street,
Zanesville 43701 ; Myron Powelson, Secretary, 2825 Maple
Avenue, Zanesville 43705. 2nd Tuesday monthly.
NOBLE — Frederick M. Cox, President, Caldwell 43724; Edward
G. Ditch, Secretary, 415 Main Street, Caldwell 43724. 1st
Tuesday monthly.
PERRY — Charles B. McDougal, President, 319 High St., New
Lexington 43764 ; Michael P. Clouse, Secretary, West Main St.,
Somerset 43783.
WASHINGTON — Mary L. Whitacre, President, Rt. 6, Marietta
45750 ; G- E. Huston, Secretai-y, 328 Fourth St., Marietta
45750. 2nd Wednesday monthly.
Ninth District
Councilor: George N. Spears, Ironton 45638
2213 S. 9th St.
GALLIA — Quentin Korfhage, President, Gallipolis Clinic, Gal-
lipolis 45631 ; John Groth, Secretary, Holzer Clinic, Gallipolis
45631. Monthly meetings at called times.
HOCKING — Jan S. Matthews, President, 9 East Second Street,
Logan 43138 ; H. M. Boocks, Secretary, Route 3, Logan 43138.
2nd Tuesday monthly.
JACKSON — John M. Cook, President, Box 316, Oak Hill 45656 ;
Earl J. Levine, Secretai-y, 120 N. Ohio Ave., Wellston 45692.
LAWRENCE — Frank W. Crowe, President, 2110 South 9th
Street, Ironton 45638 ; Geoi-ge Newton Spears, Secretary, 2213
South Ninth Street, Ironton 45638. Quarterly at called times.
MEIGS — Charles J. Mullen, President, 210% E. Main St., Pome-
roy 45769 ; Edmund Butrimas, Secretary, 204 E. Main St.,
Pomeroy 45769.
PIKE — Robert T. Leever, President, 100 East Third St., Waverly
45690 ; Albert M. Shrader, Secretai-y, East Water St., Waverly
45690. 1st Tuesday monthly.
SCIOTO — Chester H. Allen, President, 1405 Offnere Street,
Portsmouth 45662 ; Erich Spiro, Secretary, 1735 Waller Street,
Portsmouth 45662. 2nd Monday in February, April and Octo-
ber ; December meeting and summer meeting decided by the
Council and members notified one month in advance.
VINTON — Richard E. Bullock, President, 203 South Market St.,
McArthur 45651.
Tenth District
Councilor: Richard L. Fulton, Columbus 43212
1211 Dublin Rd.
DELAWARE — Don K. Michel, President, 98 W. William, Dela-
wai-e 43015 ; Tennyson Williams, Secretary, Box 265, Delaware
43015. 3rd Tuesday monthly.
FAYETTE- — R. D. Woodmansee, President, 403 East Market
Street, Washington C. H. 43160 ; M. H. Roszmann, Secretai-y,
1005 East Temple Street, Washington C. H. 43160. 2nd
Friday monthly
FRANKLIN — Joseph A. Bonta, President, 3100 Olentangy River
Road, Columbus 43202 ; Mr. W. “Bill” Webb, Jr., Executive
Secretary, 79 East State Street, Room 601, Columbus 43215.
3rd Tuesday monthly.
KNOX — Richard L. Smythe, President, 812 Coshocton Road,
Mt. Veimon 43050 ; Robert E. Sooy, Secretary, Box 470, Mt.
Veimon 43050. 1st Wednesday evening monthly.
MADISON — Sol Maggied, President, 15 East Pearl Street, West
Jefferson 43162 ; Michael Meftah, Secretary, 11 East 2nd
Street, London 43140. 1st Wednesday monthly.
MORROW — Francis W. Kubb, President, 140 North Main, Mt.
Gilead 43338 ; William S. Deffinger, Secretary, Box 8, Marengo
43334. 1st Tuesday monthly.
PICKAWAY — V. D. Kerns, President, 143 E. Main Street,
Circleville 43113 ; Carlos Alvarez, Secretary, 147 Pinckney
Sti*eet, Circleville 43113. 1st Friday evening monthly, except
months of July and August.
ROSS — Joseph McKell, President, 174 W. Main Street, Chilli-
cothe 45601 ; Lowell O. Smith, Secretary, 217 Delano Avenue,
Chillicothe 45602. 1st Thursday evening monthly.
UNION — Malcolm Maclvor, President, 110 N. Court St., Marys-
ville 43040 ; May B. Zaugg, Secretary, 225 Stockdale Drive,
Marysville 43040. 1st Tuesday, Februai-y, April, October,
December.
Eleventh District
Councilor: William R. Schultz, Wooster 44691
1749 Cleveland Road
ASHLAND — Henry C. Chalfant, President, 309 Arthur Street,
Ashland 44805 ; H. W. Smith, Secretary, 414 Samaritan Ave-
nue, Ashland 44805. 1st Thursday monthly.
ERIE— Clinton F. Lavender, President, 1218 Cleveland Road,
Sandusky 44870 ; R. D. Gillette, Secretary, P. O. Box 127,
Huron 44839. Alternate Tuesday and Thursday monthly.
HOLMES — Charles H. Hart, President, 109 South Clay Street,
Millersburg 44654; William A. Powell, Secretary, 8 West
Adams Street, Millersbui’g 44654. Monthly meeting date to
be determined later.
HURON — W. R. Graham, President, 15 Main Street, Wakeman
44889 ; E. R. McLoney, Secretary, 257 Benedict Avenue, Nor-
walk 44857. 2nd Wednesday of February, April, June, Au-
gust, October, and December.
LORAIN — Joseph A. Cicerrella, President, 209 6th Street, Lorain
44052 ; Mrs. Gladys Davidson, Executive Secretary, 428 West
Avenue, Elyria 44035. 2nd Tuesday monthly except June,
July and August.
MEDINA- — Myrl A. Nafziger, President, Albrecht Building,
Wadsworth 44281 ; Mr. A. Dana Whipple, Executive Secretary,
320 East Liberty Street, Medina, Ohio 44256. 3rd Thursday
monthly.
RICHLAND — C. J. Shamess, President, 74 Wood Street, Mans-
field 44903 ; Harold F. Mills, Secretary, 70 Madison Road.
Mansfield 44905. 3rd Thui-sday monthly except June, July and
August.
WAYNE — Howard MacMillan, President, 1740 Cleveland Road,
Wooster 44691 ; R. J. Watkins, Secretary, 1736 Beall Avenue,
Wooster 44691. 2nd Wednesday monthly, January, February,
April, September, November and December.
for April, 1966
401
JOURNAL ADVERTISERS
Advertisers in The journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The Journal,
and help make it a quality publication. In return we
place their messages on the desks of Ohio’s physicians.
Please familiarize yourself with their services and pro-
ducts, and let them know that you see their advertising
in The Journal.
In This Issue :
Abbott Laboratories 309 - 310 - 311 - 312
Allergy Laboratories of Ohio, Inc 285, 404
Ames Company, Inc Inside Back Cover
Appalachian Hall 292
Associated Credit Bureaus of Ohio 398
Ayerst Laboratories 293 - 294 - 295
Blessings, Inc 307
The Brown Pharmaceutical Co 314
Burroughs Wellcome & Co. (USA) Inc 315
The Coca-Cola Company 292
Daniels-Head & Associates, Inc 395
Data Corporation 389
Elder, Paul B., Company 404
Glenbrook Laboratories (Bayer Aspirin) 306
Hynson, Westcott & Dunning, Inc 281
The Kendall Company 297
Lederle Laboratories, A Division of
American Cyanamid Company 284, 302 -
303, 304, 316 - 317
Lilly, Eli, and Company 320
Methodist Hospital Graduate Medical
Center, Indianapolis, Indiana 385
The Medical Protective Company 308
Merck Sharp & Dohme, Division of
Merck & Co., Inc 287
Ohio State Surgical Association 387
Parke, Davis & Company Inside Front Cover
Philips Roxane Laboratories 289 - 290, 392 - 393
Robins, A. H., Company, Inc 299 - 300 - 301
Roche Laboratories, Division of
Hoffmann-La Roche Inc Back Cover
Sanborn Division, Hewlett-Packard
Company 346
Searle, G. D., & Company 344 - 345
Smith Kline & French Laboratories 318
Squibb, E. R., & Sons 319
Turner & Shepard. Inc 396
Tutag, S. J., & Co 308
The Vale Chemical Company, Inc 286
Wallace Laboratories 305, 313
The Wendt-Bristol Company 385
Windsor Hospital 394
Winthrop Laboratories 282
Table of Contents
(Contd. From Page 283)
c AGE
286 Cincinnati Surgery Team Pioneers in Clinical
Use of Argon Laser
296 Ten Commandments for the Prevention of
Alcoholic Addiction
296 Current Comments in the Field of the Drug
Manufacturers
298 Work Days Restricted by Illness in Billions
298 New Members of the Association
298 OSU Pioneers in Network Nursing Education
307 "To All My Patients”
307 M. D.’s in the News
314 Measles Vaccine for Preschool Programs
374 Good Samaritan of Cincinnati, Seminar on
Premature Care
379 Cleveland Health Museum Offers Tour
379 University of Virginia Alumni Reception
380 Proceedings of The Council
383 In Our Opinion
384 OMPAC Membership Hits 2,610
385 Obituaries
391 Group Discusses Features of Ohio State Surgical
Association Program
391 Ohio State Heart Association Luncheon
391 Caribbean Territories Sales Group Gets Cease
and Desist Order
391 Fellowship in Immunology
394 Activities of County Medical Societies
397 Woman’s Auxiliary Highlights
399 Roster of State Association Officers and
Committeemen
400 Roster of County Medical Societies’ Officers and
Meeting Dates
402 The Journal’s Advertisers in This Issue
402 Classified Advertisements (also page 403)
Classified Advertisements
FOR RENT — Doctor’s Office, 1st Floor, 310 East Main Street,
Lancaster, Ohio. Tel. 653-4721 or Res. 653-5032, Central Heating,
Central Air Conditioning, Black Top Parking Area.
CLINIC COMPLETELY FURNISHED: This might be a good
opportunity if you are interested in group practice. The building, a
nice brick, is well located in a city of approximately 50,000 people,
surrounded by many large manufacturing plants. There is adequate
free parking space. This town is growing rapidly and there is a
need for more medical men. If interested, phone 382-8520 (area
code 6l4) in the A. M. for an appointment.
YOU ARE WANTED: If you are an M. D. who is looking for
an ideal location for G. P. we have it. In a thriving rural com-
munity which is without an M. D. for the first time in history.
Well located in Southwestern Ohio, near New Township District
Hospital. New High School under construction. Modern Air Con-
ditioned office available. Call, write or see, Howard N. Henderson,
Lynchburg, Ohio; Phone 364-2351.
PSYCHIATRIST or OTHER PHYSICIAN needed as Chief of
Medical or Psychiatric Services. Acceptable areas of specialization
are psychiatry, neurology, internal medicine or any comparable spe-
cialty or subspecialty. Responsible for providing medical services to
patients at mental hospital specializing in forensic problems; super-
vising hospital ward procedures; examinations of new patients.
Starting salary from $16,884 to $19,884 depending on training and
experience plus up to $1800 additional according to responsibility
assigned; excellent fringe benefits. Contact E. F. Schubert, M. D..
Superintendent, Central State Hospital, Box 43, Waupun, Wisconsin.
402
The Ohio State Medical Journal
OHIO STATE MEDICAL
journal
Table of Contents
Page Scientific Section
447 Adenomatous Polyps of the Colon. Abdul F. Naji,
M. D., Fayiz A. Salwan, M. D., and Robert R. Bar-
tunek, M. D., Cleveland.
453 Aging and the Skin. Capt Lawrence B. Meyerson, M. C.,
Tripler Army Medical Center, A. P. O. San Francisco,
California 96438.
OSMA OFFICERS
President U|
Henry A. Crawford, M. D. H
1058 Hanna Bldg., Cleveland 44115 II
President-Elect H
Lawrence C. Meredith, M. D. 3
205 Elyria Block, Elyria 44035 g§
Past-President II
Robert E. Tschantz, M. D. 3
515 Third St., N. W., Canton 44703 {H
T reasurer §§
Philip B. Hardymon, M. D. 3
350 E. Broad St., Columbus 43215
EDITORIAL STAFF m
Editor ;
Perry R. Ayres, M. D. 3
Managing Editor and H
Business Manager g
Hart F. Page
Executive Editor and =
Executive Business Manager g{
R. Gordon Moore d
OSMA EXECUTIVE STAFF g
Executive Secretary g
Hart F. Page g§
Director of Public Relations and II
Assistant Executive Secretary g|
Charles W. Edgar d
Administrative Assistants d
W. Michael Traphagan 3
Herbert E. Gillen
Address All Correspondence: gf
The Ohio State Medical Journal d
17 South High Street, Suite 500 fg
Columbus, Ohio 43215 gj
Published monthly under the direction of the H
Council for and by members of The Ohio State =|
Medical Association, 17 South High Street, Suite II
500, Columbus, Ohio 43215, a scientific society, ==
nonprofit organization, with a definite member- =§=
ship for scientific and educational purposes.
Subscription, $6.00 per year to non-members; ||s
single copy, 50 cents (outside Continental U.S., =
$7.50 and 75 cents). ==
Entered as second class matter July 5, 1905, at g
the Postoffice at Columbus, Ohio, under the Act ||s
of Congress of March 3, 1 879; Acceptance for =
mailing at special rate of postage provided for in =
Section 1103, Act of Oct. 3, 1917. Authority =
July 10, 1918. m
The Journal does not assume responsibility for ^1
opinions expressed by the essayists. Advertisers II
must conform to policies and regulations estab- =|
lished by The Council of the Ohio State Medical i=
Association. ==
457 Frank Vectorcardiograms of Normal Adults. Robert T.
Murnane, M. D., Columbus; Louis B. Skimming,
M. D., Middletown; Galen H. Davis, M. D., Dublin,
and James R. Snyder, M. D., Suitland, Maryland.
463 Adrenal Cysts. A Case Report. Ernest B. Mainzer,
M. D., Mansfield.
466 A Clinicopathological Conference from The Ohio State
University Hospital, Columbus, Ohio.
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
News and Organization Section
474 Proceedings of The Council — Meeting of March 20
481 Resolutions Which Will Be Considered at the 1966
OSMA Annual Meeting
492 Policy Regarding Governmental Medical Care Programs
Policy Statement of The Council of OSMA
Regarding Governmental Medical Care
Programs
A Statement on : Composition and Duties of
Hospital Utilization Review Committees
Opinion of Chief, Legal Section, Bureau of
Workmen’s Compensation Inter-Office
Communication
495 Candidates for the Office of President-Elect of OSMA
496 Medical Society Officers’ Conference — Pictorial Report
of Meeting Held in Columbus, February 27
499 "Contract Practice’’ — A Large Project
506 Honors to Dr. Platter — Highlight of the 1966 OSMA
Annual Meeting Scheduled in Cleveland, May 24-28
( Continued on Page 322 )
STONEMAN PRESS, COLUMBUS, OHIO
[
PRINTED 1
IN U S A j|
I .
in the treatment of
IMPOTENCE
Android
(thyroid-androgen)
TABLETS
®
ANDROID
GOOD TO EXCELLENT 75%
PLACEBO
20%
SUMMARY
1. Forty cases reported.
2. Excellent to good results, 75% with Android, 20% with
3. Cites synergism between androgen and thyroid.
4. No side effects in patients treated.
5. Alleviation of fatigue noted.
6. Case histories on 4 patients.
7. Although psychotherapy still needed, role of
chemotherapy cannot be disputed.
CONTRAINDICATIONS — Methyl testosterone is
Placebo not to be used in malignancy of reproductive
organs in male, coronary heart disease, hyper-
thyroidism. Thyroid is not to be used in heart
disease, hypertension unless the metabolic
rate is low.
CAUTION: Federal law prohibits dispensing
without prescription.
*“ Sexual impotence treatment with methyl testosterone • thyroid (ANDROID) a
double blind study” - Montesano, Evangelista: Clinical Medicine, April 1966.
REFER TO
ANDROID
Each yellow tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. (1/6 gr.) 10 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
ANDROID-HP
Each red tablet contains:
Methyl Testosterone 5.0 mg.
Thyroid Ext. (1/2 gr.) 30 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
ANDROID -X^E7
Each orange tablet contains:
Methyl Testosterone 12.5 mg.
Thyroid Ext. (1 gr.) 64 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 or 2 tablets daily.
Available:
Bottles of 60, 500.
V
Write for literature and samples:
(broWJJm THF BROWN PHARMACEUTICAL CO. 2500 W. 6th St., Los Angeles, Calif. 90057
ANDROID-PLUS
Each white tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. Wt gr.) 15 mg.
Ascorbic Acid
(Vit. 0 250 mg.
Glutamic Acid 100 mg.
Pyridoxine HCL 5 mg.
Niacinamide 75 mg.
Calcium Pantothenate 10 mg.
Vitamin B-12 2.5 meg.
Riboflavin 5 mg.
Dose: 1 tablet twice daily.
Available:
Bottles of 60, 500.
For prompt, emphatic diuresis
(BENZTHIAZIDE)
NEW FROM TUTAG for prompt, comfortable
diuretic action with a balanced excretion
of sodium chloride and a lower potassium
loss under normal dosage and diet regimen
DIURETIC ACTION: Clinically, the oral administration of AQUATAG (benzthi-
azide) results in diuretic activity within two hours with maximal natriuretic,
chloruretic, and diuretic effects occurring during the fourth, fifth and sixth hours.
Maintenance of response continues for approximately 12 to 18 hours. Acidosis
is an unlikely complication since therapeutic doses of AQUATAG (benzthi-
azide) do not appreciably increase bicarbonate excretion. Edematous patients
receiving 50 mg. of AQUATAG (benzthiazide) daily for five days developed a
maximal increase in the rate of sodium excretion on the first day, and main-
tained this high rate until depletion of excessive body stores of sodium.
In congestive heart-failure patients, AQUATAG (benzthiazide) produced the
same weight loss, during a 48-hour treatment period as did a maximally effec-
tive dose of hydrochlorothiazide.
DOSAGE: Diuresis, initially 50 to 200 mg.; maintenance 25 to 150 mg., daily.
Hypertension 50 to 100 mg. initially, adjusted to 50 mg. t.i.d. or downward to
minimal effective dosage level.
PRECAUTIONS AND SIDE EFFECTS: Electrolyte imbalance with hypoka-
lemia, hypochloremic alkalosis and hyponatremia may occur. Other reactions
may include blood dyscrasias, hyperuricemia and gout, nausea, jaundice,
anorexia, vomiting, diarrhea, dizziness, paresthesia, photosensitivity and head-
ache. Insulin requirements may be altered in diabetes.
WARNINGS: Dosage of coadministered antihypertensive agents should be
reduced by at least 50%. Use with caution in edema due to renal disease;
advanced hepatic disease or suspected presence of electrolyte imbalance.
Stenosis or ulcer of small intestine have been reported with coated potassium
formulas and should be administered only when indicated. Until further clinical
experience is obtained, the use of the drug in pregnant patients should be
carefully weighed against possible hazards to the fetus.
CONTRAINDICATIONS: AQUATAG (benzthiazide)
is contraindicated in progressive renal disease or
disfunction including increasing oliguria and azo-
temia. Continued administration of this drug is
contraindicated in patients who show no response
to its diuretic or antihypertensive properties.
Before prescribing or administering, read the package
insert or file card available on request.
Available as 25 or 50 mg. scored tablets.
Request clinical samples and literature on your
letterhead.
S.J.TUTAG
& COMPANY
Detroit. Michigan 48234
408
The Ohio State Medical Journal
in any language
serpate®
CRESERPINE]
is the number one , first drug
for moderate hypertension
As a first step:
SERPATE® (Reserpine) exerts a gradual, sustained reduction of
blood pressure
SERPATE® (Reserpine) relieves anxiety and tension in hypertensive
patients with low resistance to everyday crises
SERPATE® (Reserpine) is modestly priced
SERPATE® (Reserpine) in low oral dosage is characterized by a
minimum of serious reactions and low-yield side effects — thus, it
may be used with comparative assurance
SERPATE®(Reserpine) combines readily with more potent anti-
hypertensives for patients exhibiting severe hypertension
Physician samples and technical data sent on request
(Supplied in doses of 0.1 mg. white tablets
and 0.25 mg. yellow tablets)
THE VALE CHEMICAL CO., INC.
PHARMACEUTICALS • ALLENTOWN, PENNSYLVANIA
W1K
INDICATIONS: mode rate hypertension;
labile hypertension, particularly when
accompanied by tachycardia or neuro-
sis; and as adjunctive therapy to the
more powerful hypotensive drugs in
severe hypertension.
DOSAGE: The initial dosage of SER-
PATE® (reserpine) is 0.5 mg. to 1.0 mg.
in divided doses daily. Initial dosage
should not be continued more than
one week. After one week, the recom-
mended daily dosage is 0.1 mg. to 0.25
mg. An occasional patient will require
a maintenance dose of 0.5 mg., but if
adequate response is not obtained
from this dosage it is well to consider
adding another hypotensive agent
rather than increase the dosage.
Reserpine action is cumulative and
maximum response may not be ob-
served until several days to two weeks
elapse after therapy is initiated. Slight
residual effects may persist for several
weeks after discontinuation of therapy.
Important: Use SERPATE® (reserpine)
with caution in patients with history of
mental depression, peptic ulcer, or
ulcerative colitis. Members of patient's
family should be alerted to watch for
and report any symptoms of mental
depression.
WARNING: Anesthetics have been
found to increase the hypotensive
effect of reserpine. Caution should be
taken to withdraw patients from
SERPATE® (reserpine) two weeks prior
to administering anesthetics or to
elective surgery. Use with caution in
gravid patients. Reserpine passes the
placental barrier and may affect the
newborn.
for May, 1966
4 11
Corporate Medical Laboratories:
A Policy Statement of AAGP
Following is a statement of policy of the American
Academy of General Practice as it appeared in the
February, 1966, AAGP Headquarters Bulletin:
"Recently the Department of Medical Ethics of
the American Medical Association forwarded cor-
respondence from a physician asking for a statement
of Academy policy concerning corporate medical lab-
oratories. I answered the query by pointing out that
no Academy policy exists in any form endorsing such
laboratories.
"The Academy’s position is in line with guidelines
expressed by the AMA Judicial Council and a 1961
policy statement adopted by the AMA House of Dele-
gates. That statement reads:
" 'The American Medical Association hereby de-
clares that the proper conduct of laboratory analyses
is a medical professional responsibility and all speci-
mens and such analysis should be referred to labora-
tories supervised by fully qualified and licensed
physicians.’
"The practice of pathology, both clinical and an-
atomical, is medical practice, of course. The AMA
holds that operation of commercial laboratories by
nonprofessional persons is against the public interest
and degrades the practice of medicine.
"In 1965 the AMA Judicial Council issued an
opinion regarding physician billing procedures for
laboratory services. The council’s ruling is:
" T. The practice of pathology is an integral part
of the practice of medicine.
" '2. All physicians should bill their patients di-
rectly, and
" '3. In exceptional cases, when it is not possible
for the laboratory bill to be sent directly to the pa-
tient, the referring physician’s bill to the patient
should indicate the charges for laboratory services,
including the name of the physician director of the
laboratory, as well as the charges for his own profes-
sional services.’
"Because the guidelines are in the best interests
of the public, the Academy does not permit labora-
tories that do not meet professional standards, or
those whose practices would encourage members to
contravene the policy of the Judicial Council, to ex-
hibit at our Annual Scientific Assembly.
"In the interests of the public, I urge that you
review the services of each applicant for space at
your meetings to insure that every exhibitor offers a
competent, professional service to the physician and
the patients whom he serves.
"Sincerely
"Mac F. Cahal
"Executive Director.”
THE WENDT-BRISTOL COMPANY
GENERAL OFFICES
AND DISPLAY ROOM
1159 Dublin Road — Columbus 12, Ohio
HU 6-9411
PLENTY OF PARKING SPACE
A Complete Source of Supply
EVERYTHING FOR THE DOCTOR
and HOSPITAL
Surgical Instruments
Office & Treatment Room Furniture
X-ray and X-ray Supplies
Sterilizing, EKG and Anesthesia Equipment
Pharmaceuticals
EVERYTHING FOR THE PATIENT
Drive-in Prescription & Retail Store
Sickroom Supplies
Hospital Beds (Rental or Sale)
Wheelchairs (Rental or Sale)
Surgical Garments fitted by
Trained Male and Female Fitters
Columbus Branch Stores
BUTTLES UNIVERSITY
721 N. High Street 1660 Neil Ave.
CA 1-3153 AX 1-7048
DOWNTOWN
26 S. Third Street
(Next door to the Dispatch)
CA 1-5105
Worthington Branch
(Serving North Columbus and Worthington Areas)
1000 High Street Worthington, Ohio
Phone 885-4079
underachievers
A residential facility for Junior and Senior
High School males who need psychiatric
help with: ■ Problems of academic under-
achievement and attendance . . . ■ Diffi-
culties in family-school-social adjustments.
Complete academic and therapy program for
grades 7 through 12.
For information contact: Rita Burgett, Secretary
The Readjustment Center
Box 373, Ann Arbor, Mich.
Phone: (AC 313) 663-5522
412
The Ohio State Medical Journal
Mediatric®
Designed for the “metabolically spent”
Nutritional reinforcement for those who can’t
- or won’t- eat properly. . . balanced amounts of
estrogen and androgen to counteract declining
gonadal hormone secretion and its sequelae of
premature degenerative changes... mild
antidepressant for a gentle “mood” uplift...
The estrogen component in MEDIATRIC is
PREMARIN® (conjugated estrogens — equine),
the natural estrogen most widely prescribed for its
superior physiologic and metabolic benefits.
MEDIATRIC also provides nutritional reinforce-
ment—blood-building factors and vitamin supple-
mentation. It contributes a gentle “mood” uplift
through methamphetamine HC1.
Three different dosage forms— Liquid, Tablets, and
Capsules— offer convenience and variety.
MEDIATRIC Liquid
Each 15 cc. (3 teaspoonfuls) contains:
*Conjugated estrogens — equine (Premarin®) 0.25 mg.
Methyltestosterone 2.5 mg.
Thiamine HC1 5.0 mg.
Cyanocobalamin 1.5 meg.
MEDIATRIC helps keep the older patient alert and active;
helps relieve general malaise, easy fatigability, vague pains in
the bones and joints, loss of appetite, and lack of interest
usually associated with declining gonadal hormone secretion.
contraindication: Carcinoma of the prostate, due to methyl-
testosterone component.
warning: Some patients with pernicious anemia may not
respond to treatment with the Tablets or Capsules, nor is
cessation of response predictable. Periodic examinations and
laboratory studies of pernicious anemia patients are essential
and recommended.
side effects: In addition to withdrawal bleeding, breast ten-
derness or hirsutism may occur.
suggested dosages: Male and female: 3 teaspoonfuls of
Liquid, 1 Tablet, or 1 Capsule, daily or as required.
In the female: To avoid continuous stimulation of breast and
uterus, cyclic therapy is recommended (3 week regimen with
1 week rest period— Withdrawal bleeding may occur during
this 1 week rest period).
In the male: A careful check should be made on the status
of the prostate gland when therapy is given for protracted
intervals.
Methamphetamine HC1 1.0 mg.
Contains 15% alcohol
MEDIATRIC Tablets and Capsules
Each MEDIATRIC Tablet or Capsule contains:
'Conjugated estrogens — equine (Premarin®) 0.25 mg.
Methyltestosterone 2.5 mg.
Ascorbic acid 100.0 mg.
Cyanocobalamin 2.5 meg.
Intrinsic factor concentrate 8.0 mg.
Thiamine mononitrate 10.0 mg.
Riboflavin 5.0 mg.
Niacinamide 50.0 mg.
Pyridoxine HC1 3.0 mg.
Calc, pantothenate 20.0 mg.
Ferrous sulfate exsic 30.0 mg.
Methamphetamine HC1 1.0 mg.
’Orally active, water-soluble conjugated estrogens derived from
pregnant mares’ urine and standardized in terms of the weight
of active, water-soluble estrogen content.
supplied: No. 910 — MEDIATRIC Liquid, in bottles of 16
fluidounces and 1 gallon. No. 752 — MEDIATRIC Tablets,
in bottles of 100 and 1,000. No. 252 - MEDIATRIC Cap-
sules, in bottles of 30, 100, and 1,000.
Mediatric
steroid-nutritional compound
AYERST LABORATORIES, NEW YORK, N. Y. 10017 • Montreal, Canada
6634
Current Comments in the Field
Of the Drug Manufacturers
The following excerpts of comments from various
sources are presented in behalf of the Pharmaceutical
Manufacturers Association and drug manufacturing
firms in general.
* * *
When physicians encounter an adverse drug reac-
tion it is not uncommon for them to write to the
distributor of the drug, possibly in the form of a
complaint or as a request for information on similar
experience. Reports are often transmitted through
the detail man. No one knows as much about
marketing experience with a drug as its distributor.
- — - Ralph G. Smith, M. D., in Jottrnal of New Drugs,
(6:66), January-February 1966.
* * *
There is certainly room for generic drugs. But
the effort to curb the branding of all drugs would
be a disastrous body blow to the public. Countless
research efforts, conducted at heavy expense both in
money and manpower, come to nothing. Others
produce valuable but specialized drugs, needed and
used by but a few people who would die without
them. The successful drugs in wide use must carry
the costs. There is no other way. A trade name is
the producer’s guarantee of quality. And it rewards
research and development which mean help to sufferers
from the endless ailments which plague mankind.
Why put a brake on medical progress — the road to
ever better health. — Editorial in St. Louis County
Medical Society Bulletin, (32:5) February 18, 1966.
* * *
When it comes to combating the tearful testimony
of the various antivivisectionist groups we may be re-
quired to become just as emotional by using the
testimony of grateful people who now live because
of the contribution animals have made to medical
knowledge. We must not be complacent. This is
the year for the antivivisectionist — unless we com-
bat emotions with tmth. — Daniel B. Powell, M. D.,
in Texas Medicine, (62:27-28) February 1966.
* * *
”... I would hate to be introducing digitalis as
a new drug today. Anyone reading the toxicity and
side effects would never use it in the present climate.
However, digitalis has been with us long enough now
that the toxicity and side effects have taken their
proper place. They are there, to be sure, but not as
prominently as the therapeutic effect. — Robert W.
Ballard, M. D., in Food Drug Cosmetic Law Journal,
(21:31-32), January 1966.
Harding Hospital
(Formerly Harding Sanitarium)
WORTHINGTON, OHIO
For the Diagnosis and Treatment of Psychiatric Disorders
and with
Limited Facilities for the Aging
GEORGE T. HARDING, M. D. JAMES L. HAGLE, M. B. A.
Medical Director Administrator
Phone: Columbus 885 - 5381
(Area Code: 614)
424
The Ohio State Medical Journal
NOTHING, THAT IS,
EXCEPT THE SEDATIVE-ANTISPASMODIC
BENEFITS OF
DONNATAL
There’s nothing quite like a vacation to ease the pressures of
the modern, “workingday” world. And for the patient who can’t
get away from it all, there’s nothing quite like Donnatal to relax
stress-induced smooth muscle spasm. For 31 years it has been
the antispasmodic-sedative most often prescribed for relieving
functional disturbances of tone and motility of the gastrointes-
tinal tract.
belladonna alkaloids in optimally balanced ratio
In Donnatal, natural belladonna alkaloids are rationally balanced
in a specific, fixed ratio that provides “the greatest efficacy with
the smallest possible dose.’’1 They avoid the clinical uncertain-
ties of the variable tincture and extract of belladonna, and are
considered superior in range of action to atropine alone.2
Furthermore, they are generally recognized as being more effec-
tive than the synthetics for relieving visceral spasm.
phenobarbital for sedation
Years of clinical use have established phenobarbital as one of
the most efficient and highly regarded sedatives. In fact, for
general sedation it is the drug of choice.3 In Donnatal, pheno-
barbital potentiates the spasmolytic effects of the belladonna
alkaloids, lessening emotional tensions and checking the neuro-
genic impulses that trigger Gl disorders.
more than 24 indications in PDR
Donnatal has withstood the test of time to become the classic
sedative-antispasmodic because of its unsurpassed effective-
ness, safety, economy, uniformity of composition, and dosage
convenience. Its widespread acceptance and usage by the pro-
fession can also be attributed to its versatility in treating dis-
orders characterized by smooth muscle spasm. There are more
than two dozen distinct and separate indications for Donnatal
listed in the current PDR.
IN EACH TABLET, CAPSULE, OR
(5 cc.) OF ELIXIR
hyoscyamine sulfate 0.1037 mg.
atropine sulfate 0.0194 mg.
hyoscine hydrobromide . . . 0.0065 mg.
phenobarbital (’A gr.) 16.2 mg.
(warning: may be habit forming)
IN EACH EXTENTAB
hyoscyamine sulfate 0.3111 mg.
atropine sulfate 0.0582 mg.
hyoscine hydrobromide . . . 0.0195 mg.
phenobarbital (3A gr.) 48.6 mg.
(warning: may be habit forming)
BRIEF SUMMARY: Blurring of vision,
dry mouth, difficult urination, and flush-
ing or dryness of the skin may occur
on higher dosage levels, rarely on
usual dosage. Administer with caution
to patients with incipient glaucoma,
or urinary bladder neck obstruction.
Contraindicated in acute glaucoma,
advanced renal or hepatic disease, or
a hypersensitivity to any of the ingre-
dients.
REFERENCES: 1. Vollmer, H.: Arch. Neurol,
and Psychiat., 43:1057, 1940. 2. Morrissey,
J.H.: J. Urology, 57:635, 1947. 3. Krantz, J.C.,
Jr., and Carr, C.J.: Pharmacological Prin-
ciples of Medical Practice, 2nd ed., Balti-
more (1954), 552.
*This one at Westover, elegant Colonial Vir-
ginia plantation, located on the James River
near Richmond. Built in the early 1730’s by
William Byrd II, founder of Richmond, it is
now the home of Mrs. Bruce Crane Fisher.
A. H. ROBINS COMPANY, INC., RICHMOND, VA.
/1-H-DOBINS
New Members . . .
Following are names of new members of the Ohio
State Medical Association certified to the Headquar-
ters Office during March. List shows name of physi-
cian, county and city in which he is practicing or tem-
porary addresses for those taking graduate work.
Belmont Franklin ( continued )
John H. Mahan, St. Clairsville
Jerry E. Schmitthenner,
Barnesville
Butler
Oscar A. Capo, Hamilton
George S. Hunt, Hamilton
C. Donald Stevens, Hamilton
Cuyahoga
R. Mario Abellera, Cleveland
Ralph J. Alfidi, Cleveland
Donald K. Anderson,
Cleveland
Marshall W. Ashby, Cleveland
Alfredo A. Austria, Cleveland
Fillmore K. Bagatell,
Cleveland
Margaret B. Cendo, Cleveland
Eva M. Dorre, Cleveland
Necdet Emir, Cleveland
John J. Eversman, Cleveland
Daryush Haghighi, Cleveland
Louis E. Hammond, Cleveland
Marinos D. Hionis, Cleveland
John J. Jane, Cleveland
Edgardo B. Katigbak,
Cleveland
John H. Kennedy, Cleveland
Gholam H. Khosh, Cleveland
David LaChance, Cleveland
Thomas J. Lavin, Cleveland
Richard C. Lavy, Cleveland
Frank Maries, Cleveland
Valentine C. Marr, Cleveland
Philip E. Morgan, Cleveland
Robert Schwartz, Cleveland
Salvadore R. Torres, Cleveland
Philip A. Vlastaris, Cleveland
Theodore R. Warm, Cleveland
Franklin
Robert M. Curran, Columbus
Herbert G. Ewy, Columbus
Richard L. Klecker, Columbus
Donald L. Lewis, Columbus
John L. Melvin, Columbus
William C. Segmiller, Jr.,
Columbus
John D. Trelford, Columbus
R. James Vaccarella, Columbus
Robert W. Vollmer, Columbus
Hamilton
Joseph D. Cionni, Cincinnati
Lawrence G. Kautz, Cincinnati
Floyd B. Main, Cincinnati
James H. Salmon, Cincinnati
Cecil H. Schapera, Cincinnati
Jackson
John W. Zimmerly, Jackson
Lucas
Charles D. Cobau, Toledo
John J. Culbertson, Sylvania
Justo M. Dominguez, Toledo
Pranas Neverauskas, Toledo
Jerry C. Rosenberg, Toledo
Charles E. Rowan, Toledo
Mahoning
Paulino R. Luna, Youngstown
Alfonso Corzo-Moody,
Youngstown
Juan A. Ruiz-Oleaga,
Youngstown
Marion
Albert N. May, Marion
Montgomery
John B. Bockoven, Dayton
Washington
Leopoldo Banuelos, Marietta
Millard C. Hanson, Marietta
Wood
Marjorie E. Conrad,
Bowling Green
Dr. John P. Minton, Columbus, was guest speaker
at the Tuscarawas County Cancer Crusade Kick-Off
meeting in March. A clinical research fellow at Ohio
State University working in the field of laser surgery,
Dr. Minton has been awarded the 1965 James Ewing
Society Resident Award, the 1965 USPHS Clinical
Society Surgery Award, and the American Ther-
apeutic Society’s Oscar B. Hunter Memorial Award.
* * *
Dr. Albert Van Sickle, Batavia, health commis-
sioner of Clermont County, is the new president of
the Ohio Valley Health Commissioners’ Association.
❖ * *
The Gold Headed Cane of the American Associa-
tion of Pathologists and Bacteriologists was given to
Dr. Harry Goldblatt, of Mount Sinai Hospital and
Western Reserve University in recent ceremonies at
the Hotel Statler Hilton in Cleveland.
^5 ^ 5k
Dr. Judson D. Wilson, Columbus orthopedic sur-
geon, was elected to the Board of Trustees of the
Columbus Automobile Club. He filled the vacancy
created by the death of Dr. C. C. Sherburne.
Bamadex® Sequels®
Contraindications: In hyperexcitability and in agi-
tated prepsychotic states. Previous allergic or
idiosyncratic reactions.
Precautions: Use with caution in patients hyper-
sensitive to sympathomimetic compounds, who
have coronary or cardiovascular disease, or are
severely hypertensive.
Dextro-amphetamine sulfate: Use by unstable in-
dividuals may result in psychological dependence.
Meprobamate: Careful supervision of dose and
amounts prescribed is advised; especially for pa-
tients with known propensity for taking excessive
quantities of drugs. Excessive and prolonged use
in susceptible persons, e.g. alcoholics, former ad-
dicts, and other severe psychoneurotics, has been
reported to result in dependence. Where excessive
dosage has continued for weeks or months, re-
duce dosage gradually. Sudden withdrawal may
precipitate recurrence of pre-existing symptoms
such as anxiety, anorexia, or insomnia; or with-
drawal reactions such as vomiting, ataxia, trem-
ors, muscle twitching and, rarely, epileptiform
seizures. Should meprobamate cause drowsiness
or visual disturbances, reduce dose — operation of
motor vehicles, machinery or other activity re-
quiring alertness should be avoided. Effects of
excessive alcohol consumption may be increased
by meprobamate. Appropriate caution is recom-
mended with patients prone to excessive drinking.
In patients prone to both petit and grand mal
epilepsy meprobamate may precipitate grand mal
attacks. Prescribe cautiously and in small quanti-
ties to patients with suicidal tendencies.
Side Effects: Overstimulation of the central nerv-
ous system, jitteriness and insomnia or drowsiness.
Dextro-amphetamine sulfate: Insomnia, excita-
bility, and increased motor activity are common
and ordinarily mild side effects. Confusion, anx-
iety, aggressiveness, increased libido, and halluci-
nations have also been observed, especially in
mentally ill patients. Rebound fatigue and de-
pression may follow central stimulation. Other
effects may include dry mouth, anorexia, nausea,
vomiting, diarrhea, and increased cardiovascular
reactivity.
Meprobamate: Drowsiness may occur and can be
associated with ataxia, the symptom can usually
be controlled by decreasing the dose, or by con-
comitant administration of central stimulants.
Allergic or idiosyncratic reactions: maculopapu-
lar rash, acute nonthrombocytopenic purpura
with petechiae, ecchymoses, peripheral edema
and fever, transient leukopenia. A case of fatal
bullous dermatitis, following administration of
meprobamate and prednisolone, has been re-
ported. Hypersensitivity has produced fever,
fainting spells, angioneurotic edema, bronchial
spasms, hypotensive crises (1 fatal case), anuria,
stomatitis, proctitis (1 case), anaphylaxis, agranu-
locytosis and thrombocytopenic purpura, and a
fatal instance of aplastic anemia, but only when
other drugs known to elicit these conditions were
given concomitantly. Fast EEG activity, usually
after excessive dosage. Impairment of visual ac-
commodation. Massive overdosage may produce
drowsiness, lethargy, stupor, ataxia, coma, shock,
vasomotor, and respiratory collapse.
428
The Ohio State Medical Journal
C-14 AS MILLIGRAMS NICOTINIC ACID EXCRETED
ged and debilitated
less confused and moody. Personal care, memory,
emotional stability, social attention improve. Fatigue,
apathy and irritability are reduced.
A prescription for 100 tablets of Geroniazol TT will
permit your patients to enjoy the benefits of time-
prolonged nicotinic acid/pentylenetetrazol therapy,
at an economical price. Dosage is only one tablet every
12 hours.
Contraindications : There are no known contraindica-
tions.
Precautions : Exercise caution when treating patients
with a low convulsive threshold.
“First with the Retro-Steroids ”
PHILIPS ROXANE LABORATORIES
Division of Philips Roxane, Inc., Columbus, Ohio
A Subsidiary of Philips Electronics and
Pharmaceutical Industries Corp.
GeroniazolTT
nicotinic acid 150 mg., pentylenetetrazol 300 mg.
Tempotrol® Time Controlled Tablet
Side Effects: Side effects are rarely encountered, how-
ever due to the vasodilatation effect of nicotinic acid,
transitory mild nausea, flushing, tingling and pru-
ritus are possible.
Dosage: One tablet every 12 hours.
Supplied: Prescribe bottles of 100 tablets, to take ad-
vantage of recent price reduction.
References: 1. Report by Nuclear Science & Engi-
neering Corp., Pittsburgh, Pa., in files of Philips
Roxane Laboratories. 2. Connolly, R. : W. Virginia Med.
J. 56: 263 (Aug.) 1960. 3. Curran, T. R., and Phelps,
D. K. : Am. Pract. & Digest Treat. 11 :617 (July) 1960.
M. D.’s in the News
Dr. Carl E. Wasmuth, Cleveland, spoke before
the recent Ciba Foundation Symposium in London,
England, where he appealed for legislation to give
living persons the right to bequeath body organs for
transplantation.
* * *
Dr. Robert M. Zollinger, Columbus, chief of sur-
gery at Ohio State University College of Medicine,
was principal speaker at a meeting of the Lancaster
Rose Club. He is president of the American Rose
Society.
* * *
The Southwestern Ohio Society of Family Physi-
cians held its Spring Seminar on April 3 in the Uni-
versity of Cincinnati College of Medicine Auditorium.
Subject of discussion was "Hematology.”
* * *
Dr. Dwight L. Becker, Lima, spoke on "Medicare”
before a meeting of St. Rita’s Hospital Auxiliary.
* ❖ ❖
Dr. George W. Petznick, Shaker Heights, spoke
at a public meeting in the Heights Christian Church
where he is an elder on the topic, "The Physician,
the Clergy, and the Whole Man.” He is a Past
President of OSMA, is chairman of the OSMA Com-
mittee and member of the AMA Committee on
Medicine and Religion.
* * *
Dr. Martin P. Sayers, clinical associate professor in
neurosurgery at Ohio State University, was speaker
at a meeting of the Parents’ Group of the Franklin
County Society for Crippled Children at the Treat-
ment Center in Columbus.
As an example of drug research expenditures
which are unprofitable to a company, American
Cyanamid Company of Pearl River, N. Y., invested
about $37 million in dmg research on live virus, polio
vaccines, cancer, tuberculosis, heart disease and other
maladies. No commercial products have resulted
from this research and expenditure.
Included among the more than 40 reports of
progress in radiology made to the convention of the
American Roentgen Ray Society in Washington, D. C.,
was a paper by Drs. Hymer L. Freidell, Earle C.
Gregg, and Abbas M. Rejali, all of Cleveland.
The topic was "Radioisotope Scanning with a Sys-
tem for Total Information Storage and Controlled
Retrieval.”
CANDIDATES FOR
“THE MOST EFFECTIVE SUNSCREEN”1 OR WINDSCREEN
RVP-Elder, called "the most effective sunscreen," is also an
ideal windscreen.
Constant occupational exposure to sun and wind often
causes major discomfort in producing irritating sunburned
and windburned skin . . . commonly found in street workers,
construction workers, and telephone linemen, to mention a few.
There’s reassuring protection and skin comfort for those
outdoor workers who use RVP-Elder. Swimmers, golfers and
others engaged in outdoor activities can have the same skin
protection.
A razor-thin layer of only 10 microns adheres tenaciously
to the skin for hours, yet washes off easily with soap and
water. Virtually invisible, RVP-Elder is odorless, non-staining,
and perspiration and water resistant, even while swimming.
No sensitivity has been encountered.
Supplied in 2 oz. and 16 oz.
Write for clinical trial package and absorption spectrum -
References: (1) Schoch, A. G.: Current News in Dermatology,
August, 1963; (2) Jillson, O. F., and Baughman, R. D.: Arch.
Dermat. 88:409, 1963; (3) Cole, H. N., et al.: J.A.M.A. 130: 1,
1946; (4) MacEachern, W. N., and Jillson, 0. F.: Arch. Dermat. 89:
147, 1964.
ALSO AVAILABLE: NEW RVP Aerosol, RVP-2, RVPaque, RVPellent
PAUL B. ELDER COMPANY • Bryan, Ohio
442
The Ohio State Medical Journal
Adenomatous Polyps of the Colon
ABDUL F. NAJI, M. D., FAYIZ A. SALWAN, M. D„
and ROBERT R. BARTUNEK, M. D.
T
1HE view expressed by Helwig1 and Coffey2
that the majority of carcinomas of the large in-
testine arise from pre-existing adenomas, is not
shared by recent authors. It is more likely that most
invasive carcinomas are malignant tumors from the
onset. Spratt, Ackerman and associates3’ 4 disagree
with the theory claiming that adenomatous polyps
may degenerate into infiltrating metastasizing carci-
nomas of the colon. The views of these authors do
not express an alarming reaction concerning ade-
nomatous polyps.
Fitts and associates5 believe that in some instances
frankly invading and metastasizing cancer appears co
develop from adenoma and that all degrees of dys-
plasia, from minor atypical changes to invasive metas-
tasizing carcinomas, can be found in any large group
of adenomatous polyps. They urge that all polypoid
lesions of the colon be removed and studied micro-
scopically unless the operative risk is prohibitive.
Turell,6 in 1959, mentioned his previous observa-
tions of adenomatous tissue in adenocarcinomas in
16 out of 150 consecutive rectocolic surgical speci-
mens. In 1962 he7 stated that there is mounting
evidence against the theory that solitary adenomas
transform into invasive metastasizing fatal cancers.
He advised a practical 'middle-of-the-road’ position
toward polyps, especially regarding treatment. There
is almost unanimous agreement that the incidence of
malignancy in colonic polyps increases to a significant
degree in the larger lesions. In Ackerman’s series,
lesions between 1.25 and 1.97 cm. in diameter showed
Submitted July 30, 1965.
The Authors
• Dr. Naji, Cleveland, is Director, Department
of Pathology, St. Alexis Hospital; Instructor in
Pathology, Metropolitan General Hospital, and
Western Reserve University School of Medicine.
• Dr. Salwan, Cleveland, is Associate Director
of Medical Education in Surgery, St. Alexis Hos-
pital; Fellowship of the American Cancer Society,
Cuyahoga Unit.
• Dr. Bartunek, Cleveland, is Director, Gastro-
enterology, St. Alexis Hospital, and Director, Gas-
troenterology, St. Vincent Charity Hospital; Assist-
ant Clinical Professor of Medicine, Western Re-
serve University School of Medicine.
a 12 per cent occurrence of carcinoma. The inci-
dence was 100 per cent in all lesions over 3 cm. in
diameter.
During a two-year period (1962 and 1963) each
colonic biopsy has been examined independently by
three pathologists at St. Alexis Hospital. In several
cases there was marked difference of opinion as to the
benignancy or malignancy of a particular specimen,
and occasionally it was difficult to determine whether
the biopsies represented fragments of a polyp or of
a colonic carcinoma. Usually the correct diagnosis
was not ascertained until serial section studies, further
biopsies, or more elaborate surgical procedures were
done.
This paper includes our findings in 67 cases of
colonic polyps. These represent surgical specimens,
447
most of which were encountered within the period of
our study. Cases of polyps in children and villous
adenomas have not been included in this study. Large
colonic biopsies and all polypoid lesions received in
the Pathology Department were fixed in 4 per cent
formaldehyde for 24 hours. They were then cut
and embedded entirely (Fig. 1). Small fragments
Fig. 1. Gross specimen. Bisected polypoid lesion of colon
after twenty-four fixation in formalin.
were fixed for six hours and processed the same day.
Serial section studies were made on lesions showing
foci of dysplasia. The stains used were mainly hem-
atoxylin and eosin.
The Anatomy of a Polyp
The body, the main portion of the polyp, consists
of a central stromal mass of vascular fibrous and
smooth muscle tissue (Fig. 2). This sends out num-
erous peripheral extensions of the same kind of tissue,
around which are found branching and anastomosing
glands separated by a variable amount of supporting
interglandular stroma. The glands are lined by tall
columnar cells. In most polyps a lobulated pattern
is noticeable on gross and microscopic examination.
The stroma may contain variable amounts of inflam-
matory cellular infiltration consisting mainly of poly-
morphonuclear leukocytes and lymphocytes. Foci of
old or recent hemorrhage may also be present within
the stroma.
The glands of a polyp are generally larger and
show more variation in size and shape than those
found in normal colonic mucosa. Their cells are two
or three times taller. The differentiation between the
glands of a polyp and those of colonic mucosa is
simple even when only a few glands are available
for examination. A striking feature of the glands
of a polyp is the marked nuclear layering or stratifica-
tion. There are five or more layers of nuclei occupy-
ing the basal half of the cells. The basal and the
luminal margins of the cells are usually sharply
demarcated. The intercellular boundaries are less
body o£
central
Stroma
basa of
pedicle
cJolordc
mucosa
Fig. 2. Diagram illustrating the anatomy of a polyp.
distinct, especially if the cells do not show mucin
vacuoles. Mucin within cells or within glands is
present in variable amounts.
An adenomatous polyp may be sessile or it may
be pedunculated. The pedicle, which is not a true
part of the polyp, is formed of a cylindroid exten-
sion of normal colonic mucosa, with or without
submucosa and muscularis mucosa. It usually meas-
ures from 1 to 3 cm. in length and from 0.2 to 1.0
cm. in diameter. The pedicle is formed as a result
of the peristalitic pressure on the body of the polyp.
The central stroma of the pedicle is continuous with
that of the body of the polyp. On the opposite end
the mucosa and stroma of the pedicle join the cor-
responding structures of the colon. The main muscu-
lar layers of the colon are usually not involved in the
formation of the pedicle.
Etiology of Colonic Polyps
As is the case in most benign and malignant neo-
plasms, the etiology of colonic polyps remains un-
known. It is generally agreed that true adenomatous
polyps are neoplasms which result from focal muco-
sal cell hyperplasia. It is quite possible that the
same stimuli responsible for the production of colonic
carcinoma are also responsible for the development
of colonic polyps. Adenomatous polyps occur with
greatest frequency in the age groups in which the
448
The Ohio State Medical Journal
incidence of colonic carcinoma is also high. The
frequent occurrence of more than one polyp in a sur-
gical or autopsy specimen of colon may indicate that
these polyps arise as the result of multifocal stimuli
or as the result of a diffuse systemic stimulus leading
to foci of abnormal cell hyperplasia. It is conceivable
that whenever there is a polyp in the colon, other
cells within the colon have the potentiality of produc-
ing more polyps.
Dunphy and associates8 reported their observation
of regression of congenital polyposis of the colon fol-
lowing subtotal colectomy and ileocolostomy. They
also acknowledged Turnbull’s similar observation. The
authors speculate that a factor leading to polyposis or
carcinogenesis produced or activated by the colonic
mucosa may be in existence.
Studies of desoxyribose nucleic acids (DNA) of
nuclei of colonic mucosa, colonic polyps and carci-
nomas by Cole and McKalen9 revealed that the maj-
ority of nuclei of adenomatous polyps had similar
DNA values to those of normal colonic mucosa, i.e.,
diploid. However, in three out of five cases of
polyps, polypoid DNA values were present in many
cells. Increased DNA content was noted in nuclei of
cells obtained from adenomatous polyps as well as
carcinomas. Leuchtenberger and Lieb10 reported the
presence of cytoplasmic inclusions in colonic polyps.
The role of heredity in familial polyposis is well
known. The colonic mucosa of persons having this
genetic factor has a tendency to produce patches of
hyperplasia. It is likely that these patches of hyper-
plastic mucosa are more prone to produce carcinomas
than ordinary colonic mucosa. Dukes11 believes that
in these individuals cancer is a secondary and in a
Fig. 3-a. Photomicro graph. Polypoid lesion of colon. The
gross appearance was suggestive of pedunculated adenomatous
polyp. The microscopic examination revealed carcinoma.
sense an accidental phenomenon following an in-
herited precancerous lesion.
Criteria of Malignancy in
Adenomatous Polyps
It is impossible to determine with certainty the
benign or malignant nature of a polypoid colonic
lesion on the basis of gross examination alone. It has
been observed that most small lesions are benign,
whereas larger lesions (over 3 cm. in diameter)
frequently prove to be malignant. However, excep-
tions to this rule are quite common. The polypoid
configuration and the presence of a pedicle likewise
do not necessarily indicate benignancy (Figs. 3a and
3b). The purplish, coarse and slightly firm charac-
Fig. 3-b. Photomicrograph. Same case as in Fig. 3-a.
Partially differentiated adenocarcinoma.
teristics of a lesion may occasionally arouse suspicion
of malignancy. However, strangulation of a benign
polyp may produce this purplish appearance. A firm
consistency localized in one part of the polyp may
indicate focal dysplasia. A magnifying glass may re-
veal distortion of the lobular pattern on the cut
surface of a polyp in dysplastic areas.
We have found that frozen sections are of limited
help in the diagnosis and management of colonic
polyps. They may even interfere with a thorough
study of these lesions by routine permanent sections.
Microscopically even minor deviations from the
ordinary benign glandular pattern of a polyp are
easily recognized. All grades of dysplasia may be
seen, ranging from slight atypism to obvious car-
cinoma (Figs. 4a, 4b and 4c). The glands in a
malignant area may show loss of polarity and lack
of uniformity in size and shape. They may appear
crowded within the stroma, which tends to be more
dense and eosinophilic. The individual cells are not
consistent in size in benign or malignant polyps, al-
though in either case they are markedly larger than
those of normal colonic mucosa.
Multinucleation and nuclear layering or stratification
is common in both benign and malignant areas; how-
ever, in the benign foci the nuclei tend to be located
for May, 1966
44 9
Fig. 4-a. Photomicrograph. Adeno?natous polyp of colon.
Arrow points to a focus of marked dysplasia.
in the basal half of the cell. The apical portion of
the cell is either acidophilic or filled with mucin.
In the malignant areas the nuclei may be central.
In view of the macronucleosis and hyperchromasia of
a malignant cell, the nuclear component in a malig-
nant area appears in greater abundance than in a
benign area. Malignant cells also exhibit prominent
nucleoli. The cytoplasm of a malignant cell is
usually less acidophilic than that of a benign cell.
The adjacent malignant cells may loose their inter-
cellular boundaries and a syncytial nuclear arrange-
ment is not uncommon. Mitotic figures and abnor-
mal mitoses are more frequent in malignant areas.
The presence of cords and sheets of malignant cells,
with or without discernible lumens within dense
stroma makes a diagnosis of malignancy in a polypoid
lesion relatively simple.
Dysplastic areas may be noted in the peripheral
zones or within the glandular mass of the body of
the polyp. In such cases the changes may be entirely
intra-epithelial. Many authors decline to call such
foci carcinomas regardless of the extent of dysplasia.
They limit the diagnosis of carcinoma to lesions
which show evidence of invasion. We believe that
if the changes in such isolated intra-epithelial foci are
severe enough to suggest carcinoma on a morphologi-
cal basis, they should then be considered intra-epithe-
lial carcinomas (Fig. 5).
Invasion in a dysplastic adenomatous polyp of
the colon may involve the central stromal mass or the
pedicle. When invasion is limited to the central
stroma near its junction with the glandular portion
450
Fig. 4-b. Photo?nicrograph. Same case as in Fig. 4-a. Be-
nign adenomatous tissue co?nprising most of the lesion.
Fig. 4-c. Photomicrograph. Same case as in 4-a. and 4-b
showing an area of marked dysplasia.
one should rule out the possibility of false invasion
in a benign polyp. In such cases the general mor-
phology of the entire polyp and the extent of cellular
dysplasia will be the deciding factor in the diagnosis.
Invasion of the stroma of the pedicle beyond the base
of the polyp should be considered submucosal invasion.
Clinical Material
Sixty-seven cases of adenomatous polyps of the
colon were studied. Forty-four patients were male
and 23 were female. The youngest patient was 32
years old and the oldest was 86. In patients in the
The Ohio State Medical Journal
Fig. 5. Photomicrograph. Adenomatous polyp. Arrow
points to a focus of intra-epithelial carcinoma.
sixth, seventh and eighth decades, the incidence of
polyps, with or without associated carcinoma, was the
highest. In 47 patients we found 58 polyps, some
with dysplastic changes. The remaining 20 patients
had 22 polyps associated with independent carcinoma
elsewhere in the colon. Forty-three of the polyps
were located within 25 cm. of the anal verge. In
five cases in our series the polyps were found on
routine examination and the patients had no previous
symptoms related to their presence. The most fre-
quent symptom related to colonic polyps was lower
gastrointestinal bleeding. This was present in 32 of
the 47 patients who had polyps without independent
carcinoma. In four additional cases blood-streaked
mucus was present. Next in frequency was the
complaint of vague abdominal pain or intermittent
cramps. This was mentioned on 15 occasions. Other
infrequent symptoms were constipation, changes in
bowel habit, anal discomfort, pruritis and prolapse
of a rectal mass.
The diagnosis was made by digital or proctoscopic
examination when the polyp was located within the
rectum. Sigmoidoscopy aided in the diagnosis of
other polyps which were beyond the reach of the
finger or proctoscope. Roentgenological examina-
tion of the colon was used to demonstrate lesions
above the level of the rectosigmoid. On several oc-
casions we encountered lesions which were observed
only through air contrast studies following expulsion
of barium.
Polyps which were associated with carcinomas were
treated as part of the major disease. In most of these
cases the polyps were found following colonic resec-
tion for carcinoma, hence their presence did not affect
the type of treatment employed. Thirty-one cases of
polyps not associated with carcinoma were treated by
simple resection through the pedicle with cauteriza-
tion of the pedicle base. These were approached
from below through a proctoscope or sigmoidoscope.
In nine cases transabdominal colotomy was necessary
and the polyps were removed at the base of the
pedicle. In seven cases the segment of the colon
which included the polyp was resected.
Pathological Findings
In accordance with the presence or absence of dys-
plastic changes in the polyps, we classified our cases
as follows:
1. Benign adenomatous polyps: 17 cases.
2. Adenomatous polyp with slight focal epithe-
lial dysplasia: 16 cases.
3. Adenomatous polyp with marked focal dys-
plasia without stromal invasion: 6 cases.
4. Adenomatous polyp with focal carcinomatous
changes : 1 case.
5. Adenomatous polyp with focal carcinomatous
changes and stromal invasion: 4 cases.
6. Carcinomatous polyp: 2 cases.
Type 1 represented the usual adenomatous polyp
with no evidence of dysplasia. In Type 2 the changes
were limited to one or more areas where the glands
were somewhat different from those of the rest of
the polyp and were formed of cells possessing slightly
hyperchromatic nuclei. Mitoses were rare. In Type 3
these changes were more striking and impressive,
but not enough so to make a diagnosis of carcinoma.
Type 4 was designated to polyps with intra-epithelial
carcinoma. In Type 5 focal carcinomas were present
with evidence of stromal invasion. A carcinomatous
polyp (Type 6) is a lesion in which the polypoid
configuration is retained but the entire body of the
polyp is formed of carcinomatous tissue. It is dis-
tinguishable from polypoid carcinoma in that the lat-
ter has a wide base and does not have the configura-
tion of a polyp. It may possess more than one mar-
ginal or surface polypoid projection of carcinomatous
tissue.
In the remaining 20 cases independent carcinoma
was present in association with the polyp. Ten of
these showed dysplasia in the polyp with stromal
invasion similar to the independent carcinoma. In
the remaining 10 cases no dysplasia was present in the
poiyp.
In one case the patient had multiple filiform polyps
of the terminal ileum and seven benign adenomatous
polyps of the colon. Five of the latter were attached
at their bases to a large ulcerating carcinoma of the
ascending colon (Fig. 6).
Summary and Conclusions
The controversy regarding adenomatous polyps
of the colon is briefly reviewed. There is still some
disagreement as to the exact nature and behavior of
these lesions. The anatomy of colonic polyps, their
etiology and criteria of malignancy are discussed. The
clinical and pathological findings in 67 cases of col-
for May, 1966
451
onic adenomatous polyps are presented. In 20 cases
an associated independent carcinoma was present
elsewhere in the colon.
The management of a polypoid colonic lesion
should be a shared responsibility of the surgeon and
Fig. 6. Photomicrograph. Base of pedicle of adenomatous
polyp implanted in area of carcinoma.
the pathologist. When detected, a polypoid lesion of
the colon should be removed unless the surgical risk
is prohibitive. Total polypectomy is highly preferred
to a fractional removal. All the material should be
studied microscopically. Although the majority of
adenomatous polyps of the colon are benign, a sig-
nificant number prove to be malignant. In our series
approximately 12 per cent of the polyps showed car-
cinomatous changes. In an additional 10 per cent
marked focal dysplasia was present. Thorough sur-
gical treatment of polypoid colonic lesions should re-
sult in the cure of many early colonic carcinomas.
The presence of all grades of dysplasia in a given
number of polypoid lesions may point to a common
etiology for both polyps and carcinomas.
References
1. Helwig, E. B.: Evolution of Adenomas of Large Intestine and
Their Relation to Carcinoma. Surg. Gynec. Obstet., 84:36-49,
(Jan.) 1947.
2. Coffey, R. J., and Brinig, F. J.: Polyps of the Large Bowel.
Surg. Clin. N. Amer., 30:1749-1765 (Dec.) 1950.
3. Spratt, J. S., Jr.; Ackerman, L. V., and Moyer, C. A.: Rela-
tionship of Polyps of the Colon to Colonic Cancer. Ann. Surg.,
148:682-696 (Oct.) 1958.
4. Ackerman, L. V., and del Regato, J. A.: Cancer: Diagnosis,
Treatment and Prognosis, ed 3, St. Louis: The C. V. Mosby Co.,
1962.
5. Fitts, W. T., Jr.: Adenomas of the Colon and Rectum. Their
Malignant Potential. Amer. J. Surg., 101:87-90 (Jan.) 1961.
6. Turell, R.: Adenoma and Cancer of the Rectum and Colon;
Advances and Retreats. Surg. Clin. N. Amer., 39:1291-1308 (Oct.)
1959.
7. Turell, R.: Adenomas of the Colon — Logic or Fantasy.
Surg. Clin. N. Amer., 42:1077-1088 (Oct.) 1962.
8. Dunphy, J. E.; Patterson, B., and Legg, M. A.: Etiologic
Factors in Polyposis and Carcinoma of the Colon. Ann. Surg.,
150:488-498 (Sept.) 1959.
9. Cole, J. W., and McKalen, A.: Observations on Cytochemi-
cal Composition of Adenomas and Carcinomas of the Colon. Ann.
Surg., 152:615-620 (Oct.) I960.
10. Leuchtenberger, C.; Leuchtenberger, R., and Lieb, E.: Studies
of the Cytoplasmic Inclusions Containing Desoxyribose Nucleic Acid
(DNA) in Human Rectal Polypoid Tumors Including the Familial
Hereditary Type. Acta, genet, med. et gemel. 6:291-297, 1956-57.
11. Dukes, C. E.: The Etiology of Cancer of the Colon and
Rectum. Dis. Colon Rectum, 2:27-32 (Jan. -Feb. ) 1959.
DISPENSING THE SAMPLE. — The samples you get from drug companies
are intended for one purpose: to be given to patients as a trial. However,
if no written prescription accompanies the sample, the transaction looks like the
dispensing of a home remedy; or looks as if the patient is being used as a guinea
pig. Common sense suggests that the sample should be accompanied by a writ-
ten prescription for the same item.
It might be best to tell the patient: "This is a sample of a new (or a good
old) medicine that has had some fine results. If it is as favorable as I expect
it to be, take the prescription to your neighborhood drug store so you can get
more of this medicine. If you are disappointed in the results, call me.
This simple procedure will prevent the embarrassment of an otherwise satis-
fied patient trying to get the drug without a prescription. It will lift the medica-
tion into the dignified "prescription" class rather than make it look like a casual
free sample. It indicates that the doctor is not going out on a limb, calling it a
wonder drug. And it acts as an automatic (if not entirely scientific) check on
the effectiveness and safety of a new drug. — Editorial: The Journal of the
Medical Society of New Jersey, Vol. 62 — Number 12 — December, 1965.
452
The Ohio State Medical Journal
Aging and the Skin
CAPT. LAWRENCE B. MEYERSON,* M. C.
"Little of all we value here,
Wakes on the morn of its hundredth year,
Without both feeling and looking queer,
In fact, there’ s nothing that keeps its youth,
So far as I know but a tree and truth.
(This is a moral that runs at large,
Take it — You’re welcome — No extra charge.)”
— O. W. Holmes: The Wonderful One Hoss Shay
* *
* * *
"What is it to grow old?
Is it to lose the glory of the form,
The lustre of the eye?
Is it for Beauty to forego her wreath?
Yes; but not this alone.”
— Matthew Arnold: Growing Old
*
T
^HE phenomenon of aging is familiar to all, yet
through the years the exact explanations for the
changes seen have been difficult to uncover.
Even the definition of aging has been a controversial
subject. Strehler, and his associates1 define aging
as "the progressive loss of functional capacity of an
organism after it has reached reproductive maturity”
and "a progressive decline in vigor which is regis-
tered in any one of many ways, most generally by an
increasing probability of death.” Thus aging tissue,
including the skin, provides a favorable environ-
ment for some diseases such as cancer, while with-
standing the stress of other diseases less than does
younger tissue.
Many theories have been proposed to explain the
general phenomenon of aging, and I wish to discuss
the three best known theories briefly before going
into the specific subject of skin aging.
One theory postulates that an accumulation of dele-
terious products of metabolism causes aging. It is
known that products such as collagen accumulate in
certain tissues, as in the skin, and give these organs
the appearance of older organs. However, accumula-
tion is marked in some tissues and practically absent
in others. Furthermore, as Curtis2 points out, organs
such as skeletal muscle which show little, if any,
accumulation of products, have marked aging changes,
and decreased muscular ability is one of the first signs
of aging. Thus, even though this theory cannot be
completely discounted it seems more likely that these
products accumulate as a result of aging rather than
as its cause.
A second theory has been termed the "wear and
tear” theory. It holds that every stress or disease
which an organ is exposed to takes its toll, and the
organ finally wears out. That is, when a disease or
other trauma causes damage, though the victim ap-
*Dr. Meyerspn, a 1965 graduate of The Ohio State University Col-
lege of Medicine, now in Military Service, is an Intern at U. S.
Army Tripler General Hospital, A. P. O. San Francisco 96438.
Submitted August 5, 1965.
pears to recover completely, some residual damage
remains which rarely, if ever, heals. This theory is
very attractive because it seems to fit very nicely with
the familiar pattern of aging in inanimate objects,3
such as a river wearing away the rocks on its bank.
However, recent experiments cast doubt on this
theory. If a series of animals is given a dose of
nitrogen mustard or typhoid toxin so that one half
of the animals die, those which survive have no short-
ening of their life span.2 Also, if small injections
of tetanus toxoid, typhoid toxin, nitrogen mustard,
or turpentine are given at frequent intervals just short
of causing death, no accelerated aging of the animals
was found.2 The only agent found to accelerate
aging is radiation, which leads us to another theory.
A third theory of aging is that of somatic mutation.
This theory postulates that somatic cells, through
a series of natural and environmentally induced muta-
tions, gradually accumulate harmful genes which
cause an increasingly larger number of cells, and
therefore the organ, to function poorly. General sup-
port for this is the evidence that ionizing radiation
produces both chromosome aberrations and a non-
specific reduction in the life span of experimental
animals.2 It is also known that older animals show
higher percentages of cell abnormalities than younger
animals of the same strain, and strains with a nor-
mally shorter life span have cells with a greater per-
centage of nuclear abnormalities than do strains with
longer life spans.2 A recent study by Anderson4 on
the survivors of the Hiroshima atomic explosion
tends to confirm the fact that exposure to radiation
accelerates aging in humans. In this paper he pro-
poses a possible relationship between aging, radiation,
and decreased longevity (See Fig. 1). This theory
will be discussed more thoroughly in relation to the
aging skin.
The Aging Skin
The skin is a fascinating organ — the largest and
most versatile in the body, and man is extremely de-
for May, 1966
4 53
pendent on the properties of his skin. It provides an
effective shield against many forms of chemical or
physical attacks. It helps repel the strong ultra-
violet rays of the sun. It keeps out microorganisms
and foreign material, as well as holding in the body’s
fluids. It is the principal participant in cooling the
body when it is hot, and preventing heat loss when it
is cold. It is important in the regulation of blood
pressure and blood flow. It provides our nervous
system with information from our environment —
pain, touch, and temperature. It is the means by
which we identify others, as well as a key to our
individuality. And last, but certainly not least, it
is the principal organ of sexual attraction. In gen-
eral, all of these functions are noticeably altered as
the skin ages.
The skin is made up of two basic components : The
epidermis, the outer surface layer, which is composed
of stratified squamous epithelium whose top layer of
dead cells, the horny layer, serves as the principal
shield of the body. Its lower layer contains the pig-
ment melanin which is produced by melanocytes
scattered deep in the epidermis. The melanocytes are
spider-shaped with long processes that inject granules
of melanin into the surrounding epidermal cells. This
melanin forms a protective covering for the cell nuclei
by absorbing the ultraviolet rays of the sun. All men,
regardless of their race, have approximately the same
number of melanocytes in their skin, the difference
being that those in the darker races manufacture more
pigment than those in the lighter races.5 This has
evolved in the tropical peoples of the world as a pro-
tective mechanism with high survival value. Both
the melanin and the horny layers have importance in
the skin’s aging process, as will be discussed later.
The second layer of the skin, the dermis, which
underlies the epidermis, is composed chiefly of thick
fibrous tissue and contains the nervous and vascular
supply to the skin. The collagen fibers and dermal
ridges are the parts of this layer which are important
in aging.
Man’s skin follows an interesting life cycle.
In infancy and early childhood it is dry, soft, velvety, clear,
and apparently almost hairless. Because it is so free of
blemishes and presumably because it suggests the clear,
soft skin of a sexually attractive young woman, baby skin
has come to be regarded as the epitome of skin beauty.5
During adolescence the hair follicles enlarge and a
more active growth of hair begins. The sebaceous
and sweat glands go from a near dormant state to
full activity. "Physiologically speaking the skin ar-
rives at full bloom with puberty.”5 The skin, after
this, runs a downhill course, being abused by both
natural and man-made hazards, such as sunlight,
wind, soaps, powders, chemicals, etc., to arrive dec-
ades later as the dry, wrinkled flaccid skin of old age,
"a tired organ — a relic of what it was in its youth.”5
The skin changes so notably as one grows older,
that its appearance is the standard by which a per-
son’s age is estimated. This is shown by the vast
sums of money spent on cosmetics in the hope of
masking these changes.
In considering the factors which cause cutaneous
aging, one must distinguish those changes produced
in exposed areas of the skin by weathering and sun-
Radiat ion
\
\
\
Direct or Indirect
(via free radicals)
Cell Death
\
Reactive Tissue Hypoxia
Fibrosis — ^-Metabolic starvation
and/or intoxication
1
Degenerative
Change
Nonlethal with
Immunologic
Divers if icat ion
Hist o-Incompat ability
or G*raft-vs-Host Reaction
Degenerative
Cha nge
Fig.
i.
This chart illustrates a proposed relationship between aging, radiation, and decreased longevity A
45 4
The Ohio State Medical Jourtial
light from the senile changes seen in areas of the skin
normally covered by clothes.
Actinic Damage
Outdoor workers have skin that appears older
than those who work indoors and they also have an
increased incidence of skin cancers. Often in white
adults a striking difference may be noted between
areas of the skin which are exposed to the sun and
those that are not. In contrast to this, elderly
Negroes may have skin that appears very young be-
cause of its natural protection by the high melanin
content.
Changes seen in actinically damaged skin include
laxity and wrinkling, a yellowish color, and a dry
coarse, leathery appearance. There usually is telangi-
ectasia, and pigmentary changes such as senile freckles
or speckled areas of depigmentation may be found.
Also, premalignant keratoses or malignant neoplasms
may develop in the skin.
These changes, rather than depending on the ac-
tual passage of time, probably depend on (1) ex-
posure to wind and weather, (2) the amount of
ultraviolet radiation in the range between 2,800 and
3,100 angstrom wave lengths which have struck the
skin, and (3) genetic factors that determine the
skin’s resistance to this exposure.6
Physiologic responses to ultraviolet light include
thickening of the stratum corneum or horny layer
plus hyperplasia and an increased production of
melanin.6 These are maintained only with regular
absorption of ultraviolet light by cells below the
horny layer. Most experts agree that the principal
layer which absorbs ultraviolet light is the stratum
corneum and that past this layer the only barrier to
it reaching the dermis is melanin. Persons with fair
skin tend to be deficient in both these factors, as well
as in their ability to respond to solar exposure by in-
creasing their defenses. This is why the lighter races
suffer more actinic damage than the dark races.
Histopathologically, the degenerative changes ob-
served in the exposed skin are primarily alterations in
the connective tissue in the dermal papillae.7 Curling
and fragmentation of elastic fibrils in the papillary
zone is considered to be the earliest sign of actinic
damage. This condition is often called "senile
elastosis,” but it is actually a combination of elastin
and collagen degeneration and is not related to senil-
ity. Therefore, many authors suggest a more proper
term would be "solar elastosis.”
Knox7 feels that, on the basis of his study and
works of others, the onset of collagen degeneration is
in all probability independent of age, and is only
dependent on the cumulative effects of ultraviolet
light exposure. He further states that "the visible
cutaneous changes usually interpreted as aging are
apparently due largely, if not entirely, to sunlight.”
However, even though it is well recognized that
much of the aging of the skin can be avoided in
white-skinned persons by decreasing solar exposure,
we must realize that other factors are also involved.
Otherwise we may develop a concept mentioned by
Daniels8 of
plump, smooth-skinned, seventy-five year old "bunny girls’’
spending their entire nocturnal lives as attractions in night
clubs and scurrying into darkrooms or coal mines before
sunrise, thus maintaining their smoothness and roundness,
but making them very pale.
Aging in Nonexposed Skin
The etiology of aging in nonexposed skin remains
to be explained. It is not known to what degree
cutaneous aging is intrinsically determined by environ-
mental and genetic factors, or to what degree it is
secondary to endocrine, vascular, or senile changes in
the rest of the individual.
The surface of unexposed senile skin is more finely
wrinkled, dry, and shiny than younger skin. It also
lacks the elasticity and turgor of normal skin, which
tends to result in redundancy and folding.
The effects of aging on various parts of the skin
and its appendages are best considered separately.
Involution of sebaceous glands, with consequent
decreased sebum production, occurs postmenopausally
in women and much later — in about the 70’s, in
men. This apparently is due largely to loss of en-
docrine factors that stimulate these glands — pro-
gesterone in women and androgens in men.9 An in-
teresting fact is that in the aged woman sebaceous
excretion can be increased to normal levels by systemic
administration of progesterone.10 Therefore, at least
in this function, the changes of aging can be reversed
by exogenous factors.
Sweat secretion decreases gradually with age, espe-
cially after the age of 70. 6 Apocrine secretion de-
creases earlier and more sharply than eccrine secretion.
Senile sweat glands, when artificially stimulated, react
more slowly and are easily exhausted. The sodium
content of senile sweat, especially in men, may be very
low or absent.
The keratinization process also undergoes certain
changes with age. The rate of keratinization de-
creases as one gets older. The rate of keratinization
is probably an indication of mitotic rates in the cells
which synthesize keratin, the underlying epidermal
cells. Thuringer and Katzberg11 through their ex-
periments found the number of mitoses in the outer
third of the epidermis to decrease dramatically with
age while the number in basal areas actually increased
with age up to 70 years. (Perhaps this is significant
in the etiology of basal cell carcinomas.)
In senescence, nail growth rates decrease strikingly
to about equal levels in both sexes, in contrast to the
normally more rapid nail growth in men than in
women.6 The nail also may become brittle or
dystrophic, and the toenails are often thickened.
Graying hair, although associated with senescence,
is very dependent on genetic factors in determining
its onset. It is now thought to be due to a decrease
or loss of melanocytes from the germinative epithe-
for May, 1966
455
lium of the affected hair follicles.12 There is also a
general reduction in the quantity of body and scalp
hair with aging. Axillary hair is commonly lost and
this occurs earlier and is more pronounced in women.
Pubic hair also decreases in old age, but less notably.
Small blood vessel fragility is found in senile skin,
and appears to be due to degeneration of the connec-
tive tissue surrounding the vessels.6 Senile purpura
is the primary manifestation of this and is usually
seen on the back of the hands and forearms.
"Senile skin can be viewed physiologically as hav-
ing generally reduced homeostatic faculties and greater
vulnerability to injury.”6
Discussion
In general, aging seems to modify the dermis and
the cutaneous appendages much more than it modifies
the epidermis and its functions. In fact, the super-
ficial atrophic appearance and fine wrinkling of senile
skin is caused more by flattening and atrophy of der-
mal papillae than by reduced epidermal thickness or
reproductive ability.7
Thus, the present knowledge of the aging skin
seems to support the theory of mutation mentioned
earlier as a possible explanation of the mechanism
of aging. By this concept, actively mitotic organs
would be able to negate the effects of mutations which
weaken its cells by proliferation of more vigorous
cells. Organs with low mitotic rates, however, could
not do this and would become composed of greater
and greater numbers of less vigorous cells, and would
consequently be the organs which would show ag-
ing.2 Thus, cell populations with continual turn-
over, such as the bone marrow and epidermis, ef-
fectively replace defective mutants with healthier cells,
while muscle, connective tissue (including the der-
mis), and brain cells, which are not replaced, grad-
ually accumulate mutant cells and have progressive
cellular dysfunction and individual cell mortality.
This possibly explains why aging affects the dermis,
composed of static connective tissue, more than the
rapidly proliferating epidermis.
Despite the many theories which attempt to explain
the aging of the skin, many feel the way Stoughton10
does:
let us say that we all know that an ancient person has paper
thin, shrivelled, cracked, lifeless, spotted, yellowish, hairless,
hanging skin - — but we don’t really know how it got that
way.
"Another example can be given in the field of medi-
cine in regard to the prolongation of human life, for
which the medical art has nothing to offer except the
regitnen of health. But a far longer extension of life
is possible.
"Therefore in regard to this we must strive , that
the wonderful and ineffable utility and splendor of
experimental science may appear and the pathway may
be opened to the greatest secret of secrets.”
— Roger Bacon: Opus Majus
References
1. Strehler, B. L., et al.: The Biology of Aging, pp. 3-4, Amer-
ican Institute of Biological Sciences. I960.
2. Curtis, H. J.: Biologic Mechanisms Underlying the Aging
Process. Science, 141:686-694, Aug. 23, 1963.
3. Curtis, H. J.: Cellular Processes Involved in Aging. Ted.
Proc., 23:662-667 (May-June) 1964.
4. Anderson, R. E.: Aging in Hiroshima Atomic Bomb Sur-
vivors. Arch. Path., 79:1-6 (Jan.) 1965.
5. Montagna, W. : The Skin. Scientific American, pp. 5 6-66
(Feb.) 1965.
6. Lorincz, A. L.: Physiology of the Aging Skin. Illinois Med.
J., 117:59-62 (Feb.) I960.
7. Knox, J. M.; Cockerel, E. G., and Freeman, R. G.: Etiologi-
cal Factors and Premature Aging. /. A. M. A., 179:630-636, Feb.
24, 1962.
8. Daniels, F., Jr.: Sun Exposure and Skin Aging. New York
J. Med., 46:2066-2069, Aug. 15, 19 64.
9. Rothman, S.: Physiology and Biochemistry of the Skin, Chi-
cago: Univ. of Chicago Press, 1954.
10. Stoughton, R. B.: Physiological Changes from Maturity
Through Senescence. J. A. M. A., 179:636-638, Feb. 24, 1962.
11. Thuringer, J. M., and Katzberg, A. A.: The Effect of Age
on Mitosis in the Human Epidermis. /. Invest. Dermat., 33:35-
39 (Aug.) 1959.
12. Montagna, W., and Ellis, R. A. (eds): Biology of Hair
Growth, New York: Academic Press, 1958, p. 255.
CHEMICAL AND BIOLOGIC WEAPONS. — There has been remarkably
little public debate, particularly among physicians, on the advisability of
developing, stockpiling and using chemical and biologic weapons. Some of these
issues, admittedly, are complex, controversial and uncomfortable. The physician,
however, has a specialized knowledge about chemical and biologic agents. No
nation could develop or protect against this kind of warfare without aid from
its doctors. In addition to his particular competence, the physician must be
concerned with chemical and biologic weaponry because of his fixed commit-
ment to the health of individuals, singly and collectively. He must therefore
be actively concerned with the medical consequences of chemical and biologic
warfare. — Victor W. Sidel, M. D., and Robert M. Goldwyn, M. D., Boston:
The New England Journal of Medicine, 274:21-27, January 6, 1966.
456
The Ohio State Medical Journal
Frank Vectorcardiograms
Of Normal Adults
ROBERT T. MURNANE, M. D., LOUIS B. SKIMMING, M. D.,
GALEN H. DAVIS, M. D., and JAMES R. SNYDER, M. D.
SEVERAL investigators have reported on the value
of oscilloscopic spatial vectorcardiography in
diagnosis as an adjunct to routine scalar electro-
cardiography. This method of studying the cardiac
electromotive forces is attracting increasing attention.
Schellong1 1937 and Johnston2 1938 demonstrated
the advantages of the oscilloscope to display vector-
ially in loop form the temporal and spatial character-
istics of cardiac electromotive forces. Widespread
acceptance of the technique has been delayed in part
because agreement was not reached regarding the
leading system to be used and because of the limita-
tions of available electronic recording equipment.
Coincident with engineering advancements in the
instmmentation, several investigators3'6 independently
proposed leading systems with variable practical and
mathematical limitations. Many laboratories have re-
cently adopted the corrected orthogonal network pro-
posed by Frank.7 His system permits easy clinical
application and gives results very close to those ob-
tained with more complex lead systems.8
From I960 through 1964, 2000 adult inpatients
with manifest or suspected myocardial infarction were
studied at the bedside with the Frank system of spatial
loop vectorcardiography in this institution.
This paper presents data recorded with the Frank
system in a group of normal adult subjects. The
vector intervals chosen for measurement were those
found to be useful for comparison with records ob-
tained in subjects with myocardial destructive lesions.
A comparison of these results with the limited num-
ber of reports9'12 dealing with the normal Frank
vectorcardiogram is presented. This was done as
a test of the practical reproducibility of this method.
A report13 on 100 normal children has appeared
which presents angular and magnitude data of
initial and terminal timed intervals of the QRS loop
studied with the Frank system. A similarly com-
prehensive report dealing with normal adults has not
appeared.
In this study the Frank vectorcardiogram was ap-
plied to a group of normal adults in broad age range
providing data on rotational direction, angular, and
This project supported by grants from The Central Ohio Heart
Association.
Submitted for publication June 24, 1965.
The Authors
• Dr. Murnane, Columbus, is a member of the
Department of Medicine, Mount Carmel Hospital;
Clinical Instructor, Medicine, The Ohio State
University College of Medicine.
• Dr. Skimming, Middletown, former Clinical
Resident in Medicine, Mount Carmel Hospital,
Columbus, presently is a member of the Attending
Staff, Middletown Hospital.
• Dr. Davis, Dublin, is a member of the Attend-
ing Staff, Mount Carmel Hospital, Columbus.
• Dr. Snyder, Suitland, Maryland, former Re-
search Fellow in Cardiology, The Ohio State Uni-
versity Hospital, presently is a Fellow in Cardiol-
ogy, Georgetown University, Washington, D. C.
magnitude measurements for clinically important
vector intervals of the P, QRS, and T loops. Angular
and magnitude measurements of successive, timed,
initial, and terminal QRS vectors were determined.
Materials and Methods
The 124 adult subjects of this study were profes-
sional and lay personnel of the Mount Carmel Hos-
pital in an age range of 20 to 69 years (Table 1).
Table 1. Age and Sex Distribution of Subjects Studied.
Age Group
(Years)
Female
Male
No. of Subjects
20 - 29
19
17
36
30 - 39
15
15
30
40 - 49
8
14
22
50 - 59
8
10
18
60 - 69
11
7
18
Totals
61
63
124
None had a history of heart, lung, or kidney disease.
Each was chosen on the basis of normal physical ex-
amination, chest x-ray, and 12-lead electrocardiogram.
The Frank leading system was used to record the
spatial loop vectorcardiograms projected onto three
mutually perpendicular planes (Fig. 1). The projec-
tion onto the sagittal plane was recorded as viewed
from the subjects left.14 The fifth intercostal space
for May, 1966
457
SUPERIOR
270
FRONTAL PLANE
ANTERIOR 180
INFERIOR
270
Y
QRS
Z
POSTERIOR
90
INFERIOR
SAGITTAL PLANE
POSTERIOR
270
HORIZONTAL PLANE
Fig. 1. Reference system used in this study.
at the sternal border was used in all cases as the level
for the chest leads. Frank’s point C, located 45 de-
grees between the anatomic axes of points A and E,
was found by inspection. Recordings were made
with the subjects in the supine position. The 12-lead
electrocardiogram was taken with a Cambridge direct-
writing electrocardiograph immediately after the vec-
torcardiogram was recorded.
To help achieve technically satisfactory vectorcar-
diograms, the skin at the electrode sites was massaged
to erythema with a tongue blade and Cambridge elec-
trode jelly. If erythema did not occur, the skin was
abraded for a maximum of 30 seconds. After elec-
trode attachment and before recording, a five minute
period of rest and reassurance reduced somatic tremor.
Tremor, commonly arising at the neck electrode, was
further minimized by placing a pillow under the head
and neck. These precautions were dictated by the
fact that fine muscle tremors were the most common
cause of unsatisfactory records.
Vectorcardiograms were recorded with the Hart
vectorcardiograph (Model PV-3). Frequency re-
sponse of amplifiers was adjusted to range from 0.1
to 1000 cycles per second. A square wave modulator
was calibrated to interrupt the loop 500 times per
second so that each dot represented 0.002 second.
Facilities for accurately delineating initial and ter-
minal forces included:
(1) A trace speed sensing device which dimmed the
slower- writing portions of the trace to minimize
fogging at the "E” point.
(2) A trace shift mechanism which separated out
P, QRS, and T loops.
(3) A range of amplification settings from 1.4 to 22
times the conventional 1 cm. for 1 mv. of potential.
The vector loops were ordinarily amplified 4 to 5.6
times to occupy approximately three fourths of the
area of the 5 inch oscilloscope screen. Expanded
views of the "E” point were routinely photographed
for additional accuracy of interpretation. Photo-
graphs were made on 3 by 4 inch type 3000-A film
with an instrument-mounted Polaroid camera. A blue
filter was used to eliminate the necessity for room
darkness (Fig. 2).
The angular and magnitude determinations were
made directly from the Polaroid prints. A 4 inch
diameter transparent protractor was the reference
frame for the angular measurements made in accord-
ance with Helm’s recommendation.15 The timed in-
tervals of the QRS loop selected for measurement
(Fig. 3) were those known to correspond with suc-
cessively dominant areas of the ventricular muscle
mass during the depolarization process.16 Checks by
three independent observers disclosed an average dis-
crepancy of 5 degrees in the angular measurements.
Adjusted figures were agreed before magnitude meas-
urements were carried out. A millimeter rule was
used for the magnitude measurements. For accuracy,
these readings were re-measured each time the ampli-
fication was varied. Corrections were made for the
disparity between the magnitude of the image on the
oscilloscope screen and its magnitude on the film.
Results
Statistical analysis of angular and magnitude meas-
urements of the P, QRS, and T loops on each plane
provided the results presented in Table 2. Mean
results and standard deviations of measurements hav-
458
The Ohio State Medical Journal
rr
“Dr*
_
liv*
i 1 {
!
r\i
*
<
1
p !
r r
LJ
i j
1 *
j \
u
;
l;
", -
<
... J
*
l.
H
j
1
Li....
!
Fig. 2. Frank vectorcardiogram recorded on normal 30 year old man. Direction of rotation indicated by the widest portion
of the tear shaped dots which form the leading edge and interrupt the beam at 0.002 second intervals. Amplified loops re-
corded without grid are shown in lower half. QRS frontal plane, clockwise; sagittal and horizontal plane, counterclockwise.
ing a Gaussian distribution are reported. Usable
limits for dispersion were determined by the follow-
ing formula:19
Only those results were reported which fell within
two standard deviations determined by the formula
X ± 2s.19
Frontal Plane: No significant difference was noted
in the location of the maximum QRS vector whether
the QRS loop on the frontal plane rotated clockwise
or counterclockwise. The QRS maximum vector was
0.06 SEC.
Fig. 3. Schematic depiction of a normal Frank horizontal
plane vector loop. The intervals at which measurements
were made are shown.
more superior for subjects for whom a linear or fig-
ure-of-eight loop was recorded than those for whom
complete clockwise or counterclockwise loops were
recorded.
The angular locations of the 0.01 and 0.02 sec.
QRS forces were eliminated from this study because
of wide scatter. Deviations in their magnitudes were,
however, within permissible limits.
Sagittal and Horizontal Planes: Superimposability
of loops in these mutually perpendicular planes has
been shown13 to be nearly complete with the Frank
system. All QRS loops showed only counterclockwise
rotation on these planes. With the Frank system,
the QRS loop on these two planes will sometimes
have its maximum vector in an extremely posterior
location.9 Because of this, the half-area QRS vector
has been proposed9 as a more useful measurement
than the maximum QRS vector. It is true that the
half-area QRS vector is easy to determine by simple
planimetry, that its normal values fall within a re-
stricted range, and that this range is narrower than
the range of values for the maximum QRS vector.
Flowever, this proposal17 was originally made for
loops obtained with Schmitt’s (SVEC III) orthogonal
leading system. With this corrected system the maxi-
mum QRS vector is more often in an extremely pos-
terior position than with the Frank system. In this
study we encountered a posteriorly located maximum
for May, 1966
459
vector as that portion of the QRS loop furthest from
the "E” point during the initial 0.05 sec. inscription
(Fig. 4). We did so for the following reasons:
(1) The relative infrequency of posteriorly located
maximum QRS vectors with the Frank system. (2)
The propensity for myocardial infarction, exclusive of
posteromedial lesions, to alter some portion of the
initial 0.05 sec. QRS forces. (3) By so defining
and limiting the maximum QRS vector we were able
to derive restricted mean results and standard devia-
tions for this vector as well as for the maximum
QRS-T angle.
Correspondence between direction of rotation of T
loops and QRS loops was noted on all planes
(Table 2).
Table 3 is a comparison of results from different
laboratories which have used the Frank vectorcardi-
ogram. It is of particular interest to compare our
results, where common data exist, with those reported
from other laboratories as a valid test of the practical
reproducibility of this method of vectorcardiography.
Table 2. Mean Results and Standard Deviations of Angular and Magnitude Measurements of the Frank Vectorcardiogram
in 124 Normal Adult Subjects.
FRONTAL
SAGITTAL
HORIZONTAL
Rotation of QRS loops
(number of cases)
Clockwise (CW) 60
Counterclockwise (CCW) 23
Linear or fig. of 8 (LF/8) 41
Counterclockwise 124
Counterclockwise 124
Maximum QRS vectors
a. direction
(degrees)
43 4- 13 SE* 1.0 (124) f
CW 45 4- 13 SE 1.7 (60)
CCW 43 -+- 12 SE 2.5 (23)
LF/8 31 ± 5 SE 0.8 (41)
91 ± 25 SE 2.2 (124)
4 ± 17 SE 1.5 (124)
b. magnitude
(millivolts)
1.39 ± 0.34 SE 0.03 (124)
1.02 ± 0.36 SE 0.03 (124)
1.07 ± 0.29 SE 0.026 (124)
0.01 sec. QRS vectors
a. direction
b. magnitude
wide scatter
.11 ± 0.04 SE 0.01 (100)
210 4- 11 SE 1.0 (124)
0.14 ± .07 SE 0.01 (124)
108 4- 26 SE 2.3 (124)
0.16 ± 0.07 SE 0.01 (124)
0.02 sec. QRS vectors
a. direction
b. magnitude
36 -+- 41 SE 4.1 (100)
0.27 ± 0.19 SE 0.02 (100)
161 -+- 26 SE 2.3 (124)
0.32 ± 0.13 SE 0.01 (124)
55 4- 23 SE 2.0 (124)
0.41 ± 0.19 SE 0.02 (124)
0.02 5 sec. QRS vectors
a. direction
b. magnitude
38 4- 18 SE 1.8 (100)
0.61 ± 0.29 SE 0.03 (100)
133 + 24 SE 2.0 (124)
0.49 ± 0.20 SE 0.02 (124)
30 4- 17 SE 1.5 (124)
0.63 ± 0.27 SE 0.02 (124)
0.03 sec. QRS vectors
a. direction
b. magnitude
40 4- 12 SE 1.2 (100)
0.99 ± 0.34 SE 0.03 (100)
110 4- 22 SE 2.0 (124)
0.70 ± 0.25 SE 0.02 (124)
14 4-15 SE 1.3 (124)
0.86 ± 0.29 SE 0.03 (124)
0.04 sec. QRS vectors
a. direction
b. magnitude
45 ■+- 21 SE 2.1 (100)
1.05 ± 0.44 SE 0.04 (100)
79 +26 SE 2.3 (124)
0.83 ± 0.34 SE 0.03 (124)
343 4- 28 SE 2.5 (124)
0.83 ± 0.35 SE 0.03 (124)
0.05 sec. QRS vectors
a. direction
b. magnitude
NCJ
NC
31 4- 28 SE 2.5 (124)
0.48 ± 0.17 SE 0.02 (124)
278 4- 30 SE 2.7 (124)
0.44 ± 0.18 SE 0.01 (124)
0.06 sec. QRS vectors
a. direction
b. magnitude
NC
NC
357 4- 26 SE 2.4 (120)
0.29 ± 0.12 SE 0.01 (120)
260 4- 29 SE 2.7 (124)
0.26 ± 0.16 SE 0.01 (124)
0.07 sec. QRS vectors
a. direction
b. magnitude
NC
NC
4 4- 37 SE 3.6 (110)
0.15 ± 0.08 SE 0.01 (110)
252 4-16.7 SE 1.5 (124)
0.14 ± 0.08 SE 0.01 (124)
Maximum T. vectors
a. direction
b. magnitude
43 -t- 11 SE 1.0 (124)
0.34 ± 0.10 SE 0.01 (118)
120 4- 19 SE 1.7 (124)
0.29 ± 0.10 SE 0.01 (119)
30 4- 17 SE 1.5 (124)
0.30 ± 0.11 SE 0.01 (124)
QRS-T angle. Degrees
between maximum QRS
and Maximum T vectors
9 ± 8 SE 0.7 (124)
32 ± 29 SE 2.6 (124)
29 ± 21 SE 1.8 (124)
Maximum P vectors
a. direction
b. magnitude
77 -+- 17 SE 1.5 (121)
0.11 ± 0.04 SE 0.01 (100)
98 4- 10 SE 1.0 (119)
0.12 ± 0.04 SE 0.01 (106)
8 4- 22 SE 1-8 (112)
0.07 ± .02 SE 0.01 (90)
Rotation of T loops
(number of cases)
CW (64)
CCW (17)
CW (1)
CCW (123)
CW (3)
CCW (121)
*SE — standard error. Not calculated to less than 0.01 mV. for magnitude.
fNumber of subjects. When the number in parentheses is less than 124, it indicates only those subjects for whom exact determinations
could be made.
JNC = not calculated. Terminal QRS vectors are perpendicular to frontal plane and therefore not measurable.
QRS vector in only 3 of the 124 subjects. Because
of this infrequent occurrence we did not consider the
use of the half-area QRS vector. Our experience in
this matter confirms that of other investigators.10-12
We have chosen to define the maximum QRS
HORIZONTAL PLANE
SAGITTAL PLANE
Fig. 4. Diagram of a horizontal plane loop with the maxi-
mum QRS vector having an extreme posterior location. M
shows that portion of the first 0.05 sec. QRS forces furthest
from the point of origin ("E”) for the maximum QRS data
determined on the 124 subjects of this study.
460
The Ohio State Medical Journal
Table 3. Angular and Magnitude Data of Selected Vectors with a Comparison of Other Series (in Degrees and Millivolts)
Present Series
FRONTAL
iH rH
• H
c5 —
vi & rt
^ -*->
3- 3 u
"*22
OX, o «
2^
PLANE
°
~3— :
cs
al
O o
VO Ph
72 young adults
Bristow0
Present Series
SAGITTAL
H *"*
• r-l
— o —
3 — 3 "
«u
O U O c*
2£ 2^
PLANE
°
”3— :
~0 ri
rt
o o
vo Ph
72 young adults
Bristow0
Present Series
HORIZONTAL PLANE
M £© £
H. "3— «* "3
t/i 5/5 rt ^ 4_i
<u — irt cuo 11 m_
3- 3 c%
'O— -O.C 3 " 3 £
”u ”22 gjg c£
O x o rt ^
o>5 OJ> O o C4 w
— r^PQ
QRS Vectors (seconds)
0.01
NR*
—
—
NR*
—
210
187
108
98
(11)
(25)
(26)
(25.6)
0.02
36
30$
33
161
165$
151
55
60t
50
(41 )t
(22.4)
(26)
(25)
(23)
(24)
0.03
40
39
110
102
14
8
(12)
(10.6)
(22)
(29.5)
(15)
05.6)
0.04
45
44
79
65
343
343
(21)
(14.2)
(26)
(24.8)
(28)
(25)
QRS Maximum Angle
43
37
35$
40
33
91
96
90$
651
39 §
4
1
5$
346§
341 §
(13)
(13)
(10.6)
(13)
(25)
(23)
(31.2)
(30)
(17)
(18)
(30.5)
(17)
magnitude
1.39
1.25
1.67
1.02
.81
1.24
1.07
1.03
1.58
(.34)
(.33)
(.45)
(.36)
(.33)
(.36)
(.29)
(.32)
(.37)
T Maximum Angle
43
40
37
120
104
135
30
16
37
(ID
(17.7)
(12)
(19)
(27.3)
(23)
(17)
(24.7)
(17)
magnitude
.34
.47
.29
.44
30
.51
(.10)
(.14)
(.10)
(.12)
(.11)
(.14)
QRS-T Angle
9
12
32
96§
29
71§$
(8)
(18)
(29)
(39)
(21)
P Maximum
77
64
98
98
8
356
Angle
(17)
(19.9)
(10)
(ID
(22)
(19.4)
*NR = not reported because of wide scatter.
tStandard deviations in parentheses.
JStandard deviations not given.
iSeries with maximum QRS vector in terminal 0.03 second of loop. See text for discussion.
Discussion
The results of this study show a restricted range
of normal values with the Frank vectorcardiogram.
They confirm the limited observations available with
this system used on normal adults. The angular
measurements presented in this study show excellent
correlation with those previously reported11'12 when
those had been carried out on subjects of similar age
ranges and groups studied in the supine position.
This correlation indicates that reproducibility with
this method of vectorcardiography is practical. The
location of the "R” loop of McCall et al.12 and the
maximum QRS vector reported by Walsh et al.11
are essentially the same as the maximum QRS vector
of the present series.
This indicates that these investigators measured
this interval as that portion of the initial 0.05 sec.
QRS force farthest from the "E” point. Location of
the maximum QRS vector in our series in this man-
ner does not entirely agree with the work of Fork-
ner et al.10 and Bristow.9 The explanation may be
that these investigators studied young adults and
measured the maximum QRS vector when it was
posterior to the 0.05 sec. interval.
The study of the angular location of successive,
timed, initial intervals of QRS loops as recorded on
three mutually perpendicular planes has yielded use-
ful clinical information18 in myocardial infarction.
This study does more than confirm previous work
on the angular location of initial QRS forces. It
offers angular data for successive terminal QRS vectors
for normal subjects as well as magnitude measure-
ments for both initial and terminal timed intervals.
Our magnitude results show occasional disparity
when compared with those of previous studies. The
few magnitude measurements available for compari-
son show closest agreement when compared with the
results of McCall et al.12 This emphasizes the need
for a uniform method of standardization.
Abnormal magnitudes of initial and terminal QRS
forces as well as of the P and T loops exist, whether
the angular location is normal or abnormal. Hence
these magnitude measurements may sometimes pro-
vide the only clue to certain cardiac abnormalities.
The T loop has a consistent direction of rotation.
The fact that this direction corresponds with the di-
rection of rotation of the QRS forces has proved help-
ful in clinical practice. It provides another frame of
reference in the consideration of cardiac abnormalities.
Summary
The corrected orthogonal leading system of Frank
was used to record vectorcardiograms on 124 normal
adult subjects. This method of vectorcardiography
is simple to apply and provides a restricted range of
normal data.
Angular and magnitude determinations of initial
and terminal successive timed intervals of the QRS
loop, as well as maximum P and T loop measure-
ments, are presented. An alternative to measure-
for May, 1966
46 1
ment of the half-area QRS loop is suggested. Data
regarding direction of T loop inscription on each
plane are provided.
The results are compared with the limited num-
ber of reports dealing with this method of vector-
cardiography in the normal adult. When subjects of
similar age range and groups were studied in the
supine position and similar methods of measurement
were employed excellent correlation of results was
obtained. This would seem to attest to the practical
reproducibility of the Frank vectorcardiogram in
clinical practice.
Acknowledgment: The authors wish to thank Robert
Hamlin, D. V. M., and Phillip T. Knies, M. D., for their
counsel in this project and preparation of manuscript.
References
1. Schellong, E.; Heller, S., and Schwingel, F.: Das vektordia-
gramn; eine untersuchungsmethode des herzens. Ztschr. f. Kreis-
laufforsch, 29:497-509 (July 15 ) 1937.
2. Wilson, F. N., and Johnston, F. D.: Vectorcardiogram.
Amer. Heart ]., 16:14-28 (July) 1938.
3. Schmitt, O. H., and Simonson, E.: Symposium on Electro-
cardiography and Vectorcardiography; the Present Status of Vector-
cardiog.aphy. Arch. Int. Med., 96:574-590 (Nov.) 1955.
4. McFee, R., and Johnston, F. D.: Electrocardiographic Leads:
III. Synthesis. Circulation, 9:868-880 (June) 1954.
5. Helm, R. A.: An Accurate Lead System for Spatial Vector-
cardiography. Amer. Heart J., 53:415-24 (Mar.) 1957.
6. Burger, H. C., and van Milaan, J. B.: Heart-Vector and
Leads. Brit. Heart ]., 10:229-233 (Oct.) 1948.
7. Frank, E.: An Accurate, Clinically Practical System for
Spatial Vectorcardiography. Circulation , 13:737-749 (May) 1956.
8. Langner, P. H., Jr.; Okada, R. H.; Moore, S. R., and Fies,
H. L.: Comparison of Four Orthogonal Systems of Vectorcardi-
ography. Circulation, 17:462 (Jan.) 1958.
9. Bristow, J. D.: A Study of the Normal Frank Vectorcardi-
og am. Amer. Heart J., 61:242-249 (Feb.) 1961.
10. Forkner, C. E., Jr.; Hugenholtz, P. G., and Levine, H. D.:
The Vectorcardiogram in Normal Young Adults. Frank Lead Sys-
tem. Amer. Heart J., 62:237-246 (Aug.) 1961.
11. Walsh, T. J.; Tiongson, P. M.; Stoddard, E. A., and
Massie, E.: The Vectorcardiographic QRS-sE-loop Findings in In-
fe oposterior Myocardial Infarction. Amer. Heart ]., 63:516-527
(Apr.) 1962.
12. McCall, B. W. ; Wallace, A. G., and Estes, E. H., Jr.:
Characteristics of the Normal Vectorcardiogram Recorded with the
Frank Lead System. Amer. J. Cardiology, 10:514-524 (Oct.) 1962.
13. Hugenholtz, P. G., and Liebman, J.: The Orthogonal Vec-
torcardiogram in 100 Normal Children (Frank System). With
Some Comparative Data Recorded by the Cube System. Circulation,
26:891-901 (Nov.) 1962.
14. Kossman, C. E., Chairman, Committee on Electrocardiography,
American Heart Association: Recommendations for Standardization
of Electrocardiographic and Vectorcardiographic Leads. Circulation,
10:564-573 (Oct.) 1954.
15. Helm, R. A.: Vectorcardiographic Notation. Circulation,
13:581-585 (May) 1956.
16. Scher, A. M., and Young, A. C. : Ventricular Depolarization
and the Genesis of QRS. Ann. New York Acad. Sci., 65:768-778
(Aug. 9) 1957.
17. Pipberger, H. V.: The Normal Orthogonal Electrocardiogram
and Vectorcardiogram. Circulation, 17:1102, 1958.
18. Hugenholtz, P. G.; Fornker, C. E., Jr., and Levine, H. D.:
A Clinical Appraisal of the Vectorcardiogram in Myocardial In-
farction. II. The Frank System. Circulation, 24:82 5-850 (Oct )
1961.
19. Croxton, F. E.: Elementary Statistics with Application in
Medicine. New York: Prentice-Hall, (1953) pp. 84-91.
INFERIOR MYOCARDIAL INFARCTION. — Seventy-three consecutive pa-
tients with a Q wave in Lead III and aVF in the electrocardiogram were
studied. Vectorcardiograms were recorded with the use of the Frank system.
In 32 cases the ECG’s were compatible with the diagnosis of an inferior
myocardial infarction based on a Q wave in Lead III and/or aVF greater than
0.04 second duration and greater than 25 per cent of the amplitude of the R
wave. In this group, there were 16 patients with coronary disease and the VCG
confirmed the electrocardiographic diagnosis of an infarction in 14 cases. In 13
of the other 16 cases without history of coronary disease the VCG did not suggest
the presence of an infarction.
In all 17 cases with questionable electrocardiographic diagnosis of an in-
ferior infarction, and without history of coronary disease, the VCG denied the
presence of an infarction. In 18 cases with small Q III or Q aVF the VCG’s
were within normal limits. In two cases with normal Q III and Q aVF the
VCG’s did not detect the presence of an infarction in both cases.
The vectorcardiographic diagnosis of an inferior myocardial infarction was
based on the superior orientation (at or above 360 degrees) of the 10, 20, 25
and 30-msec vectors in the frontal plane, superior displacement of the maximum
QRS vector and clockwise rotation. In the left sagittal plane the 10, 20, 25 and
30-msec vectors were oriented at or above 180 degrees with the loop rotating
counterclockwise.
The data presented suggest that vectorcardiography is a useful adjunct to
electrocardiography in the diagnosis of an inferior myocardial infarction. — Al-
berto Benchimol, M. D., Mark W. Roberts, M. D., and E. Grey Dimond, M. D.,
La Jolla: California Medicine, 100:168-174, March 1964.
462
The Ohio State Medical Journal
Adrenal Cysts
A Case Report
ERNEST B. MAINZER, M. D.
The Author
• Dr. Mainzer, Mansfield, is a member of the
Active Staff, Department of Internal Medicine,
Mansfield General Hospital.
7\ DRENAL cysts are rare and often constitute a
surprising finding. They can reach large size
-A. JA. before they give rise to serious symptoms.
Until November 1959, the total case reports have
been about 155.1 Since then about five have been
added.2 Wahl3 found nine cases in 13,996 autopsies,
Hodges and Ellis4 report two in 11,000 autopsies in
Wayne County General Hospital.
Case Report
In November 1958 during a routine examination of a
33 year old native Caucasian man some hardness and ten-
derness was noted in the left mesogastrium. There were no
symptoms. Radiographic studies were recommended but
were not then carried out. He had never been seriously ill.
In June 1961, the patient appeared with the complaint
of broken blood vessels on the left anterior chest. Exami-
nation showed venectasia on the left upper quadrant of the
abdomen. Systemic examination was unchanged from pre-
vious times, with the exception of the abdomen. There a
mass could be felt, though poorly outlined, in the left upper
quadrant. The spleen was not palpable. There was no in-
creased dullness to percussion. The mass seemed to be in
depth of the left epigastrium and upper mesogastrium, was
tender to pressure, and was difficult to define. Blood pres-
sure was 120/80 and the weight was 250 pounds. The
urine examination was normal.
Radiologic interpretation by R. L. Garber, M. D.: "Exami-
nation of the abdomen shows a large oval soft tissue mass,
15 by 20 cm., of ground-glass appearance, in the left upper
abdomen, which replaces the kidney shadow outline and is
thought to represent a large cyst of this kidney. The right
kidney is outlined to be normal in size and position. The
liver is normal in size, but the spleen cannot be definitely
separated from this mass in the left abdomen. The excretory
urogram shows normal function of both kidneys, with dis-
placement downward of the left kidney by the large mass
in the L. U. Q. which also displaces the body and fundus
of the stomach to the right. This is of a uniform density,
of ground-glass appearance, and appears to be a large cyst
of the left upper pole of the kidney. The rest of the ex-
cretory tract is negative.” (See Figs. 1, 2, and 3.) Urine
and blood findings including blood urea nitrogen were
normal. Serologic tests for syphilis were nonreactive.
The mass was excised by Dr. Hall Wiedemer after aspi-
ration of 5 liters of fluid. A very large cystic mass, appar-
ently a single one, appeared in juxtaposition to the upper
pole of the left kidney. It was gray and contained on its
surface flat yellow structures which appeared to be adrenal
tissue. The cyst was very thin-walled and ruptured dur-
ing an attempt to dissect it from the surrounding structures.
About 5 liters of brown cloudy, moderately viscous fluid was
aspirated from the cyst and from the retroperitoneal space
in which it had escaped. The pathological specimen was
examined by Dr. Robert Harsh.
Gross Description
"Multiple portions of fatty tissue total 50.0 ml. in vol-
ume. Collapsed thin-walled cyst measures 8.0 cm. in
Submitted July 26, 1965.
greatest dimension. The wall is partly composed of fibrous
tissue and partly of a dense layer of bright yellow cellular
tissue measuring no more than 0.3 cm. in thickness. The
lining membrane is gray, fibrous, and slightly opaque.”
Microscopic Examination and Diagnosis:
"Cyst wall has a flattened, almost indistinguishable lin-
ing layer of spindle cells supported by fibrous connective
tissue and smooth muscle. Outside this layer are irregular
masses of adrenal cortex and medulla. Lipid storage is
quite prominent. The cells are well preserved and the
adrenal elements themselves are not neoplastic. Separate
fatty tissue is not remarkable. Some fibrous connective
tissue from the wall of the cyst is disorganized but not
typically a new growth. This formation is probably best
classified as a cystic hamartoma of the adrenal gland also
referred to as myolipofibroma of the adrenal.”
Discussion
The first adrenal cyst was reported by Greiselius
in 1607. It ruptured and 12 pounds of red fluid
and over 2 pounds of fetid clot had mostly escaped
into the peritoneal cavity.5
Incidence: The cysts occur rarely before the thir-
tieth year.6 The average age is 47.8 years.7 There
has been generally a 50 per cent preponderance of
women.1-6 Bilateral cysts occur in about 15 per cent
of cases.6
Endocrine Dysfunction: This is uncommon. Cush-
ing’s syndrome was first reported by Brindley and
Chisholm11 in unilateral cysts. If the function of
both adrenals is impaired removal of the cyst and
residual gland may initiate an Addisonian crisis.
Careful search for bilateral cysts in the patient and
in other members of his family is therefore indi-
cated.6 Such adrenal insufficiency can result from se-
vere adrenal hemorrhage in children and infants with
ensuing pseudocysts.2 Pluriglandular syndrome with
thyroid and parathyroid deficiency has been reported,1
also one cyst in a functioning pheochromocytoma.7
Symptoms: Symptoms are not characteristic and
are often entirely absent. In large cysts, there is us-
ually dull, persistent pain over the adrenal mass pos-
for May, 1966
463
teriorly with occasional radiation around anteriorly
to the upper abdominal quadrant or epigastrium.
Sharp colicky pain was present in two reported cases.
Gastrointestinal symptoms such as epigastric distress,
abdominal distension, eructation, nausea, vomiting,
Fig. 1. Excretory urogram showing distal displacement of
renal pelvis.
constipation, etc., are frequently present and are due
to pressure of the cyst on the adjacent gastrointesti-
nal tract. Constitutional symptoms such as general
malaise, fatigue, weakness, loss of weight, etc., are
occasionally noted.1’6’7 Due to this paucity of
symptoms, the majority of these cysts were found
only during necropsy.1’6’7
Size: The cysts seldom exceed 10 cm. in dia-
meter, but several larger ones have been reported.
Fig. 2. Retrograde urogram showing displacement of
kidney and ureter.
Gardiner’s8 had a diameter of 30 cm. and weighed 12
kg (26 lbs.) after 8 liters of fluid had been removed
during operation, thus having a total weight of 21
kg (46 lbs.). Others had dimensions of 30 cm. in
diameter, 25 cm., 21 by 17 by 11.5 cm., and 15 by
13 by 12 cm. Some contained 11, 10, and over 5
liters of fluid.1, 4,6
Pathogenesis: The following classification by
Terrier and Lecene9 and Levison10 has been most
commonly used.
1. True cysts
2. Cystic adenomas or hamartomas
3. Cystic lymphangiomas
4. Pseudocysts
Hodges et al.4 have revised the classification as
follows:
A. True cysts
( 1 ) Glandular cysts
(2) Lymphangioma or lymphangiectasis
( 3 ) Hemangioma
B. Pseudocysts resulting from:
( 1 ) Hemorrhage into cortex
(2) Necrosis and cystic degeneration of benign
or malignant primary tumors
( 3 ) Parasitic infection
Ellis, Dawe and Clagett7 divide their 12 cysts in
the following ways:
1. Serous cysts
2. Pseudocysts
a. Hemorrhage and necrosis in benign or malig-
nant tumor
b. Cystic resolution of a hematoma in the absence
of neoplasm
The reported cyst falls in the second category of
the Terrier and Lecene9 and Levison10 classification,
being a cystic hamartoma. In the revision by Hodges
et al.4 it would be B-2 — necrosis and cystic degen-
Fig.3. Barium enema showing mass with lateral displace-
ment of descending colon.
eration of benign tumors. It would be the same ac-
cording to Ellis et al.7
Diagnosis: Diagnosis is always difficult and has
rarely been made preoperatively, only seven times
according to the literature. Preoperative diagnoses
have included cyst of spleen, pancreas, liver, kid-
neys, and mesentery, retroperitoneal tumor, dermoid
cyst, renal tumor, empyema of the gallbladder,
aneurysm of the splenic artery and disseminated
lupus erythematosus, retrocecal appendicitis, and
calcified hemangioma of the liver.1,4’6
Differential diagnosis further includes hydatid
cyst, chylar cyst, urachal cyst, and solid adrenal
tumors.1, 4> 5) 7
Localization to the adrenal gland is a major step
in differentiation. Displacement of adjacent organs
such as kidneys, spleen, stomach, descending colon,
464
The Ohio State Medical Journal
— and ureters is helpful in identification. Displace-
ment of the kidney with accompanying distortion of
the superior collection structures is a significant
localizing indication, which occurs in the majority of
the cases, but even exact localization does not ascer-
tain the diagnosis.7
Treatment: The treatment is complete excision.
The approach is governed by size and location.
Summary
Adrenal cysts are rare and have been mostly
found only post mortem. They very seldom cause
endocrine dysfunction. They can become huge and
then cause symptoms through pressure on and dis-
placement of abdominal viscera.
Radiography, especially the urogram, is the most
important diagnostic measure. The cysts are found
on either side and have a 50 per cent predomi-
nance in women. Diagnosis has rarely been made
preoperatively.
An adrenal cyst of 15 by 20 cm. in a man has
been reported. Incidence, pathogenesis, symptoma-
tology, diagnosis, and treatment have been discussed.
References
1. Abeshouse, G. A.; Goldstein, R. B., and Abeshouse, B. S.:
Adrenal Cysts: Review of the Literature and Report of Three Cases.
/. Urol., 81:711-719 (June) 1959.
2. Barron, S. H., and Emanuel, B.: Adrenal Cyst; A Case Re-
port and a Review of the Pediatric Literature. /. Pediat., 59:592-599
(Oct.) 1961.
3. Wahl, H. R. : Adrenal Cysts. Abstr. in Amer. J. Path.,
1952, 27, 758.
4. Hodges, F. V., and Ellis, F. R.: Cystic Lesions of the
Adrenal Glands. Arch. Path., July 58, 66:53-58 (July) 1958.
5. Greiselius: De rene succenturiato cum ulcere, Miscellamae
Curiosa medico-physica Acad. Naturae curiosorum. sive ephemeridium
medicophysicarum Germanicum., etc. observ. LVI, p. 152, 1670.
6. Palubinskas, A. J.; Christensen, W. R.; Harrison, J. H., et
al.: Calcified Adrenal Cysts. Amer. J. Roentgen., 82:853-861 (Nov.)
1959.
7. Ellis, F. H., Jr.; Dawe, C. J., and Clagett, O. T.: Cysts
of the Adrenal Glands. Ann. Surg., 136:217-227 (Aug.) 1952.
8. Gardiner, W. R.; Bell, H. G., and Althausen, T. L. : Large
Adrenal Cystic Tumor Without Endocrine Manifestations. Postgrad.
Med., 11:297-300 (April) 1952.
9. Terrier, F., and Lecene, P. : Les grands Kystes de la capsule
surrenale. Rev. de chir., Paris, 34:321-337, 1906.
10. Levison, P.: Case of Bilateral Adrenal Cysts. Endocrinology,
17:372-376, (July-Aug.) 1933.
11. Brindley, G. V. Jr., and Chisolm, J. T.: Cystic Tumors of
the Adrenal Gland Associated with Cushing’s Snydrome. Texas J.
Med., 47:234-237 (Apr.) 1951.
CADAVERIC RENAL TRANSPLANTATION. — Twenty patients in termi-
nal renal failure were treated between October 4, 1963, and April 26, 1965,
by bilateral nephrectomy, splenectomy, transplantation of a kidney from a cadaver,
and administration of the immunosuppressive drugs azathioprine and prednisone.
With the exception of ABO blood-group compatibility, donor and recipient were
unmatched. Eight of the patients are alive and well with transplants that have
been functioning for from three months to one year eight months.
Rejection episodes occurred in all patients who survived the immediate period
after transplantation but were all controlled by increased doses of the immuno-
suppressive agents and by the addition of actinomycin C.
Acute tubular necrosis was encountered in 6l per cent of the renal homografts.
This was related to the time during transplantation that the kidney was without a
blood-supply and not cooled, rather than to the total period of ischemia. Early
function was good in cases where this "warm” time was less than 85 minutes.
When there was poor initial function the toxicity of azathioprine was in-
creased. This toxicity was reduced but adequate immunosuppression still obtained
when the dose of azathioprine was lowered to 1.5 mg./kg. daily.
The major cause of death of patients in this series was infection. — J. F.
Mowbray, M. B., B. Chir., M. R. C. P., et al, London: British Medical Journal,
2:1387-1394 (December 11) 1965.
A TTENTION PROGRAM CHAIRMEN: We are most anxious to receive
for consideration manuscripts, abstracts, or news items based upon lectures,
symposia, etc., presented to Ohio physicians or those presented by Ohio physicians
to other groups. — The Editor.
for May, 1966
465
A Clinicopathological Conference
From The Ohio State University Hospital, Columbus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
COLIN R. MACPHERSON, M. D., President
PRESENTATION OF CASE
A NEGRO woman, aged 54, was admitted to
Ohio State University Hospital with the chief
complaint of weakness of her legs and arms.
Three weeks prior to admission she did more than
her usual work as a dormitory maid, including mak-
ing up 27 triple-deck beds. The next day she noted
generalized muscle weakness and tenderness which
progressed until she was unable to get out of bed or
to lift her arms to comb her hair. She was seen by
her family physician the next day, who gave her
codeine for pain. That same evening the patient
noted that her urine became somewhat dark in color.
Four days after the onset of symptoms she experi-
enced swelling and tenderness of the hands and fin-
gers, which spontaneously disappeared. The muscle
tenderness seemed to decrease up to the time of ad-
mission; however, the weakness progressed.
During the three weeks prior to admission the
patient lost 10 lbs. She denied any chills or fever,
however claimed to have had soaking night sweats
during the two weeks prior to admission. The pa-
tient stated that she had occasional generalized head-
aches, however denied any dyspnea, orthopnea, par-
oxysmal nocturnal dyspnea, palpitations or pedal
edema. She had had some anorexia associated with
her present illness but no nausea, vomiting, abdomi-
nal pain, or melena. The patient had chronic con-
stipation with no change in bowel habits. She had a
mild upper respiratory infection with a sore throat but
no chills or fever four weeks prior to admission. Be-
cause of the progression of the severe muscle weak-
ness the patient came to the emergency room and
was admitted.
The patient had been followed in the Outpatient
Department intermittently for the past 11 years for
hypertension and had been treated with various medi-
cations. She stated that she had not been on any
medications for five to six months preceding this
admission. On her last visit to the Medical Clinic,
six months prior to admission, her blood pressure was
Submitted February 26, 1966.
Presented by
• Charles E. Mengel, M. D., Columbus, and
• Dante G. Scarpelli, M. D., Columbus.
Edited by Dr. Scarpelli.
220/110 and treatment was started with reserpine
and chlorothiazide. An intravenous pyelogram done
at that time as part of a hypertension evaluation re-
vealed blunting of minor calyces bilaterally, suggest-
ing chronic pyelonephritis. Chest x-ray done at the
same time revealed an enlarged aorta, cardiomegaly
with left ventricular predominance, and normal lung
fields. The blood urea nitrogen (BUN) was 20
and the creatinine 1.8 mg./lOO ml.
The family history was significant in that hyper-
tension was described in a brother, who died at age
45, and a sister, who died at age 49.
Physical Examination
The patient was an obese Negro woman in no
apparent acute distress, with a blood pressure of 170/
100, pulse rate 110 per minute and regular, respira-
tory rate 20/min., temperature 99-6° F. The fundus-
copic examination showed mild arteriolar narrowing
with arteriovenous nicking. The neck was supple
and showed no venous distention or enlargement of
the thyroid. Fine expiratory rales were heard at
both lung bases. The left border of cardiac dullness
was 2 cm. to the left of the midclavicular line. The
cardiac rhythm was regular. A grade I-II/VI apical
systolic ejection murmur was heard. A presystolic
gallop was present. The abdomen was obese, had no
fluid wave. The liver was palpable 3 cm. below the
right costal margin. The spleen was not palpable.
Rectal examination was normal.
Examination of the extremities showed decreased
muscle mass in the legs and marked weakness of all
extremities. Only the deltoid muscles were tender at
the time of admission. There was superficial throm-
bophlebitis of the right calf. The deep tendon re-
466
The Ohio State Medical Journal
flexes were equal and slightly hypoactive bilaterally.
No sensory deficits or pathologic reflexes were noted.
Laboratory Data
On admission her hemoglobin was 12.1 Gm., the
hematocrit 38 per cent; the white blood cell count
was 12,200 with 90 per cent neutrophils. The urine
had a specific gravity of 1.010 and contained 20 mg.
of protein per 100 ml. and 0-2 white blood cells per
high power field. The C02 combining power was
19 mEq. /liter, the sodium 139, potassium 6.3, and
chloride 113 mEq./liter. The fasting blood sugar
was 94 mg., the BUN 104 mg., and creatinine 7.2
mg./lOO ml. The serum glutamic oxalacetic transami-
nase (SGOT) was 396 units, the lactic dehydrogenase
(LDH) was 1550 units, aldolase 81 units; alkaline
phosphatase 4.7 units; total protein 6.2 Gm./lOO ml.
(albumin 4.0, globulin 2.2); total bilirubin 0.1
mg./lOO ml.; calcium 4.3 mEq./liter; uric acid 17.5
mg./lOO ml.; cholesterol 285 mg./lOO ml. with 69
per cent esterification. The protein-bound iodine was
4 meg./ 100 ml. The serology was nonreactive for
syphilis; latex fixation titer was negative; antistrep-
tolysin O titer was 12 units; C-reactive protein 4 plus;
lupus erythematosus preparation negative; urinary
vanillomandelic acid was 2 m eg./ mg. creatinine.
The electrocardiogram showed sinus tachycardia
and possible left ventricular enlargement. The elec-
tromyogram was interpreted as indicative of diffuse,
moderately severe myopathy.
The chest x-ray showed cardiomegaly with pulmo-
nary congestion and bilateral pleural effusion. Barium
enema, upper gastrointestinal and small bowel series
were all normal. Bilateral retrograde pyelogram
showed slight dilatation of the calyces of the right
kidney without any obvious obstruction. The reno-
gram showed good vascularity with poor function
bilaterally and marked excretory delay.
Hospital Course
The patient was admitted for evaluation and treat-
ment of diffuse muscle weakness. Repeated uri-
nalyses did not again reveal proteinuria. The BUN
climbed steadily although she was not oliguric. The
creatinine clearance was 2 cc. per minute. On the
tenth hospital day the patient underwent peritoneal
dialysis with ten exchanges, which brought her BUN
down from 180 to 143 mg., with improvement in the
lethargy and nausea that the patient had developed.
The hyperkalemia was treated with exchange resins.
The enzymes continued to be elevated. Right deltoid
skin and muscle biopsies were performed. The skin
was reported as normal. The muscle showed focal
chronic inflammation and focal myofibrillar atrophy.
After dialysis the patient remained rather stable
but no improvement in her muscle strength was noted.
Again her BUN rose, leveling off between 160 and
165 mg. with a creatinine between 6.5 and 7 mg.
On her 24th hospital day she developed respirator}7
distress which was partly relieved with nasal oxygen
and intermittent positive pressure breathing (IPPB).
The following day she suddenly became hypotensive.
She was treated with vasopressors and responded
briefly, then suddenly developed cardiac standstill.
Closed chest massage and tracheal intubation were
followed by temporary recover}7. However, she again
went into cardiac standstill and died, on the 25th
hospital day.
CLINICAL DISCUSSION
Dr. Mengel: The patient today is a very in-
teresting one who raises many problems, not all of
which will be settled by either me or Dr. Scarpelli.
Reading from the protocol, I will reiterate very
briefly certain aspects and summate salient features of
this patient’s illness.
The essence of the history that this patient gave us
was that four to five weeks prior to admission she
had mild symptoms of upper respiratory infection,
followed three weeks prior to admission by consider-
able physical activity incident to her work as a maid.
Following this she noted generalized muscular weak-
ness and tenderness progressing to the point where
she was not just unable to carry out her work, but
she apparently couldn’t raise her arms to comb her
hair. This became so severe that she consulted her
physician, who prescribed some codeine. At this
same time this woman had at least one episode in
which her urine became dark. Barring the transient
change in her hands with arthralgias and some swel-
ling and perhaps minimal arthritis, this was her im-
mediate present illness. There is the history of soak-
ing night sweats and I would have to say, if indeed
this turns out to be tuberculous arteritis of the muscles
or tuberculosis of the muscle, I will be surprised.
Dark Urine
I would like to comment on the significance of
dark urine. Very frequently when we take histories
we are not alert enough to changes that occur in the
color of the urine, because when it occurs significantly
it may have very important meaning in pointing us
in the direction of the proper disease. Dark urine,
in addition to just meaning concentrated small urinary
volumes, can also occur in settings of hemoglobinuria,
myoglobinuria, porphyrin excretion, alcaptonuria,
ochronosis, and of course in a variety of other condi-
tions and circumstances where someone has ingested
methylene blue tablets, blueberry pie, or a number of
other substances that may have no relationship to
the illness whatsoever. I was a little disappointed
that in the subsequent protocol no statements were
made relevant to the color of the urine, while great
attention was paid to the BUN, the creatinine, and
things that perhaps really wouldn’t have pointed us
most assuredly in the proper direction.
On the basis of the history I will assume that the
patient did not have porphyuria, ochronosis, or alcap-
tonuria, and that she had not ingested something
that would color her urine. So the basic issue at stake
for May, 1966
467
is, Was this hemoglobinuria or myoglobinuria? Here
again we have precious little data to go on. I would
like to make two observations relevant to the separa-
tion of hemoglobin from myoglobin. The am-
monium sulfide separation is not reliable. The spec-
troscopic bands for these two iron-containing proteins
are so close that separation by this means is quite dif-
ficult. Since myoglobin migrates more slowly than
hemoglobin in an electrical field, on paper electro-
phoresis a band that has migrated more slowly than
the hemoglobin band is diagnostic of myoglobin.
A much easier way that one can utilize is simple
visual inspection simultaneously of the plasma and
the urine. The myoglobin molecule is about one-
quarter of the size of the hemoglobin molecule.
Since it is not bound to haptoglobin when it is re-
leased into the peripheral circulation, it appears in the
urine very quickly. Therefore it very rarely, if ever,
accumulates in the plasma. So if you had dark brown
urine for examination, and the plasma was clear, you
could almost unequivocally say that you had myo-
globinuria and not hemoglobinuria. When you are
dealing with hemoglobinuria, then the plasma is con-
sistently darkened because of the binding of hemo-
globin to haptoglobin. We have no such data, and
I was somewhat disappointed that no statement was
made later on during the course.
Now the past history I would dismiss quickly. She
had had hypertension for a long time. She had a
family history of hypertension, and aside from pos-
sibly contributing to some aggravations in the kid-
neys I doubt whether that really points us in the direc-
tion of the significant problem.
On physical examination the pertinent features
were that she had a temperature of 99.6 — she was
febrile. She had some vascular changes in her eye-
grounds, her liver was enlarged, and there were a
few rales at the lungs. Examination of the extrem-
ities showed decreased muscle mass in legs and
marked bilateral weakness of both upper and lower
extremities, and this very brief statement about the
neurological examination leaves me with the impres-
sion that the people who saw her believed that there
was nothing inherently wrong with her nerves. This
may not be an appropriate evaluation, but this is the
way I see it at the moment. So all of the data point
to a primary muscle disease of some sort.
Now with her laboratory data this case becomes
more intriguing. Hematologically, she appeared nor-
mal. She had mild proteinuria and elevation of
SGOT, LDH, and aldolase enzymes in her serum,
which I think for convenience sake may be consid-
ered muscle enzymes. I would only point out that the
LDH may also be elevated in two other conditions.
One is malignancy and often it points toward recog-
nition of an occult neoplasm. An unusual elevation
of the LDH relevant to the aldolase and the SGOT
did make me at least pause once to consider under-
lying carcinoma, but only briefly. The proteins were
of interest in that there was a normal level of globu-
lin. Obviously, as we come to the differential diag-
nosis shortly, the possibility that this is a collagen-
type disease becomes somewhat remote in the light of
these data. I wonder if we could look at the chest
x-rays now?
Radiologist’s Discussion
Dr. Harris: I will just discuss the positive find-
ings. An intravenous pyelogram done six months
before her admission showed kidneys with a mod-
erate excretion and minimal blunting of several of
the miner calcyces, and this was corroborated on the
bilateral retrogrades done during her hospitalization.
An upper G. I. series was entirely normal. A chest
film 18 months before her admission showed cardi-
omegaly with a slightly dilated aorta — changes
compatible with the known diagnosis of hypertension.
The next film was at the time of her present illness,
and the interesting feature here is the poorly defined
infiltration in both lower lobes and the absence of
pleural fluid. Heart size and contour were unchanged
at this examination. The pulmonary infiltrations re-
mained unchanged during the subsequent examina-
tions done during the interval of a week.
Of great interest in this chest film taken shortly
before her death is the pulmonary consolidation or
atelectasis of the right lower lobe with what may be
slight pleural effusion. The differential diagnosis
here would be between multiple small pulmonary in-
farctions and inflammatory disease, either of which
would give the small amount of fluid present in this
case. In summary then, I feel we are dealing with a
minimal bilateral pyelonephritis and infiltrations of
both lower lobes, probably inflammatory, although I
would certainly want to exclude the possibility of
pulmonary infarction.
Renal Dysfunction
Dr. Mengel: Despite her hypertension, this
woman did not appear to be suffering from conges-
tive heart failure. The only question I would raise
is relative to the renal dysfunction. The marked ele-
vation of the BUN in the absence of other urinary
findings is of interest. I just wonder what your
thoughts are, Dr. Carter, about the nature of this renal
failure. My interpretation has been that if there is
renal failure here it must be of a relatively acute na-
ture and perhaps in a diuretic phase, and, second, a
good bit of the BUN elevation is probably secondary
to acute muscle injury.
Dr. Carter: I think this could be the result of
an acute renal insult associated with whatever her
illness was. The paucity of findings in the urine sedi-
ment is what one would expect in the recovery stage.
The relationship of the blood urea nitrogen levels to
the recovery phase of acute renal failure is variable,
so that it is not uncommon to see the blood urea
nitrogen continue to rise despite recovery. One may
468
The Ohio State Medical Journal
deduce from this that recovery is taking place but the
filtration rate and the urine output are still diminished.
Dr. Mengel: There are two major questions
which must be answered in this case: one, What was
the underlying disease that was predominantly affect-
ing her muscles? I think that myopathy was the
major feature of this woman’s illness; the history,
symptomatology, physical examination, electromyo-
graphic studies, her subsequent course in the hospital,
and the enzymes all point to predominant myopathic
changes, and I would like to consider these first.
Myopathies
I have been unwilling to separate muscle diseases
by either primary or secondary causes because I don’t
think this can always be done, and accordingly I
classified primaries and secondaries into the following
categories: progressive muscular dystrophies, myoto-
nias, metabolic defects, myasthenia gravis, myositides,
periodic paralyses with either hyper- or hypokalemic
episodes, atrophies of muscle which relate to either
denervation, disuse or cachexia, and finally a variety
of endocrine abnormalities among which thyroid
disease stands out eminently. I think the normal
PBI in this patient and the absence of other changes
well rule out thyroid disease, and we certainly have
no clinical information that could lead us to any of
the other endocrinopathies. There is no doubt that
progressive muscular dystrophies represent a heter-
ogeneous group of diseases. They undoubtedly are
related to some of the problems that we will come
to shortly, but in the usual pattern of inherited mus-
cular dystrophies nothing in the course of this pa-
tient really points to this group of diseases.
Infections
It is important to consider infections in the cause
of muscle disease, and here we have specific infec-
tions of trichinosis and toxoplasmosis. Trichinosis is
a possibility, but I don’t think we have enough in-
formation really to document that. Certainly in the
setting of certain generalized rickettsial infections and
systemic dissemination of tuberculosis muscle pathol-
ogy has been described. Sarcoid may also give rise
to a myopathy. However, there is little to suggest
etiologies of this sort in this case.
Myopathy due to altered internal environment, re-
lated to either altered chemical status of the muscle
or the neuromuscular junction, or to an altered vascu-
lar supply, must also be considered. Certainly alter-
ations in potassium and sodium can result in signifi-
cant myopathy. If you wanted to push the issue you
could really look at this woman as a case of uremia
who developed a peculiar myopathy, but I think there
are too many things that speak against this. The
possibility of altered vascular supply is an intriguing
one, and the ones we know best are arteritis and poly-
arteritis nodosa; platelet thrombi in the thrombotic
thrombocytopenic purpuras; dissecting aneurysms, now
described with myopathies and myoglobinuria; and
severe arteriosclerotic vascular disease, perhaps not a
direct arteritis but a severe, widespread, diffuse small
blood vessel disease of necrotizing type.
Then, finally, there is sickle cell disease, not only
in the homozygous but in the heterozygous state, and
we have seen at least one patient in whom, during
periods of hypoxia, thromboses had formed in situ
resulting in infarction of groups of voluntary muscles.
I have not had the opportunity to review the biopsy,
but the description given us was that of a chronic in-
flammatory change with degeneration of muscle.
Metabolic Defects
Another group of diseases also to be considered is
the so-called metabolic defects of muscle. This
could be a glycolytic abnormality involving a phos-
phorylase deficiency in muscle often referred to as
McArdle’s syndrome. It is characterized in some
instances by a myopathy clearly related to exertion.
There is myopathy, myoglobinuria, and indeed death
may ensue during the first attack. Direct assay on
muscle for phosphorylase activity shows that it is
low or absent. Since these patients are unable to
make glucose- 1 -phosphate from glycogen, they do
get a rise in their blood lactate after significant ex-
ercise. An exercise test measuring serial blood lac-
tates is of great help in establishing this diagnosis.
There are many features in this patient’s illness
which would point in the direction of some glyco-
lytic abnormality. Of interest in this regard is the
recent report by Dr. Carl Hinz1 from Cleveland in
the American Journal of Medicine describing three
patients who clinically appeared to have this syndrome
but who did not show muscle phosphorylase defici-
ency, but rather, metabolic changes which suggested
abnormalities in the Kreb’s cycle enzymes in muscle.
Another important member of this group is primary
intermittent myoglobinuria — a disease of unknown
etiology. Since myoglobin is lost from muscle in
both diseases, a diagnosis of primary myoglobinuria
can only be made when it is clear that myoglobinuria
is not secondary to a known metabolic disturbance
of muscle.
Myositis
A final category that merits mention is the myosi-
tides, which includes polymyositis. There seems to
be a group of patients who present as a primary
idiopathic disease that often comes on after a mild
upper respiratory infection which may be associated
with a myoglobinuric episode and occasionally as-
sociated with exertion. Patients in a second group
with the same kind of syndrome show stigmata of the
collagen group of diseases. They may have a little
pleural effusion, splenomegaly, and mild hematologic
abnormalities not dissimilar to the patient under dis-
cussion, whose pleural effusion may really reflect a
widespread systemic disorder. This group includes
dermatomyositis, in which case the skin biopsy should
be distinctly abnormal. In this patient the skin biopsy
for May, 1966
469
was reported as normal. The relationship of cancer
to dermatomyositis is cited in the literature and it
seems to be an unequivocal association. We have no
evidence in this particular patient that this is the case.
In conclusion I would say that the most likely pos-
sibility in this case is idiopathic primary polymyositis.
Perhaps because of the hepatomegaly, and pulmonary
changes, this may be related to some underlying col-
lagen disease with a severe vasculitis. Another possi-
bility, although less likely, is that there is a deficient
muscle phosphorylase activity to support McArdle’s,
or changes suggestive of primary myoglobinuria. I
think the renal bout represented transient renal injury,
perhaps from the bout of myoglobinuria, or more re-
motely, diffuse renal vascular disease, and we may be
seeing a combination of the diuretic phase of renal
failure — acute tubular necrosis — and increasing tis-
sue destruction.
Finally we come to the second question: the cause
of death. With pulmonary infiltrates, pleural ef-
fusion, the bout of respiratory distress on the 24th
hospital day which was partly relieved by intermittent
positive pressure nasal oxygen, her momentary re-
sponse to closed chest massage later on, I would
think that the most likely cause of death was a mas-
sive pulmonary embolism or that perhaps she had had
recurrent showers of pulmonary emboli. She may
well have had other problems, but with the intermit-
tent respiratory distress I would think this the most
likely possibility.
Dr. Carr: I will entertain a period of questions
and comments to Dr. Mengel.
Dr. Saslaw: This patient fits the classical pic-
ture of what we have seen in dermatomyositis. The
fact that she had marked muscular weakness, particu-
larly involving the deltoids, would suggest this diag-
nosis. These patients frequently develop pneumonias
bilaterally due to involvement of muscles of respira-
tion. We have had biopsies on these patients of
skin and peripheral voluntary muscles and they
showed the pathologic changes consistent with der-
matomyositis. In the case at hand, it would be help-
ful to know if she had difficulty in breathing. Was
she using the accessory muscles of respiration?
Dr. Thompson: There was no mention of that.
Dr. Wombolt, do you recall any problem?
Dr. Wombolt: She had no recognizable prob-
lem with breathing except on the day prior to her
death.
Dr. Mengel: I would certainly agree in general
that in many respects she had a classic polymyositis
syndrome, but with the report of a normal skin
biopsy I just think it impossible to entertain der-
matomyositis as a diagnosis.
Dr. Saslaw: The reason I chose this diagnosis in
the absence of skin lesions is that in my experience
respiratory difficulties may be seen in these situations
in the early acute phase in the absence of skin
involvement.
Dr. Carr: I think this argument is really a
semantic one. We read about idiopathic myositis;
whether they all fit into the same basket or whether
you can split them off into separate entities is a moot
point. It would depend upon whether you are a
splitter or a lumper, I suppose, but basically, as far
as the dermatitis is concerned, it’s a completely non-
specific one; second, none was seen, so I would pre-
sume none was present; and third, even under the
microscope it is far from diagnostic. Dr. Mengel, I
was interested in the fact that you could rule out the
possibility of an underlying malignancy with little
difficulty in a woman over 40 who develops an idi-
opathic myositis.
Dr. Mengel: The LDH did suggest to me the
possibility of an underlying malignancy, but her
gastrointestinal tract, kidneys, and pelvis were essen-
tially normal, and we had no findings anywhere to
suggest malignancy.
Dr. Carr: Dr. Scarpelli, will you present your
findings in this case?
CLINICAL DIAGNOSIS
1. Idiopathic primary polymyositis with myo-
globinuria.
2. Myoglobinuric nephropathy, diuretic phase.
3. Hypertension.
4. Massive pulmonary embolism.
PATHOLOGIC DIAGNOSIS
1. Acute polymyositis primarily affecting mus-
cles of the upper extremities, shoulder girdle,
and tmnk.
2. Focal muscle atrophy and replacement by fat.
3. Hypertensive heart disease.
4. Myocarditis.
5. Bilateral fibrosing alveolitis.
6. Myoglobinuric nephropathy.
7. Arteriolar nephrosclerosis.
8. Uremia.
DISCUSSION OF THE PATHOLOGY
Dr. Scarpelli: I think we are bringing up this
case not because it was a very difficult diagnostic prob-
lem but to discuss some of the interesting pathology
associated with the primary disease. For example,
what is the relation of the pulmonary lesions to the
muscle? What was responsible for the rapid deter-
ioration and death of this patient?
This was an obese Negro woman measuring 6 3 in.
in length and weighing 200 lbs. Both the pleural
and abdominal cavities were free of fluid and adhe-
sions. She had hypertensive heart disease, her heart
weighing 475 Gm. and showing a left ventricular
hypertrophy. There were no valvular deformities
or vegetations. The myocardium was soft and flabby
and had a very pale reddish-brown color. The most
470
The Ohio State Medical Journal
outstanding feature of the gross appearance at au-
topsy was a very curious mottling of her peripheral
muscles, especially in the chest and shoulder girdle.
The deltoid, intercostal, and rectus muscles were
whitish-yellow and appeared not unlike boiled fish
muscle. More distal muscle masses were also ab-
normal but not as severely changed as the proximal
ones.
The right lung weighed 475 Gm., the left 425 Gm.
On cut surface the lower lobes of both lungs and the
right middle lobe showed a diffuse area of grayish-
white induration. The remainder of the lungs ap-
peared normal. The liver was enlarged, weighing
1950 Gm.; the cut surface showed a deeply hyperemic
parenchyma in which the gross architecture appeared
unaltered. Each kidney weighed 175 Gm. The
capsule stripped with ease and beneath it the kidney
surface was finely granular. The cut surface showed
a thickened renal cortex and an indistinct cortico-
medullary junction and hyperemic medulla.
Microscopic examination of the myocardium showed
muscle cell hypertrophy, interstitial fibrosis and peri-
vascular fibrosis. Of considerable interest were the
focal interstitial accumulations of polymorphonuclear
leukocytes and lymphocytes, especially in the left
ventricle and septum. These were of sufficient in-
tensity to warrant a diagnosis of myocarditis. The
lungs showed diffuse areas of septal fibrosis with
obliteration of alveoli and an interstitial inflammatory
exudate consisting of lymphocytes and an occasional
plasma cell. There were also foci of acute broncho-
pneumonia. The submucosal connective tissue of the
esophagus was infilterated by numerous lymphocytes
and contained dense accumulations of collagen.
The peripheral voluntary muscles showed all stages
of polymyositis, from the acute phase consisting pre-
dominantly of a polymorphonuclear exudate with
focal muscle cell coagulation necrosis with subsar-
colemmal nuclear proliferation and phagocytosis of
necrotic sarcoplasm, to the chronic changes of muscle
atrophy with infiltration by fatty and fibrous con-
nective tissue. Although there were occasional peri-
vascular accumulations of inflammatory cells, these
did not appear to be associated with blood vessel
injury or vasculitis. Skin from the shoulder obtained
at autopsy showed slight edema and a small focal in-
flammatory exudate of lymphocytes in the dermis.
These changes were not of sufficient severity to justify
a diagnosis of dermatomyositis.
The kidneys showed an intense inflammatory reac-
tion and edema in the interstitium and dilatation of
the distal tubules and collecting ducts by a pale-tan
granular material which gave a positive histochemical
reaction for iron. There were also focal epithelial
cell necrosis and exfoliation of these cells into the
tubular lumens. There was a moderate arteriolar
nephrosclerosis and the renal glomemli showed no
significant changes.
The primary disease process was polymyositis which
by the histology encountered appeared to have been
present for some time, with periods of clinical activity
and quiescence. However, in view of the absence of
historically old reference to muscle disease, it is highly
probable that much of the time the polymyositis was
subclinical. Noteworthy in this case is the fibrotic
lung disease, and since clinical evidence of impaired
respiration due to muscle involvement occurred only
one day prior to death, the myositis cannot be
considered as the indirect cause of the pulmonary
disease.
Bilateral fibrosing alveolitis identical to that pre-
sent in this woman has been reported by Dr. Hepper2
and his associates at the Mayo Clinic in patients with
polymyositis. It is significant that in one of three
patients considerable amelioration was observed fol-
lowing corticosteroid therapy. They suggest that it
may be that the pulmonary fibrosis is another organ
manifestation of the basic pathology responsible for
polymyositis. The manner of death in the present
case suggested a cardiac cause. This was substan-
tiated by the presence of myocarditis, although
hypertensive hypoxia, such as this woman certainly
suffered secondary to her pulmonary disease and
respiratory muscle weakness could most certainly have
led to a fatal cardiac arrhythmia. The uremia, al-
though severe, was not, I believe, immediately respon-
sible for her death.
References
1. Hinz, C. F.; Drucker. W. R., and Lamer, J.: Idiopathic
Myoglobinuria. Amer. J. Med., 39:49, 1965.
2. Hepper, N. G. G. ; Ferguson, R. H., and Howard, F. M., Jr.:
Three Types of Pulmonary Involvement in Polymyositis. Med. Clin.
N. Amer., 48:1031, 1964.'
1IGATION OF THE INFERIOR VENA CAVA is the most effective means
^ of preventing pulmonary embolism. With proper postoperative manage-
ment this procedure will be followed by a low incidence of disabling sequelae.
Further experience with the various methods of plication and compartmentation
of the inferior vena cava is necessary before one can determine the possible
superiority of these methods over ligation of the inferior vena cava. — Donald
C. Nasbeth, M. D., and John M. Moran, M. D., Boston: The New England
Journal of Medicine, 273:1250-1253, December 2, 1965.
for May, 1966
471
472
The Ohio State Medical Journal
Flagyl
brand of
metronidazole
Flagyl eliminates the difficulties and frus-
trations that have long attended the treat-
ment of trichomonal infection.
These difficulties arose mainly from:
1) the failure of any previously known
agent to destroy the protozoan in para-
vaginal crypts and glands;
2) the failure of any previously known
agent to prevent reinfection by eradicat-
ing the disease in male consorts.
The introduction of Flagyl removed both
of these long-standing deficiencies. Hun-
dreds of published investigations in thou-
sands of patients have confirmed the ability
of Flagyl to cure trichomoniasis.
Correctly used, with due attention to re-
peat courses of treatment for resistant,
deep-seated invasion and to the presump-
tion of reinfection from male consorts,
Flagyl has repeatedly produced a cure rate
of up to 100 per cent in large series of
patients.
Nothing cures trichomoniasis like Flagyl.
Dosage and Administration
In women: one 250-mg. oral tablet t.i.d. for
ten days. A vaginal insert of 500 mg. is avail-
able for local therapy when desired. When the
inserts are used one vaginal insert should be
placed high in the vaginal vault each day for
ten days, and concurrently two oral tablets
should be taken daily.
In men: in whom trichomonads have been
demonstrated, one 250-mg. oral tablet b.i.d.
for ten days.
Contraindications
Pregnancy; disease of the central nervous sys-
tem; evidence or history of blood dyscrasia.
Precautions and Side Effects
Complete blood cell counts should be made
before and after therapy, especially if a sec-
ond course is necessary.
Infrequent and minor side effects include:
nausea, unpleasant taste, furry tongue, head-
ache, darkened urine, diarrhea, dizziness, dry-
ness of mouth or vagina, skin rash, dysuria,
depression, insomnia, edema. Elimination of
trichomonads may aggravate moniliasis.
Dosage Forms
Oral— 250-mg. tablets/Vaginal— 500-mg. inserts
SEARLE
Research in the Service of Medicine
for May, 1966
473
Proceedings of The Council . . .
Minutes of the Meeting of March 20 in the Columbus Office
With Reports of Actions Taken and Other Matters Discussed
A REGULAR meeting of The Council of the
Ohio State Medical Association was held
March 20, 1966, at the headquarters office,
Columbus. All members of The Council were present
except Dr. George Newton Spears, Ironton, Councilor
of the Ninth District. Others attending the meeting
were: Dr. John H. Budd, Cleveland, chairman, Ohio
Delegation to the American Medical Association; Mr.
Wayne Stichter, Toledo, OSMA legal counsel; Messrs.
Page, Edgar, Gillen, Traphagan and Moore, members
of the OSMA staff.
Minutes Approved
Minutes of the meeting of The Council held Feb-
ruary 20, 1966, were approved by official action.
Membership Statistics
The following membership statistics were an-
nounced by Mr. Page: OSMA membership as of
March 16, 1966, 8,903, compared to a total member-
ship of 8,856 on March 16, 1965, and 10,042 on
December 31, 1965. He reported that of the 8,903
members, 7,962 were affiliated with the AMA.
Reports of Councilors
The Councilors reported on activities in their re-
spective districts.
Doctor-Draft Call
It was announcd that Ohio is still about 16 physi-
cians short on doctor-draft Call No. 37 and that Call
No. 39 will involve 1 63 Ohio doctors. Interns will
be called first.
1966 Annual Meeting
By official action, The Council approved the pres-
entation of a certificate to past presidents of the Ohio
State Medical Association. The wording and the de-
sign of such certificate were ratified by The Council.
The Executive Secretary submitted 15 resolutions
filed at the OSMA headquarters office by the county
medical societies since the February 20th meeting.
A motion to proceed with the creation of a Section
for Hospital Directors of Medical Education was ap-
proved by official action.
A resolution honoring Dr. Herbert Morris Platter,
Columbus, for his long service to the public and to
medicine received the unanimous approval of The
Council. It was suggested that such resolution be
engraved on a plaque and that the plaque be pre-
sented at the first session of the House of Delegates,
May 24, 1966. The President will request that the
mles be suspended and the resolution acted upon
immediately upon presentation. (The text of the
resolution is published on page 481 in this issue of
The Ohio State Medical Journal.)
A resolution on dues exemption for financial emer-
gencies, resulting from the passage of Resolution No.
8 by the 1965 House of Delegates, was considered
by The Council. By official action, The Council
approved the wording of the resolution and voted to
submit it to the 1966 session of the OSMA House of
Delegates in confirmity with the instructions of Res-
olution No. 8, 1965. (The text of the resolution
is published on page 483 in this issue of The Ohio
State Medical Journal.)
Ohio Medical Indemnity, Inc.
Dr. Tschantz, as chairman, presented the report
of the nominating committee appointed by the Presi-
474
The Ohio State Medical Journal
dent to submit the names of candidates for the Board
of Directors of Ohio Medical Indemnity, Inc.
By official action, The Council approved the nomi-
nations presented and authorized the following to cast
the votes of the Ohio State Medical Association, a
stockholder, at the annual stockholders’ meeting of
OMI in April on all business matters coming before
that meeting, including the election of directors
placed in nomination by The Council at this meeting
on March 20, 1966, and subsequently: Dr. H. M.
Clodfelter, Columbus, or Dr. Edmond K. Yantes,
Wilmington, or Mr. Hart F. Page, Columbus.
By the unanimous consent of The Council, Dr.
Meredith, the President-Elect, received permission to
appoint as chairman of the Liaison Committee be-
tween The Council and Ohio Medical Indemnity Dr.
Robert E. Tschantz, Canton, to serve during Dr.
Meredith’s administration beginning May 27, 1966.
OMI Liaison Report — In connection with the re-
port of the OMI Liaison Committee the following
communications were presented to The Council for
study :
1. A communication dated March 15 to the Ex-
ecutive Committee of Ohio Medical Indemnity, Inc.,
from Charles H. Coghlan, Executive Vice President,
with regard to the OSMA resolution on the sendees
of anesthesiologists and with the following attach-
ments: Copy of OMI Preferred Certificate of In-
demnity Benefits; OMI Claim Form M-42 and OMI
Form for Anesthesia Benefits.
2. Minutes of meeting of Research Committee,
Ohio Medical Indemnity, Inc., February 16, 1966.
3. Minutes of meeting of Research Committee of
Ohio Medical Indemnity, Inc., March 9, 1966, with
representatives of the Ohio State Radiological Society.
Riverside Hospital Proposal — A report from a
special committee of the Columbus Academy of Medi-
cine which met February 23, 1966, with representa-
tives of Blue Cross and Riverside Hospital, Colum-
bus, regarding a proposed pilot insurance plan, was
discussed by The Council. Such plan suggests a pre-
admission diagnostic workup program with payments
made by Blue Cross for medical sendees involved.
The Council voted to ask Ohio Medical Indemnity,
Inc., to move forward with all expedience in the de-
velopment of policies which will indemnify the pa-
tient for the fees of "hospital-based” specialists. In
addition, The Council requested that appropriate of-
ficials of Ohio Medical Indemnity be invited to appear
at the next meeting of The Council, April 23-24, to
discuss this matter.
Congress of County Medical Societies
The Council considered a communication from the
Academy of Medicine of Cincinnati asking an opinion
on the Congress of County Medical Societies. The
Council asked the Executive Secretary to inform the
Academy that affiliation with this group is a matter
for local determination.
Committee Reports
Cancer Coordinating Committee — The Council
accepted the report of the Ohio Cancer Coordinating
Committee, based on the minutes of a meeting held
January 9, 1966.
Committee on Mental Health — Mr. Traphagan
presented a report on the meeting of the Committee
on Mental Health held January 16. The Council
approved, in principle, recommendations made by
the committee relative to the development of legisla-
tion regarding mental health. Further, The Council
approved the introduction of the following resolu-
tion, which embodies these principles, at the 1966
session of the OSMA House of Delegates:
BE IT RESOLVED, That the House of Delegates of The
Ohio State Medical Association direct the Association’s
Committee on Mental Health to develop legislation calling
for the establishment of an Ohio Mental Health Council,
appointed by the Governor, this Council to consist of seven
members with staggered terms at least four of which mem-
bers shall be doctors of medicine. The duties of The Council,
to be defined in the legislation, should include:
(a) The submission of a list of names to the Governor
from wffiich he shall appoint the Director of Mental
Health;
(b) The development of a list of qualifications for the
positions of Director of Mental Health and Commissioners;
(c) The submission of a list of names to the Director
from which the Director shall appoint the Commissioners;
(d) The establishment of tenure of office for the Com-
missioners;
(e) Meeting a given number of times each year;
(f) Making recommendations to the Director and Com-
missioners upon their request or when it is otherwise
deemed desirable;
(g) To make an annual public report on the activities
and accomplishments of the Department, and
(h) To provide for itself an adequate staff to carry
out its functions; and
BE IT FURTHER RESOLVED, That the House of Dele-
gates direct the Association’s Committee on Mental Health
to develop separate legislation calling for the establishment
of two separate and distinct departments of the State Govern-
ment, a Department of Mental Health and Retardation and
a Department of Correction; and
BE IT FURTHER RESOLVED, That the House of Dele-
gates direct the Association’s Committee on Mental Health
to develop separate legislation calling for statutory autonomy
for mental retardation within the Department of Mental
Health; and
BE IT FURTHER RESOLVED, That the principles de-
veloped above be the official policy of The Ohio State Medical
Association. However the desirability of OSMA sponsorship
of such legislation in the 107th General Assembly be deter-
mined by The Council.
The Council also approved the recommendation of
the committee that the Association inform Mrs. Rose
Papier, coordinator, Administration on Aging, Ohio
Department of Mental Hygiene and Correction, that
the Ohio State Medical Association is willing to co-
operate in areas where qualified in the administration
of the Older Americans’ Act of 1965 in Ohio.
The Council also approved a recommendation of
the committee that it inform the Ohio Psychiatric As-
for May, 1966
475
sociation that the committee will be willing to send
a representative or representatives to the OPA’s sug-
gested committee to talk and make recommendations
regarding possible legislation with regard to criminal
responsibility. It was pointed out that these represen-
tatives may serve only in an auditive capacity and
cannot reflect official OSMA policy.
Acting on another committee recommendation, The
Council approved a postgraduate meeting to be spon-
sored by the committee during 1967, the meeting to be
two days and that it be self-supporting. This meeting
will be a followup to the "First Ohio Congress on
Psychological Medicine” held October 24, 1965.
Radiological Advisory Council
A report on the January 18, 1966, meeting of the
Radiological Advisory Council, Ohio Department of
Health, as presented by Mr. Traphagan, was accepted
by The Council.
Ohio Association of Blood Banks
A request for the approval of the organization of
an Ohio Association of Blood Banks was submitted,
along with the proposed Constitution of the Ohio
Association of Blood Banks. The constitution was
referred to Mr. Wayne Stichter, OSMA legal counsel,
for review, and this matter was rescheduled for the
April 23-24 meeting of The Council.
Phenylketonuria Regulations
The Council considered a letter of March 3, 1966,
from E. W. Arnold, M. D., Ohio Director of Health,
which was accompanied by a copy of Amended Sub-
stitute Senate Bill No. 19, enacted at the last session
of the General Assembly to require phenylketonuria
tests for all newborn infants, and a February 28,
1966, draft of proposed Ohio Public Health Council
regulations for carrying out the provisions of the law.
By official action, The Council requested that a
letter be directed to the Ohio Director of Health,
outlining the following objections to the regulations
as presently constituted:
1. Only physician directed laboratories should be
approved for processing of phenylketonuria tests.
2. Local laboratories both hospital and private
should be encouraged by the public health council
to process PKU screening tests.
3. The Director of Health should approve several
acceptable tests and neither he nor the regulation
should state a preference for any one or more.
4. The day of collection of the specimen should
not even be suggested within the regulation. This
is a matter of medical judgment, a decision to be met
by an individual physician not by regulation. Fur-
ther, the suggestion that the specimen be collected
on the fourth or fifth day of life will tend to extend
hospital stay of newborn in Ohio, for no other reason
than the collection of a specimen for a test.
5. Section C (Item 6) would, again, seem to
dictate medical judgment. Further, the requirement
of repeated serum phenylalanine determinations would
seem to go beyond the law.
The question is also raised as to who will pay for
the tests when done in a laboratory other than the
state laboratory? "We are not referring to the mate-
rials which will be supplied by the Ohio Department
of Health, we are referring to the cost of time in-
volved in collection, etc.”
Workmen’s Compensation
Mr. Edgar presented a report of the minutes of the
meeting of the Committee on Workmen’s Compensa-
tion held February 16, 1966.
The committee recommended to The Council that:
1. In keeping with the Principles of Medical
Ethics and the laws of Ohio prohibiting corporate
practice of medicine, Council requested the Ohio Bu-
reau of Workmen’s Compensation to fix a future date,
after which the Bureau will require a separate billing
for hospital services and a separate billing from physi-
cians for their professional medical services.
2. The Chairman of the committee be authorized
to appoint a subcommittee to develop and recom-
mend to BWC a special claim form to be used by
physicians in complicated cases.
The recommendations of the committee and the
minutes of its meeting were approved by Council.
Mr. Edgar presented to The Council a summary
of 42 fee bills questioned by the Bureau of Work-
men’s Compensation under the usual and customary
fee program. It was the expression of Council that
Councilors must bring to the attention of local medi-
cal societies the obligation of review committees to
act on "questionable” fee bills submitted by the Bu-
reau of Workmen’s Compensation in the same man-
ner as if the committee were mediating a complaint
on fees submitted by an individual patient.
A communication from the legal section of the
Bureau of Workmen’s Compensation, expressing the
opinion that the Bureau could not legally pay hospi-
tals for physicians’ services and that such procedures
was therefore being discontinued by the Bureau, was
brought to the attention of The Council by Mr. Edgar.
Maternal Health Committee — Mr. Gillen re-
ported on a meeting of the Committee on Maternal
Health held January 22-23, 1966. The report was
accepted.
Mr. Gillen announced that Dr. Anthony Ruppers-
berg, Columbus, chairman of the committee, appeared
before the Ohio Hospitalization Benefits Committee
on February 23, 1966, to discuss the OSMA policy
on the use of obstetrical beds for clean gynecological
patients. Dr. Ruppersberg testified before a subcom-
476
The Ohio State Medical Journal
TOPICAL TYPICAL
TREATMENT RESULTS
PRIMARY PYODERMA AFTER TREATMENT WITH
'NEOSPORIN' ANTIBIOTIC OINTMENT
AND SALINE COMPRESSES
“‘NEOSPORIN’-
Polymyxin B- Neomycin -Bacitracin
OINTMENT
Each gram contains:
‘Aerosporin’® brand Polymyxin B
Sulfate 5,000 Units
Zinc Bacitracin 400 Units
Neomycin Sulfate (equivalent to
3.5 mg. Neomycin Base) 5 mg.
Tubes of V2 oz. and 1 oz.
• clinically effective
• comprehensive bactericidal action against most
Gram-negative and Gram-positive organisms, in-
cluding Pseudomonas
■ rarely sensitizes
For the eradication of infectious organisms in a
wide range of dermatologic disorders: impetigo,
ecthyma, pyodermas, sycosis vulgaris, paronychia,
traumatic lesions, eczema, herpes and seborrheic
dermatitis. Prophylactically, for protection against
bacterial contamination in burns, skin grafts, inci-
sions and other clean lesions, abrasions and minor
cuts and wounds.
Caution: As with other antibiotic preparations, pro-
longed use may result in overgrowth of nonsus-
ceptible organisms and/or fungi. Appropriate
measures should be taken if this occurs.
Contraindication: This product is contraindicated
in those individuals who have shown hypersensi-
tivity to any of its components.
Complete literature available on request from
Professional Services Dept. PML.
-Li.l BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, New York
for May, 1966
477
mittee of the Ohio Hospitalization Benefits Commit-
tee on March 12, 1966.
Hospital Relations Committee
A report on a meeting of the Committee on Hospi-
tal Relations, held March 13, 1966, was presented by
Mr. Gillen.
Utilization Committees
A statement by the Subcommittee on Utilization
Committees was amended to read as follows and
subsequently adopted by The Council:
1. It is pointed out that based on the demands of
the law the factual presentation of the requirements
of the Utilization Review Plan prepared by HEW
and presented in the OSMJ March, 1966, pages 249-
251, must be accepted as a condition for approval of
the hospital, and the guidelines for organization and
activity of utilization committees should be accepted
by the medical staff of every hospital.
2. The medical staff of every hospital should have
presented to it by a member of that medical staff,
the information contained in the above (Standards
for Utilization Review Committees Under Medicare)
and have open discussion concerning these standards.
3. The criteria for utilization should be deter-
mined by the medical staff of each hospital. It is
suggested that these criteria be developed to conform
with the guidelines of Standard B as presented in
the OSMJ March, 1966, pages 249-251.
4. It is further suggested that these criteria be
acceptable to the medical staff from the standpoint of:
(a) the ability of the medical staff to accomplish
these reviews on a continuing basis; (b) recording
its conclusions when appropriate to meet the require-
ments of the law; (c) furnishing to the medical staff
the results of these reviews.
Staffing Emergency Rooms
The statement of the Hospital Relations Commit-
tee on the medical staffing of emergency rooms, which
rescinded a previous OSMA policy on this subject,
was amended and adopted. The statement reads as
follows:
The following are recommended as acceptable
methods for the medical staffing of emergency rooms:
1. Services by use of bona fide interns and resi-
dents in AMA-approved training programs, under
the active guidance of the Medical Staff :
2. Services on a fee-for-service basis by one or
more licensed physicians approved by the Executive
Committee of the Medical Staff of the hospital, with
a minimum compensation guaranteed in a manner
satisfactory to the Medical Staff.
3. Services by members of the Medical Staff, either
voluntary or mandatory, on a fee-for-service or gra-
tuitous basis, with the method of billing for profes-
sional services being direct billing by the physician
for his services.
4. Services by licensed physicians employed by a
medical partnership or corporation, approved by the
Executive Committee of the Medical Staff, and com-
posed of all or part of the members of the Medical
Staff, billing and remuneration for such professional
services to be on any mutually satisfactory arrange-
ment between the medical partnership or corporation
and the employed physicians.
Hospital Based Physicians
The committee submitted its review of eight prin-
ciples for reimbursement of hospital-based physicians
as announced by the Social Security Administration.
The recommendations of the committee were amended
and adopted as follows:
Principle No. 1: "It is not the function of the
health insurance program to determine the arrange-
ment which a hospital and a hospital-based physician
may enter into for the compensation of the physician.”
Recommendation: The OSMA is in agreement
with the principle as stated. However, the basis for
contractual relationships between physicians and hos-
pitals must be in keeping with the laws and with the
Principles of Medical Ethics of the American Medical
Association.
Principle No. 2: "Whatever the arrangement
may be between hospital and physician, the law re-
quires that medical and surgical services rendered to
a covered individual by a hospital-based physician be
reimbursed only under the supplementary medical in-
surance program. The costs to a hospital for services
furnished in a hospital by a physician which are not
professional services to a patient will be included in
the reasonable cost reimbursement under the hospital
insurance program.”
Recommendation : This statement is in accord
with OSMA policy. The law requires that medical
and surgical services be reimbursed only under the
supplementary medical insurance program. Pathology
and radiology, as other hospital-based specialties, are
practices of medicine and, as such, are medical services.
Principle No. 3: "A professional service ren-
dered by a physician to a patient that can be reim-
bursed only under the medical insurance program
means an identifiable service requiring performance
by a physician in person, which contributes to the
diagnosis of the condition of the patient with respect
to whom the charge under the medical treatment pro-
gram is to be recognized, or contributes to the treat-
ment of such patient.”
Recommendation: It is felt that no discussion of
this principle is necessary. However, it should be
pointed out that the Directory of Medical Specialists
(Marquis, 1955-66), page 1005, defines pathology
478
The Ohio State Medical Journal
as "that specialty of the practice of medicine dealing
with the causes and nature of disease, which con-
tributes to diagnosis, prognosis and treatment through
knowledge gained by laboratory applications of the
biologic, chemical or physical sciences to man, or
material obtained from man.”
Principle No. 4: "For purposes of reimburse-
ment, the Government will respect, within reasonable
limits, an agreement between a hospital and a physi-
cian concerning the portion of the physician’s com-
pensation which is to be attributed to the care of in-
dividual patients and the portion which is to be at-
tributed to service to the institution. If they fail
to agree, or if their agreement appears unreasonable,
it will be the function of the fiscal intermediary hand-
ling payments under the hospital insurance program
and the carriers handling payments under the medical
insurance program to resolve the issue — by negotia-
tion if possible, otherwise by time studies or other
suitable methods.”
Recommendation : It is the opinion of the OSMA
that this arrangement does not provide the physician
with equal representation in the arbitration proced-
ure specified. Therefore, it is recommended that this
principle be amended to provide for mediation by
the Executive Committee of the Medical Staff, with
the approval of the hospital board of trustees, and
the recommendations of this Committee forwarded to
the fiscal intermediary for implementation.
Principle No. 5: "Once the portion of a physi-
cian’s compensation attributable to professional serv-
ices to medical insurance beneficiaries has been deter-
mined, a schedule of charges can be developed. To
be deemed reasonable, the charges should be de-
signed to yield him in the aggregate, as nearly as may
be possible, an amount equal to such portion of his
compensation. As among the patients to be charged
(identifiable in accordance with Principle No. 3),
the allocation of charges may be based on a schedule
of relative values, on a uniform percentage of the
charges made by the hospital or the physician to other
patients for both profesisonal and supporting com-
ponents of the services, or on another method ap-
proved by the carrier as equitable.”
Recommendation: Strike out all of the lines be-
ginning with "the allocation of changes” and ending
with "approved by the carrier as equitable.” Sub-
stitute in lieu thereof, "the usual and customary fee
as determined by the individual physician will apply.”
Principle No. 6: "Where a hospital-based physi-
cian himself bears some or all of the cost of opera-
tion of a hospital department and bills his patients
directly rather than through the hospital, the rea-
sonable charges for his services recognized under the
medical insurance program will reflect the costs so
borne by him. Where all of the costs are borne by
the physician, charges heretofore established for such
services by agreement between the physician and the
hospital may be acceptable as reasonable charges for
purposes of the medical insurance program, but they
will require adjustment either upward or downward
if the hospital has been bearing a cost significantly
greater or less than its share of the proceeds of such
charges.”
Recommendation : No recommendation is offered.
Principle No. 7: "Hospitals and hospital-based
physicians will be required to keep records and be
prepared to furnish information which can substan-
tiate the agreements they enter into with respect to the
allocation of the compensation of the physicians.”
Recommendation: No comment is offered re-
garding Principle No. 7.
Principle No. 8: "Nothing in the foregoing
principles restricts the right of the physician (in the
absence of his acceptance of an assignment by the
patient) to determine the amount of his charge to
the patient for his services, or restricts the hospital
and the physician in providing for disposition of the
payments received from the Government and the
beneficiaries under the program as they may agree
upon. The total costs of services to inpatients and
outpatients prior to the inauguration of this program
should not be increased solely by reason of the re-
quirement for division of payments for such services
between the hospital insurance program and the medi-
cal insurance program.”
Recommendation: It should be brought to the
attention of the physician that the acceptance of an
assignment involves the waiver of certain rights with
regard to charging his usual and customary fee.
Material from Heart Association Approved
Material on the "Prevention of Rheumatic Fever”
and "Prevention of Bacterial Endocarditis,” submitted
by the Ohio State Heart Association, was approved.
American Medical Association
A letter concerning a proposed increase of $25
in the annual AMA membership dues was resched-
uled for discussion at the meeting on April 23-24.
The Council voted to nominate Dr. John H. Budd,
Cleveland, chairman of the Ohio Delegation to the
AMA, for membership on the AMA Council on
Medical Service.
It was the Council’s decision to nominate Dr.
Henry A. Crawford, Cleveland, President of the Ohio
State Medical Association, for membership on the
AMA Council on National Security.
The Executive Secretary was instructed to notify
the American Medical Association that in connection
with a communication of February 28, 1966, from
Mr. Leo E. Brown with regard to arrangements for
the AMA President’s Reception, it is the expression
for May, 1966
479
of The Council that the Ohio State Medical Associa-
tion and the American Medical Association cosponsor
the reception with each association paying one-half
of the expenses.
The staff was instructed to reserve a large double-
size display room with measurements of 17 by 42 feet
on the seventh, eighth or ninth floor of the Palmer
House as described in a letter from Mr. George
Larson, February 14, 1966.
The Council requested that Dr. Budd, chairman of
the Ohio Delegation, establish a schedule of hours
when the hospitality room is to be manned by the
delegates.
The Council approved the following resolutions
and instructed the Executive Secretary to submit them
to the American Medical Association for consideration
at the Annual Meeting of the AMA House of
Delegates, June 26, 1966:
Quarterly Sessions for AMA
House of Delegates
WHEREAS, Business before the House of Delegates of
the American Medical Association each year becomes of
greater volume and importance; and
WHEREAS, The delegates are faced with problems of
lack of time for in depth discussion of resolutions which
are placed before the House; and
WHEREAS, A huge array of activities at the Clinical
and Annual Meetings of the delegates tends to interfere with
the opportunity for concentration on the important matters
involved in the resolutions submitted; therefore be it
RESOLVED, That the House of Delegates of the Ameri-
can Medical Association meet four times each year in Chicago
to conduct the business of the American Medical Associa-
tion; and be it further
RESOLVED, That the Clinical and Annual Meetings of
the House be continued as ceremonial and election meetings
and only such business as is necessary be conducted at these
sessions.
Hearings before AJVLA Councils and
Committees
WHEREAS, A frequent disposition of AMA House of
Delegates resolutions is to refer them to the Board of
Trustees or to Councils or Committees; and
WHEREAS, Adequate and equitable consideration would
be assisted by presentation of the case for the resolutions by
the proposing individual or delegation; therefore be it
RESOLVED, That it be established as policy of the
American Medical Association that when resolutions are
referred by the AMA House of Delegates to Board of
Trustees, Committees or Councils of the Association, an
invitation be extended to representatives of the introducing
delegation to participate in hearings or discussions of such
resolutions.
Eligibility of Osteopathic Physicians for
Internship and Residency Programs
WHEREAS, The American Medical Association has seen
fit to make ethical the association between its members and
those osteopaths who practice "Scientific Medicine"; and
WHEREAS, The evaluation of an osteopathic physician
will remain difficult because his own training programs have
not received accreditation by the appropriate committees of
the American Medical Association; and
WHEREAS, If it were possible for the graduate of an
osteopathic school to receive internship and residency train-
ing in an AMA approved program, he could then be judged
on the basis of his demonstrated abilities to practice scien-
tific medicine; and
WHEREAS, Graduates of schools of osteopathy who do
not hold M. D. degrees are not eligible for appointment to
internships or residencies approved by the Council on Medi-
cal Education of the AMA; therefore be it
RESOLVED, That the House of Delegates of the Ameri-
can Medical Association instruct the Council on Medical
Education to develop a method whereby qualifications of
osteopathic physicians who are willing to subscribe to the
Principles of Medical Ethics of the American Medical As-
sociation and who express the wish to join a component
county medical society may be evaluated in order to determine
eligibility for intern and residency training in AMA ap-
proved hospital programs, without jeopardizing the hospital’s
accreditation status.
Government Medical Care Programs
The Council adopted a statement with regard to
government medical care programs and directed that
it be submitted to the membership as Medicare News-
letter No. 3, and that copies be sent to the 50 state
medical societies and to the AMA News. (The text
of the statement is published on page 492 in this issue
of The Ohio State Medical Journal.)
Generic Equivalent Drugs
A letter from the Pharmaceutical Manufacturers
Association, Washington, D. C., regarding the use of
"generic equivalent” drugs, was referred to the Com-
mittee on Public Relations and Economics.
Hospital Signs on Highways
The Council voted to support a recommendation
that Ohio highways and interstate highways be marked
to indicate the location of the nearest hospital equipped
with emergency facilities.
Request from Practical Nurse Association
The Council approved a request from the Practical
Nurse Association for the appointment of a represen-
tative of the Ohio State Medical Association to its
state advisory committee and authorized the President
to make this appointment.
OSMA Group Term Life Insurance Plan
Printed information with regard to the increase in
coverage available under the OSMA group term life
insurance plan was submitted to The Council by
Turner & Shepard, Inc., Columbus.
Investment Program for Physicians
An investment program for physicians suggested
by Messrs. Jacob Shawan and Wayne Lewis, Colum-
bus, was presented by Dr. Fulton. This matter was
referred to the Insurance Committee for study.
The next meeting of The Council was set for 3:00
p. m., Saturday, April 23, and for Sunday, April 24,
with no evening meeting Saturday.
Attest: Hart F. Page
Executive Secretary
480
The Ohio State Medical Journal
Resolutions Which Will Be Considered
At the 1966 Annual Meeting
HERE are the texts of resolutions which will be
presented for consideration of the House of
Delegates at the 1966 Annual Meeting of the
Ohio State Medical Association, May 24-28, in Cleve-
land. These resolutions were received at the Columbus
Office on or before March 25, thereby meeting the 60-
day deadline. No resolution which failed to meet the
60-day deadline may be introduced unless the sponsor
secures at least a two-thirds consent vote of the dele-
gates present at the meeting.
Copies of all resolutions presented to the Columbus
Office have been sent to the individual Delegates and
Alternate Delegates so that they may discuss them
with their county medical societies, if they care to
do so.
A resolution to be considered by the House of
Delegates must be typed in triplicate; introduced by
a delegate or his duly accredited alternate seated in
his place; and introduced at the first session of the
House of Delegates. This procedure must be fol-
lowed even though the resolution may have been
published in The Journal or sent in writing to all
delegates prior to the meeting.
Sessions of the House of Delegates will be as
follows: First Session, Tuesday, May 24, starting with
registration at 5 :00 P. M. in the Gold Room Assembly,
followed by a complimentary dinner at 6:00 P. M. in
the Whitehall Room with business session starting at
7:30 P. M. in the Gold Room, all on Mezzanine Floor
of the Sheraton- Cleveland Hotel. Final Session will
be held on Friday, May 27, at 9:00 a. m. in the Gold
Room, Mezzanine Floor, followed by a complimentary
luncheon for the Delegates, Alternates and Council
of the Ohio State Medical Association in the White-
hall Room, Mezzanine Floor. Meetings of the Res-
olutions Committees will be held all day on Wednes-
day, May 25, and on Thursday, May 26, if necessary.
RESOLUTION NO. 1
Herbert Morris Platter, M. D.
(By The Council of the Ohio State Medical Association)
WHEREAS, Herbert Morris Platter, M D., served the citizens
of Ohio as Secretary of the State Medical Board of Ohio
from 1917 through 1965, and has been a symbol of the
purposes of this Association in promoting the science and
art of medicine and the protection of public health, and
WHEREAS, Dr. Platter:
Conducted statewide investigations into epidemics of
typhoid, scarlet fever and polio in 1908;
Established the first health program for the Columbus,
Ohio, Public Schools in 1913;
Compiled the first Public Health Code for the State of
Ohio in 1914;
Served as President of the Ohio State Medical Associa-
tion in 1932-1933;
In 1964 was presented a Certificate of Merit by the
American Medical Association for his initiation of the
first scientific exhibit to be shown at an AMA Conven-
tion, held in Columbus in 1899;
Was awarded a certificate of appreciation by the Presi-
dent of the United States and was awarded a bronze
plaque of recognition by the Federation of State Medical
Boards of the United States in 1964, NOW THERE-
FORE BE IT
RESOLVED, that this 1966 Annual Meeting of the Ohio
State Medical Association be dedicated to Herbert Morris
Platter, M. D., in appreciation for his many years of serv-
ice, as a physician and a citizen, to the people of Ohio,
AND BE IT FURTHER
RESOLVED, that the Ohio State Medical Association and the
physicians of Ohio hereby express their admiration and
gratitude to Dr. Platter for his outstanding leadership,
guidance and counsel.
RESOLUTION NO. 2
Dues Exemption for Financial
Emergencies
(By The Council of the Ohio State Medical Association)
WHEREAS, Amended Resolution No. 8, as adopted by the
1965 OSMA House of Delegates, has directed that an ap-
propriate amendment regarding dues exemption for finan-
cial emergencies be prepared by the legal counsel, under
the supervision of The Council of the Ohio State Medical
Association, for submission to the 1966 OSMA House of
Delegates, the following resolution is offered in compliance
therewith: THEREFORE BE IT
RESOLVED, that Section 1 of Chapter 2 of the By-Laws
of this Association be amended and supplemented by
adding at the end thereof the following paragraph:
A member of this Association for whom payment of
his regular dues in this Association constitutes a finan-
cial hardship may request The Council of this Associa-
tion for an adjustment of dues. Such request shall be
in writing, signed by such member and filed with the
secretary of such member’s local medical society. If
the society7, or the council of the society, finds that
payment by such member of his regular dues in this
Association shall constitute a financial hardship and
certifies such finding to The Council of this Association.
The Council will make such adjustment of his OSMA
dues for such period of time, and subject to such con-
ditions, as The Council may deem appropriate and
advisable.
RESOLUTION NO. 3
Mental Health Legislation
(By The Council of the Ohio State Medical Association)
BE IT RESOLVED, that the House of Delegates of the
Ohio State Medical Association direct the Association’s
Committee on Mental Health to develop legislation calling
for the establishment of an Ohio Mental Health Council,
appointed by the Governor, this Council to consist of
seven members, at least four of whom shall be doctors of
for May, 1966
481
medicine. The duties of The Council, to be defined in the
legislation, should include:
(a) The submission of a list of names to the Governor
from which he shall appoint the Director of Mental
Health;
(b) The development of a list of qualifications for the
positions of Director of Mental Health and Com-
missioners;
(c) The submission of a list of names to the director
from which the director shall appoint the com-
missioners;
(d) The establishment of tenure of office for the com-
missioners;
(e) Meeting a given number of times each year;
(f) Making recommendations to the director and com-
missioners upon their request or when it is other-
wise deemed desirable;
(g) To make an annual public report on the activities
and accomplishments of the department, and
(h) To provide for itself an adequate staff to carry out
its functions, AND BE IT FURTHER
RESOLVED, that the House of Delegates direct the Asso-
ciation’s Committee on Mental Health to develop separate
legislation calling for the establishment of two separate
and distinct departments of the State Government, a De-
partment of Mental Health and Retardation and a Depart-
ment of Correction, AND BE IT FURTHER
RESOLVED, the House of Delegates direct the Association’s
Committee on Mental Health to develop separate legisla-
tion calling for statutory autonomy for mental retardation
within the Department of Mental Health, AND BE IT
FURTHER
RESOLVED, that the principles developed above be the official
policy of the Ohio State Medical Association. However,
the desirability of OSMA sponsorship of such legislation
in the 107th General Assembly be determined by The
Council.
RESOLUTION NO. 4
For Reorganization of Ohio State
Mental Health Activities
(By the Academy of Medicine of Cleveland)
PREAMBLE
WHEREAS, Ohio State facilities for treatment of mental
illnesses are supervised by a Director of Mental Hygiene
and Correction who also oversees the penal system, thus
linking the mentally ill and criminals under one system
to the detriment of both, it is believed that creation of
a separate Department for Mental Health would be a
major step toward providing more nearly adequate
facilities for this State of Ohio. THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association take
steps to initiate and to support in the next session of the
Ohio Legislature, legislation which will
( 1 ) Create a separate Department of Mental Health
in the State of Ohio;
(2) Establish a position of "Director of Mental
Health’’ with cabinet status; and
( 3 ) Establish a Board of Mental Health composed of
5 to 7 members appointed by the Governor, who
shall serve overlapping terms of not less than 3
years and at least 3 of whom shall be physicians
of recognized competence in the care of the men-
tally ill, AND BE IT FURTHER
RESOLVED, that said Board of Mental Health shall have
at least the following functions:
( 1 ) Advise and assist in the establishment and imple-
mentation of policies for the Department of
Mental Health.
(2) Recommend to the Governor candidates for the
position of Director of the Department of Mental
Health.
( 3 ) Meet several times yearly to consider all matters
pertinent to effective function of the Department
of Mental Health.
(4) Submit to the Governor semiannual reports which
shall be made public.
RESOLUTION NO. 5
Policy Statement on Services to the Mentally 111
(By the Delegates of the Summit County Medical Society)
WHEREAS, the Ohio State Medical Association, representing
the physicians of Ohio, has always acknowledged its re-
sponsibility to promote improved services to the ill, and
WHEREAS, in recent years the more effective measures for
treatment of mental and emotional illness have been estab-
lished, and
WHEREAS, we believe that an informed citizenry is essen-
tial to expanding the application of these treatment meth-
ods, THEREFORE BE IT
RESOLVED, that this association adopt the following
statement of position and actively encourage and, where
necessary, seek sponsorship for legislation to effect the
changes to wit:
"It is the position of the OSMA that service to the
mentally ill under public auspices must be improved.
"In order to provide improved service to the citizens of
this state, we will seek to have the Ohio General As-
sembly enact measures which will alter the structure of
the state agency providing such service and place more re-
sponsibility in the local community for the conduct of
mental health programs.
"We believe this can most effectively be accomplished
by altering the statutes to provide, firstly, for a Department
of Mental Health not related to correctional institutions,
directed by a properly qualified doctor of medicine. The
director would be nominated to the Governor by a State
Mental Health Board which itself would be appointed by
the Governor on a rotating basis. The State Mental
Health Board, working in conjunction with the director,
would establish policies and programs which would permit
careful professional planning and continuity of program.
The Department of Mental Health should establish assist-
ant directors for the various divisions, and Mental Retard-
ation should be a major division.
"Secondly, we believe that there should be adoption
of a Community Mental Health Services Act which places
in the local community the responsibility for specific treat-
ment programs. Such programs have now been enacted in
20 other states and have improved the services provided
since they are tailored to the ill person in the community
rather than to efficient means of providing for the masses.
The determination as to needed services and facilities
would be developed in the community with appropriate
assistance from the county medical society.”
RESOLUTION NO. 6
Admissions of Mentally Retarded Children
(By the Putnam County Medical Society)
PREAMBLE
Since the State of Ohio assumes the care and treatment of
the mentally retarded children and there is a marked limit
as to admissions, and since many small counties with high
birth rates can only admit two (2) children per year,
THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association en-
courage a more equitable method of admission to the
Mentally Retarded Children’s Hospital or that the institu-
tion be enlarged.
RESOLUTION NO. 7
Method of Payment to Physicians from
Government Agencies
(By the Stark County Medical Society)
WHEREAS, Ohio has been one of the leaders in this coun-
try in offering a comprehensive type of indemnity in-
surance which pays the individual physician’s usual and
customary fee for those persons with income below $7,500.
Recently National Blue Shield has given national publicity
482
The Ohio State Medical Journal
to a service contract alleged to be a prevailing usual and
customary fee, and
WHEREAS, Ohio Medical Indemnity in a special News-
letter dated February 2, 1966, pointed out very important
differences in these two programs, as follows:
(a) Ohio’s individual physician’s usual and customary
fee program is an indemnity type insurance; na-
tional prevailing fee is a service contract.
(b) Ohio’s individual physician’s usual and customary
fee program pays all physicians their usual and
customary charges to persons with incomes of
$7,500 or less in counties where it is offered. In
national prevailing fee programs, the physicians
first must submit a detailed report on all their
usual charges and only those physicians are in-
cluded whose charges fall within the 90th percentile
of charges submitted.
(c) Under Ohio’s individual physician’s usual and
customary program, physicians do not have to
sign contracts to participate. Under the national
prevailing usual and customary program only those
physicians whose charges fall within the 90th per-
centile of the areawide charge are offered a con-
tract to sign and these physicians must then sign a
service contract and agree to accept the payment
from the carrier as payment in full, and
WHEREAS, Ohio’s Resolution No. 5, approved at the
special meeting of the AMA in October, 1965, stated that
physicians shall be entitled to reasonable remuneration as
provided by P. L. 89-97 and this shall be interpreted as
the individual physician’s usual and customary fee for the
care of private patients, and
WHEREAS, it is most important for the physicians in Ohio
and the nation not to confuse these two very basically
different concepts, THEREFORE BE IT
RESOLVED, that further publicity be given to the physicians
in Ohio on these two different concepts, AND BE IT
FURTHER
RESOLVED, that Ohio’s delegation to the American Medi-
cal Association is hereby instructed to present in resolu-
tion form Ohio’s individual physician’s usual and cus-
tomary fee concept as the one of choice in dealing with
government agencies.
RESOLUTION NO. 8
Usual and Customary Fee
(By the Huron County Medical Society)
WHEREAS, the House of Delegates at the American Medi-
cal Association Convention in June, 1965, adopted the
position that, "When Government assumes financial re-
sponsibility for an individual’s health care, reimbursement
for professional services should be on the same basis as in
the case of other indispensable elements of health care.
Therefore, reimbursement of the services of physicians
participating in government-supported programs should be
on the basis of usual and customary fees,” and
WHEREAS, the "usual and customary fee” basis "is a
proven method of providing service benefits at acceptable
cost,” — (Carl A. Tiffany, Chicago; consulting actuary
for a number of State Medical Associations), and
WHEREAS, AMA House of Delegates adopted an Iowa res-
olution at the Philadelphia clinical convention November
28 - December 1, 1965, to "reaffirm its support of the
usual and customary fee concept as the basis for reimburs-
ing physician participants in government programs,” and
WHEREAS, it is unreasonable to be expected to provide
charitable services to persons who are the responsibility
of government, and
WHEREAS, there is no longer a question of physicians
helping financially distressed people who need help —
rather, a matter of expecting the government to pay "us-
ual and customary fees” for the health care services prom-
ised to its beneficiaries — the people, THEREFORE
BE IT
RESOLVED, that starting June 1, 1966, the Ohio State
Medical Association advise the Ohio Department of Pub-
lic Welfare that the physicians of Ohio will expect 100
per cent payment for professional services rendered to wel-
fare recipients — based on the "usual and customary fee”
determined by the individual physician.
RESOLUTION NO. 9
Usual and Customary Fees
(By the Mahoning County Medical Society)
WHEREAS, the Bureau of Workmen’s Compensation has
now accepted the Ohio State Medical Association pro-
posal that the usual and customary fee be applied to
compensation recipients, and
WHEREAS, Government agencies pay realistically for all
other goods and services and should neither expect nor
demand a discount for medical services, and
WHEREAS, each physician should receive a fair fee for
his professional services as do others who deal directly
with the government, and
WHEREAS, in other areas physicians have convinced
government agencies that cut-rate fees are unfair and that
these agencies, when they are paying bills for the indigent,
should not seek special fee treatment, and
WHEREAS, under the antipoverty program, and in ac-
cordance with the policy of the Great Society, each pa-
tient, whether governmental or private, should not feel
that there is any discrimination because of variation of
fees, THEREFORE BE IT
RESOLVED, that the members of the Ohio State Medical
Association go on record that they expect their usual or
customary fee in the medical and surgical care or treat-
ment of all governmental patients and patients provided
for by other third party plans.
RESOLUTION NO. 10
Usual and Customary Fee
(By the Muskingum County Academy of Medicine)
WHEREAS, governmental agencies at all levels, city, county,
state, and federal have assumed the obligation for indigent
and disabled, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association notify
such agencies that the members of the Ohio State Medical
Association feel that payment of the individual physicians’
usual and customary fee should be made.
RESOLUTION NO. 11
Usual and Customary Fees
(By the Holmes County Medical Society)
WHEREAS, the House of Delegates at the American Medi-
cal Association Convention in New York in June, 1965,
adopted the position that, "When government assumes
financial responsibility for an individual’s health care,
reimbursement for professional services should be on the
same basis as in the case of other indispensable elements
of health care. Therefore, reimbursement of the services
of physicians participating in government-supported pro-
grams should be on the basis of usual and customary
fees,” and
WHEREAS, the usual and customary fee has been a proven
method for providing reimbursement at acceptable cost,
and
WHEREAS, the Ohio Bureau of Workmen’s Compensation
has chosen to authorize the usual and customary fee for
services provided to approved Workmen’s Compensation
cases, and
WHEREAS, it is unreasonable to be expected to provide
charitable services to individuals for whom government
— state, federal or local — claims responsibility, and
WHEREAS, there is no longer a question of physicians
helping financially distressed persons who need help, but
rather, a matter of expecting the government to pay "usual
for May, 1966
483
and customary fees” for the health care programs which
it has promised to its beneficiaries, THEREFORE BE IT
RESOLVED, that
(1) Starting June 1, 1966, the Ohio State Medical
Association advise the Ohio Department of Pub-
lic Welfare that the physicians of Ohio will expect
100 per cent payment for professional services
rendered to welfare clientele — based on the
"usual and customary fees” that prevail in any
particular locality, and
(2) The clientele covered by the Welfare Department
shall include all divisions of the State Department
of Public Welfare.
RESOLUTION NO. 12
Usual and Customary Fee
(By the Licking County Medical Society)
WHEREAS, it has been the self-imposed obligation of the
medical profession to donate its services freely and gladly,
individually and collectively, to the care of the medically
indigent, and
WHEREAS, it is now a fact established by Acts of Con-
gress and directives of governmental departments that the
government has assumed financial responsibility for the
medical care of a large segment of society, and
WHEREAS, the unrealistic fee schedules imposed by state
and local governmental agencies have placed an inequi-
table burden upon a large segment of the medical profes-
sion, and
WHEREAS, it is our considered opinion that government
— • federal, state or local — is no longer an object for
charity from the medical profession than it is from any
other supplier of goods or services, THEREFORE BE IT
RESOLVED, that the House of Delegates of the Ohio State
Medical Association instruct The Council and the ap-
propriate committees appointed to negotiate with govern-
ment agencies, to press vigorously for the establishment
of usual and customary fees for medical services.
RESOLUTION NO. 13
Medical Benefits for Welfare Cases
(By the Trumbull County Medical Society)
WHEREAS, the fee schedule for the payment of physician
services in welfare cases is unreasonably low, and
WHEREAS, the Kerr-Mills Law states that a state cannot be
unreasonably restrictive in its medical benefits, and
WHEREAS, the payment of services to indigents at a re-
duced fee is no longer justified when the government is
responsible for their care, and
WHEREAS, welfare-discount rates should give way to full
payment of charges consistent with prevailing rates in the
community, and
WHEREAS, it is no longer a question of physicians helping
financially distressed persons who need help, but it is
purely a matter of expecting the government to pay rea-
sonable fees for the health care services promised to its
beneficiaries, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association advise
the Ohio Department of Public Welfare that members
of OSMA will expect usual and customary fees for pro-
fessional services to welfare clientele beginning July 1,
1966, the date that Part B of the Medicare Law becomes
effective.
RESOLUTION NO. 1 4
Usual and Customary Fee
(By the Butler County Medical Society)
WHEREAS, in addition to the Medicare Program for Social
Security beneficiaries, Public Law 89-97 contains under
Title XIX a vastly-expanded health care program for
public assistance recipients of all ages, and
WHEREAS, the passage of Medicare legislation will vastly
change the health economic picture in Ohio with the hos-
pital portion of the Medicare Act not only relieving the
Department of Public Welfare of financial commitments
to persons over age 65, but also liberalizing amendments
to the existing Kerr-Mills Program, and
WHEREAS, the value of medical services shall be deter-
mined by the seller and not by the purchaser, and
WHEREAS, no other segment, professional or otherwise,
of our population accepts compensation for services ren-
dered at a rate which he deems below the value of his
services, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association inform
the Ohio Department of Public Welfare that the physi-
cians of Ohio, members of the Ohio State Medical Associa-
tion, will not treat welfare patients, or patients under any
other of its programs, including Title 19: P. L. 89-97,
where the fee for payment is arbitrarily set by the Welfare
Department, AND THEREFORE BE IT FURTHER
RESOLVED, that the Ohio State Medical Association meet
with the State Welfare Department relative to establish-
ing physicians’ fees based on the principle of "usual,
customary, and reasonable fees.”
RESOLUTION NO. 15
Hospital Admission
(By the Mahoning County Medical Society)
WHEREAS, Public Law 89-97 (Medicare) may require
federal forms for physician certification of hospital ad-
mission, and
WHEREAS, the American Medical Association during its
October 2-3, 1965 meeting, adopted the policy that "cur-
rent practices and customary procedures with respect to
certification for hospital admission and care shall be con-
tinued under Public Law 89-97,” and
WHEREAS, the current admissions practice in most Ohio
hospitals is an oral request for bed facilities, followed by
the signing of the patient’s hospital chart after the pa-
tient’s admission, and
WHEREAS, hospital admission procedures should be the
same for all patients, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association adopt
as official policy the principle that in certifying any patient
for hospital care, a physician may ethically continue to use
the current practice of signing the patient’s hospital chart.
RESOLUTION NO. 16
Reimbursement for Services of Hospital-Based
Physicians Under Medicare
(By the Lorain County Medical Society)
WHEREAS, the Medicare Law (P. L. 89-97) establishes
separate provisions for hospital care and for coverage of
physicians’ services, and
WHEREAS, the Congress clearly defined the separation be-
tween these two provisions by specifically rejecting the
Douglas Amendment, which would have impounded those
physicians designated as "hospital-based physicians” within
that coverage defined only for hospitalization costs, and
WHEREAS, the Social Security Administration has seen
fit to unilaterally interpret the law and attempt to force
"hospital-based physicians” to accept reimbursement for
professional services under the hospitalization provision
of the Medicare Law, and
WHEREAS, the national governing bodies of the concerned
physician specialists and the American Medical Association
have issued directives requiring fee for service arrange-
ments and direct billing of individual patients in the ulti-
mate interest of maintaining the best possible medical
care with the least possible interference by professionally
unconcerned third parties, and
WHEREAS, relief from the oppressive regulations of the
Social Security Administration, which threaten to even-
tually include any physician who performs any service
for a patient in the hospital, requires separation of any
484
The Ohio State Medical journal
and all physicians from payment for services by a hos-
pital, THEREFORE BE IT '
RESOLVED, that the Ohio State Medical Association en-
dorse and actively support the position of "hospital-based
physicians" in altering whatever hospital contracts as are
necessary, so as to establish a normal and ethical relation-
ship (fee for service arrangement with individual billing
of all patients) as is and should be the normal and
ethical practice for all physicians.
RESOLUTION NO. 17
Physicians, Ethics and the Corporate
Practice of Medicine
(By the Stark County Medical Society)
WHEREAS, the Ohio State Medical Association legal coun-
sel has provided an excellent presentation of the ethical
and legal aspects of the corporate practice of medicine,
this presentation having been sent to all members of this
Association February 8, 1966, under the heading of "Spe-
cial Medicare Newsletter No. 2,” and
WHEREAS, Section 4, Principles of Medical Ethics, states,
"The medical profession should safeguard the public and
itself against physicians deficient in moral character or
professional competence. Physicians should observe all
laws, uphold the dignity and honor of the profession,
and accept its self-imposed disciplines. They should expose,
without hesitation, illegal or unethical conduct of fellow
members of the profession,” and
WHEREAS, the Judicial Council of the American Medical
Association states (1966 Opinions and Reports, Page 16,
Section 4, Article 9):
"OBLIGATIONS OF COUNTY MEDICAL SOCIETIES
The Council has emphasized the autonomy of the county
society and the fact that such autonomy imposes responsibil-
ities. If medical societies fail to accept and discharge their
obligations in matter of ethics, others will assume these obli-
gations by default. The Judicial Council urges county and
state societies to adopt critical attitudes toward their pro-
grams to "uphold the honor and dignity” of the profession
of medicine. These programs must be based on a sound
knowledge and understanding of ethical principles. As long
as ethical principles are widely and sedulously observed, the
reputation of the medical profession will be upheld. The
reward will be commensurate with the services rendered in
the observation of these ideals. On the other hand, if there
is flagrant or even careless disregard of ethical principles, the
reputation of the profession of medicine will suffer and its
responsibilities and obligations will be usurped by others.
(AMA House of Delegates, 1958.)” THEREFORE BE IT
RESOLVED, that this House of Delegates urges each
Component Medical Society of this Association to review
all medical practice contracts of all physician members
to determine the ethical and legal compliance of such
contracts in light of legal counsel’s opinion, AND BE IT
FURTHER
RESOLVED, that the Ohio State Medical Association Dele-
gates to the American Medical Association are hereby
instructed to present a similar resolution before the Ameri-
can Medical Association House of Delegates at the 1966
Annual Convention.
RESOLUTION NO. 18
Removal of Physicians’ Services
from Hospital Insurance Contracts
(By the Delegates of the Summit County Medical Society)
WHEREAS, Section 1701.03 of the Revised Code of Ohio
prohibits the practice of a profession by a lay corporation
and Opinion 1751 of the Attorney General of Ohio stated
specifically that a corporation, whether or not organized
for profit, could not lawfully engage in the practice of
medicine in Ohio, and
WHEREAS, Blue Cross has become the major mechanism
in Ohio for hospital corporations practicing medicine via
employed physicians, and
WHEREAS, this has resulted in the medical specialties of
pathology, radiology, anesthesiology and physiatry being
looked upon and dealt with as hospital services to the
point where the American Hospital Association and ele-
ments in the Department of Health, Education, and Wel-
fare have argued for their inclusion under the hospital
portion of Public Law 89-97, and
WHEREAS, these efforts jeopardize the continued obser-
vance of the principle established in Ohio law of sepa-
rating professional practice from hospital management,
THEREFORE BE IT
RESOLVED, that the House of Delegates of the Ohio State
Medical Association instruct The Council of the OSMA
to petition the Director of Insurance, State of Ohio, to
require removal from all prepaid hospitalization insurance
plans provisions for benefits covering physicians’ services,
and that this be first accomplished in the case of the major
carrier — namely, Blue Cross.
RESOLUTION NO. 19
Assignments Not Acceptable
(By the Lake County Medical Society)
WHEREAS, the ethical propriety of charging a fee for
service at the usual and customary level has been ac-
cepted by the Ohio State Medical Association, and
WHEREAS, the ethical propriety of direct billing of the
patient by the physician has been repeatedly endorsed, and
WHEREAS, the Ohio State Medical Association has joined
other professional bodies in visiting censure upon con-
tractual arrangements between a physician and a hospital
or a corporation involving modes of collection of the
physician’s fees by indirect means such that the physician
receives his recompense through the hospital or corpora-
tion, and
WHEREAS, the physician makes no claim to being an
expert in the management of financial problems of his
patients, limiting advice to medical matters, NOW
THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association en-
courage the physician to eschew collection practices
whereby the physician relieves the patient of the direct
management of the patient’s own financial affairs by virtue
of the physician’s acceptance of an assignment to a
third party for remuneration, this resolve to be imple-
mented by the physician’s acceptance of remuneration
only from the hand of the patient himself or from the
patient’s legal guardian.
RESOLUTION NO. 20
Direct Billing
(By the Lake County Medical Society)
WHEREAS, Public Law 89-97 (Medicare) provides that the
physician may seek his fee either from the patient di-
rectly or from the "carrier” assigned by the patient, ac-
cording to the physician’s own option, and
WHEREAS, this option affords the individual physician
a means to exercise his own initiative in setting his own
fee for service and. in doing so, encourages the develop-
ment of a contractual relationship between the individual
patient and the individual physician largely free of the
encumbrance of the third party "carrier,” and
WHEREAS, this professional body has repeatedly and pub-
licly announced its support of measures that support the
integrity of that patient-physician relationship in the
interest of the best medical care to the individual patient,
NOW THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association an-
nounce its support of that lawful option and endorse di-
rect billing of each patient as the form of fee collection
to be preferred, encouraging its members to its exclusive
use.
RESOLUTION NO. 21
Medicare
(By the Stark County Medical Society)
WHEREAS, Public Law 89-97 provides the option of direct
reimbursement of patients eligible for benefits under Part
B of said law, and
for May, 1966
485
WHEREAS, Public Law 569 (Military Dependent’s Medical
Care Act) 84th Congress, does not provide such an
option, and
WHEREAS, the lack of such option destroys the physi-
cian-patient relationship, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association
strongly recommends that all necessary actions be taken
in order to provide that patients eligible for benefits
under Public Law 569 be afforded the same option of
reimbursement as is provided for patients eligible for
benefits under Public Law 89-97, Part B.
RESOLUTION NO. 22
Public Law 89-97 (Medicare)
(By the Stark County Medical Society)
WHEREAS, since Medicare is now the law of the land, it
is the avowed purpose of the American Medical Associa-
tion, through the President, Board of Trustees, and the
House of Delegates, to work for the repeal of those por-
tions of the law that will lead to the deterioration in the
quality of medical care, disturb that patient-physician
relationship and are in conflict with the nine points laid
down by the AMA House of Delegates concerning health
care legislation in October, 1965, and
WHEREAS, the Houses of Delegates of the American Medi-
cal Association and the Ohio State Medical Association
have said it would be unethical for any physician to prac-
tice any system of medicine that leads to a deterioration
in quality or disturbs the patient-physician relationship,
THEREFORE BE IT
RESOLVED, the House of Delegates of the Ohio State
Medical Association reaffirm these principles as guide-
lines for all physicians to follow in the trying period
ahead.
RESOLUTION NO. 23
Endorsement of the "Open Staff”
(By the Delegates of the Summit County Medical Society)
WHEREAS, Ohio physicians are concerned about the trend
in postgraduate medical education which tends to create
closed-staff hospitals, and
WHEREAS, we believe this to be a nationwide problem
requiring the immediate attention and attempted correction
by the American Medical Association, THEREFORE BE IT
RESOLVED, that the Ohio Delegates to the AMA House of
Delegates introduce at the next regular session of that
body the following resolution:
"Endorsement of the Open Staff”
WHEREAS, the policy of "open staff” in hospitals
is believed to provide and encourage the best quality
medical care, and
WHEREAS, current emphasis on the educational
aspects of training of interns as structured by the
Joint Commission on Accreditation of Hospitals and
the similar emphasis by specialty boards on the train-
ing of residents has tended to cause community hos-
pitals to model their programs after those found in
university-affiliated hospitals, and
WHEREAS, in subtle ways such model programs
exert pressures which tend to create "closed-staff”
hospitals, thereby encroaching on the freedom of
many physicians with the potential of reducing the
general level of quality of medical service, THERE-
FORE BE IT
RESOLVED, that the AMA, representative of most
physicians, exert its influence so as to assist all
hospital staffs in providing excellent training pro-
grams and at the same time continuing its efforts to
maintain the principle of "open-staff” hospitals.
RESOLUTION NO. 24
Standardized Claims Form
(By the Mahoning County Medical Society)
WHEREAS, under Public Law 89-97 (Medicare) a claim
form has been proposed by the Department of Health,
Education and Welfare for the implementation of Part B
of the Act, and
WHEREAS, the completion of such form together with the
physician’s signature, may establish precedence with refer-
ence to future and even more objectionable forms, and
WHEREAS, it is reasonable to provide essential, medical
information for the purpose of reimbursement, and
WHEREAS, a standardized claims form is desirable for all
third party claims, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association adopt
a standardized claims form, to be used in lieu of any
proposed form submitted by the Department of HEW
or its fiscal intermediary, AND BE IT FURTHER
RESOLVED, that the Ohio State Medical Association make
available to all its members who desire to use it, a claims
form similar to the one attached.
(See Insurance Form on facing page)
RESOLUTION NO. 25
Commendation to OSMA Officers, Ohio’s
AMA Delegation and Staff of the OSMA
(By the Huron County Medical Society)
WHEREAS, the officers and all members of the Ohio Dele-
gation to the Clinical Convention of the American Medi-
cal Association, November, 1965, showed superb resolve
in action; put forth untiring efforts and effected many
worthwhile causes in the interest of the preservation of
the private practice of medicine, and
WHEREAS, they were most loyally complemented and
helped by the staff of the Ohio State Medical Association
in their efforts to preserve American Medicine, THERE-
FORE BE IT
RESOLVED, that the House of Delegates of the Ohio State
Medical Association, in behalf of the physicians of Ohio,
convey to said officers, members of the Ohio AMA Dele-
gation, and the staff of the Ohio State Medical Association
a vote of lasting thanks, gratitude, and appreciation,
AND BE IT FURTHER
RESOLVED, that the Physicians of Ohio show undivided
allegiance in word, deed, and action, to the able and
capable leaders of the Ohio State Medical Association and
pledge our help in a common effort to preserve the at-
mosphere within which is practiced the best quality medi-
cal care the world has ever known, possible only under
the free enterprise private medical care system.
RESOLUTION NO. 26
Changes in Certificate of Live Birth
(By the Montgomery County Medical Society)
WHEREAS, the knowledge of the incidence of congenital
abnormalities at birth is essential, and
WHEREAS, the compilation of the statistics of these ab-
normalities is vital, and
WHEREAS, prevention can be accomplished only by the
study and interpretation of the above, and
WHEREAS, the space allotted on the present live birth
certificate is inadequate, and
WHEREAS, this inadequacy is contributing to the failure
to record abnormalities, THEREFORE BE IT
RESOLVED, that the Bureau of Vital Statistics be directed
to change the form of the present live birth certificate so
that adequate space will be provided for the recording of
all abnormal findings according to standard medical nom-
enclature.
RESOLUTION NO. 27
AAPS Essay Contest
(By the Columbus Academy of Medicine)
BE IT RESOLVED, that the House of Delegates of the
Ohio State Medical Association endorse the Essay Contest
486
The Ohio State Medical Journal
of the Association of American Physicians and Surgeons
with the titles: (1) The Advantages of the American
System of Private Medical Care and (2) The Advantages
of the American Free Enterprise System.
RESOLUTION NO. 28
In Opposition to the Fluoridation of Public
Drinking Water Supplies
(By Joseph G. Crotty, M. D., Delegate, Hamilton County)
WHEREAS, fluorine seems to be conducive to, but not
necessarily essential to the normal development of tooth
structure in children, and
WHEREAS, there is grave doubt as to the morality and
ethics of forced medication in the form of adding such
fluorine to the public drinking supplies, and
WHEREAS, water is necessary for life, and
WHEREAS, most people are dependent on public supplies
for water, and
WHEREAS, chronic fluorosis, produced by the presence of
fluorides in drinking water, may produce mottling, dis-
coloration, and other damage to tooth structure, as well
as to the general health of the people drinking such water,
even to the extent of death from chronic fluorosis, the
latest incident of which has been reported in the January
1966 issue of the Annals of Internal Medicine, THERE-
FORE BE IT
RESOLVED, that the Ohio State Medical Association, as-
sembled in Cleveland, Ohio, condemn the addition of
fluorine or any other substance to public water supplies
for the purpose of affecting the body, or the bodily or
mental functions of the consumers, AND BE IT FUR-
THER
RESOLVED, that copies of this resolution be transmitted to
the House of Delegates of the American Medical Asso-
ciation, to the President of the United States, the Mem-
bers of Congress, the governors of the several states, and
the mayors of our principal cities, and released to the
media of public information.
(See Resolution No. 24)
INSURANCE FORM
APPROVED BY THE OHIO STATE MEDICAL ASSOCIATION
Date.
Patient Address
Diagnosis
Report of Services Rendered
Date Service Charge
Date Service Charge
! 1
Total $
Code for Above Services
PE physical examination ECG electrocardiogram
S surgery R injection
P physiotherapy L laboratory
Degree of Disability
Prognosis
Disposition
Comments
The above report has been read
and approved by me.
OV office visit
HC house call
HV hospital visit
Patient’s signature
If not patient — relationship Physician’s signature
All charges are based on my usual and customary fee.
for May, 1966
487
RESOLUTION NO. 29
Training More General Practitioners
(By the Huron County Medical Society)
WHEREAS, Richard Meiling, M. D., Dean of Ohio State
University College of Medicine, has been quoted in the
public press as stating: "I Don’t Know What General
Practice Is” — (Cleveland Plain Dealer, March 13, 1965),
and
WHEREAS, Julius Michaelson, M. D., Past President of
the Academy of General Practice, has defined a general
practitioner (family physician) as a physician — "whose
power of diagnosis, in both physical and mental spheres
— with respect to all ages and all sexes, in the family
structure or individually — are highly attuned; whose
knowledge of the total therapeutic armamentarium and
the medical structure is acute; and whose practical ap-
plication of the Art and Science of Medicine in its best
sense is highly developed,” and
WHEREAS, the American Academy of General Practice
is indeed the only medical organization in this Country
compelling its membership to maintain high standards
by requested yearly postgraduate educational refresher
courses, and
WHEREAS, James Z. Appel, M. D., President of the
American Medical Association, recommended more em-
phasis on training of family physicians by medical schools
as a way to alleviate the problem of fragmentation of
community health services and further stated — "I feel
strongly — and in doing so I merely echo the feeling of
the majority of my colleagues in medicine — that it is
time some of our medical schools get over a rather giddy
preoccupation with medical specialty,” — (address at
meeting of American Association of Public Health Physi-
cians, Chicago, November, 1965), and
WHEREAS, the Ohio State Medical Association — Ohio
Academy of General Practice Joint Committee on Family
Practice has met personally with Dean Meiling, his staff,
and other deans of medical schools of the State of Ohio
to present a detailed comprehensive plan for the detailed
tentative procedures in attaining such a realistically desir-
able goal as graduating more family physicians, and
WHEREAS, it is a statistical fact that Ohio communities
request family physicians (OSMA Physicians’ Placement
Service) 15 times more often than specialists, and
WHEREAS, it would be a realistic and functional respon-
sibility of the medical schools in the State of Ohio, in a
democratic spirit of supply and demand free enterprise
system, to meet the demands (needs) of the citizens of
Ohio pertinent to a need of more family physicians;
THEREFORE BE IT
RESOLVED, that the House of Delegates of the Ohio State
Medical Association express a most sincere thanks and
token of gratitude to the Joint Committee of the Ohio
State Medical Association — Ohio Academy of General
Practice for their untiring efforts to bring about the ful-
fillment of the most realistic, dire, and critical need for
an increase in the numbers of family physicians in the
State of Ohio — and even nationally; BE IT FURTHER
RESOLVED, that Richard Meiling, M. D., Dean of the Ohio
State University College of Medicine, be reminded of the
meetings with the above joint committee, perhaps by being
forwarded a copy of this resolution; AND BE IT FUR-
THER
RESOLVED, that the suggestions of this resolution be
acted upon swiftly and commensurate with the acute and
dire critical need for more family physicians, both State-
wide and nationally. The latter action being taken whole-
heartedly, most diligently, and most sincerely by the
various deans of the medical schools in the State of Ohio
as a fulfillment of their responsibilities as medical leaders
and as has been voiced by the President of the American
Medical Association.
RESOLUTION NO. 30
Licensing Foreign Graduates
(By the Delegates of the Summit County Medical Society)
WHEREAS, the Ohio State Medical Board has limited
Ohio medical licensure to full citizens of the United
States similar to action by 22 other states, and
WHEREAS, the Constitution and By-Laws of the Ohio State
Medical Association require that an applicant for mem-
bership have an Ohio license, and
WHEREAS, foreign graduates finish residency requirements,
obtain permanent visas, file declarations of intent for
citizenship and then must wait up to three years before
being eligible for licensure and membership, and
WHEREAS, the Ohio State Medical Board is ignoring the
practice of medicine in this interim by these men, and
county medical societies cannot offer membership with its
corollary orientation and discipline during this period, and
WHEREAS, certain hospitals may be illegally employing
these physicians for the corporate practice of medicine
in emergency rooms, obstetrical services and other dis-
ciplines, THEREFORE BE IT
RESOLVED, that the House of Delegates, of the Ohio State
Medical Association, request The Council to confer with
the Ohio State Medical Board on this threat to the stand-
ard of health care in Ohio, AND BE IT FURTHER
RESOLVED, that these conferences take into consideration
the following facts:
( 1 ) A significant decrease in the ratio of physicians to
population in the metropolitan centers of Ohio is
occurring;
(2) Citizenship is not relevant to a man’s professional
ability or ethics;
(3) State Board examinations (which are already
failed by 40.9 per cent of foreign graduates and
1.7 per cent of graduates of U. S. schools nation-
ally) be made sufficiently difficult that the im-
properly or inadequately trained man would be
eliminated on this basis rather than for a reason
of ethnic origin;
(4) Help in examining foreign graduates by specialty
boards could provide an additional yardstick of
ability, which again is more appropriate to the
object in mind of licensing only the scientifically
qualified applicant;
( 5 ) The public needs the protection that would be
afforded by ethical orientation and discipline of
these foreign graduates in their first years of
practice in this country.
RESOLUTION NO. 31
Procedure for Amendments to the Medical
Practice Act of the State of Ohio
(By the Academy of Medicine of Cincinnati)
WHEREAS, the House of Delegates of the Ohio State Medi-
cal Association has recommended that action be taken to
amend the Medical Practice Act of the State of Ohio; and
WHEREAS, medical inspectors are experiencing difficulty in
enforcing the Medical Practice Act in its present form;
THEREFORE BE IT
RESOLVED, that The Council of the Ohio State Medical
Association be authorized to schedule a conference on the
necessary amendments to the Medical Practice Act of the
State of Ohio; AND BE IT FURTHER
RESOLVED, that the secretary, executive secretary and legal
counsel representing county medical societies be invited to
participate in such conference.
RESOLUTION NO. 32
Voluntary Health Insurance
(By the Stark County Medical Society)
PREAMBLE
A direct result of organized medicine’s effort to fore-
stall King- Anderson type legislation was the emergence
488
The Ohio State Medical Journal
of a splendid voluntary health insurance industry which
extended coverage to persons over 65. Under the Medi-
care Law, it is legal for persons over 65 not to participate in
either part A or B of the government program, there
are many people over 65 that do not want to participate
if their voluntary health insurance is still available to
them.
It is the declared intent of labor to extend the Medi-
care Law to persons of all ages. If this effort is success-
ful over the American Medical Association’s campaign
to repeal portions of the Medicare Law, the voluntary
health insurance industry and the public will suffer a
grievious blow.
Blue Cross Plans in some areas of the country already
are announcing that at midnight on June 30, 1966, some
contracts for persons 65 or older will be canceled,
THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association make
every effort to encourage the voluntary health insurance in-
dustry in Ohio not to cancel contracts but to continue of-
fering improved contracts to persons 65 and older, and
these contracts should not be confined to supporting the
Medicare Law but should be written to meet the wide
variety of needs for persons over 65.
RESOLUTION NO. 33
Industrial Commission Usual and Customary Fee
(By Charles H. McMullen, M. D., Delegate, Ashland County)
WHEREAS, the Industrial Commission of Ohio and the
Bureau of Workmen’s Compensation have initiated a pro-
gram of reimbursing physicians their usual and customary
fees for professional medical care of Workmen’s Compen-
sation cases, and
WHEREAS, this program demonstrates a spirit of coopera-
tion with and confidence in the physicians of Ohio, and
WHEREAS, this usual and customary fee program reflects
sound leadership in the administration of the respon-
sibilities of the commission and the bureau, THEREFORE
BE IT
RESOLVED, that this House of Delegates of the Ohio State
Medical Association officially commends the Industrial
Commission of Ohio and the Bureau of Workmen’s
Compensation for this program, AND BE IT FURTHER
RESOLVED, that the component county medical societies
and their members continue to extend their full coopera-
tion and assistance in helping to insure the successful ad-
ministration of this usual and customary fee program.
RESOLUTION NO. 34
Industrial Commission - Physician Ethical
Relationship Concerning Prescriptions
(By the Lorain County Medical Society)
WHEREAS, it is recognized that there be a fundamental
respect maintained for attending physician-industrial pa-
tient relationship in the best interests of treatment, and
WHEREAS, it is recognized that the attending physician is
in the best position to prescribe unusual medications for
unusual injuries and industrial sickness, and
WHEREAS, it is also recognized that it is also the pri-
vilege of the Industrial Commission to question the
rationale of unusual drugs in unusual injuries, and
WHEREAS, it is recognized that notification of disapproval
of unusual prescriptions directly to the pharmacist, before
notifying attending physician, infers erroneous therapeutic
judgment of said physician and casts doubt on said
physician’s medical ability, THEREFORE BE IT
RESOLVED, that the Industrial Commission be urged to
first request explanation of rationale of unusual prescrip-
tions from attending physician to maintain respectful
relationship between physician and patient, and between
physician and pharmacist, in the best interests of the
treatment of industrial patient.
RESOLUTION NO. 35
Aircraft Safety
(By the Academy of Medicine of Cleveland)
WHEREAS, air travel is a major means of transportation
today, and
WHEREAS, it is used by nearly all persons, and
WHEREAS, the magnitude of an air crash tragedy is
usually proportional to the number of passengers on
board, and
WHEREAS, some pilot error and mechanical failure are in-
evitable, and
WHEREAS, speedy evacuation of still living passengers
after a crash is absolutely necessary if their lives are
to be saved, THEREFORE BE IT
RESOLVED, that
(1) The Federal Aviation Agency be urged to limit
the number of passengers allowed on any one
commercial aircraft, and
(2) the minimum seating space per passenger be in-
creased, and
(3) emergency means of egress be improved.
RESOLUTION NO. 36
Public Health
(By the Huron County Medical Society)
WHEREAS, in 1962, we had a national health menace from
importations from the Orient, namely contaminated
stuffed chicken, and
WHEREAS, apparently the usual appropriate committees
of the American Medical Association and the U. S. Pub-
blic Health Sendee have failed to endorse, legislate and
enforce sufficient laws to prohibit this from recurring in
the future as evidenced by subsequent importations, and
WHEREAS, in 1965 we witnessed several examples of mate-
rial, toys, "ice balls,” and trinkets, grossly contaminated,
again being freely sold in this country, and
WHEREAS, nothing is done to prevent epidemiological
trouble, but rather alarm is spread after the products are
imported, and
WHEREAS, many of our population are not immune to
these type organisms thus allowing a potential epidemic
to exist, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association in-
struct its Delegates to the AMA to introduce and support
a resolution instructing the appropriate committee of the
AMA to work with the public health authorities, the
port authorities and the Bureau of Customs to insure that
the health of the American public is protected from such
dangers.
RESOLUTION NO. 37
Health Insurance for Migrant Workers
(By the Huron County Medical Society)
WHEREAS, the State of Ohio imports seasonal migrant
workers, and
WHEREAS, medical and hospital care is a continual need
for the welfare of said people, and
WHEREAS, more often than not, said people do not carry
health insurance, and
WHEREAS, many communities are left with sizeable unpaid
hospital and medical bills as the migrant workers leave the
communities in which they were temporarily employed,
THEREFORE BE IT
RESOLVED, that the House of Delegates of the Ohio State
Medical Association instruct the officers and the staff of
the Association to help resolve this problem by meeting
with the Blue Cross-Blue Shield representatives; mem-
bers of the State Department of Health; other health in-
for May, 1966
489
surance agencies; and with representatives of industrial
organizations or whatever other sources they might think
helpful to solve the problem of adequate health insurance
for the migrant workers.
RESOLUTION NO. 38
Traffic Accidents and Medically Incompetent
Aged Drivers
(By the Lorain Counuty Medical Society)
WHEREAS, the number of automobiles and traffic have
increased by leaps and bounds, and
WHEREAS, the number of aged 65 and older have in-
creased due to medical advances, and
WHEREAS, a good percentage of drivers 65 years and older
are affected with the infirmities of age causing vertigo,
transient syncope, hazard of a sudden heart attack and
cerebral vascular accident, emotional instability, decreased
neuromuscular integrity, threat of insulin reactions or
diabetic coma due to brittle diabetes, and
WHEREAS, under present system of driver’s license renewal,
such incompetent aged drivers cannot be denied licensure
until said drivers are involved in serious traffic accidents,
THEREFORE BE IT
RESOLVED, that everyone reaching age 65 years be re-
quired by law to take a driver’s test by state patrol or any
other officers of the law designated by Highway Department
within six months after 65th birthday or within one year
if presently over 65 years of age, to evaluate mechanical
and judgmental competency to operate a motor vehicle;
said examination to determine whether driver’s license
should be revoked or whether driver should repeat exami-
nation every six months, one year, or two years according
to judgment of examiner.
RESOLUTION NO. 39
To Upgrade the Education of the Deaf and
Hard of Hearing
(By the Fourth District Councilor,
Robert N. Smith, M. D., Toledo)
WHEREAS, the problems of deafness are founded in the
loss of auditory communication, and
WHEREAS, these problems can be largely overcome by
proper special education, and
WHEREAS, in the 1963 research of the Division of Special
Education of the State of Ohio it was estimated that one
child in every 20 in school or at the preschool level had
a significant hearing loss, and
WHEREAS, only fifteen per cent of today’s deaf young
people successfully complete the full scale high school
academic program, and
WHEREAS, the deaf are conceded to have potentially nor-
mal intelligence when tested by standardized nonverbal
tests, and
WHEREAS, it is the duty of the physician to promote
rehabilitation when he cannot cure; THEREFORE BE IT
RESOLVED, that the House of Delegates of the Ohio State
Medical Association urge that the State Board of Educa-
tion be instructed by the Governor to upgrade deaf educa-
tion in the State of Ohio
(a) by promoting oral education of the deaf child in
contrast to the manual method;
(b) by providing more educational facilities, properly
staffed and equipped, with a goal of one special
education unit for the deaf per county, or small
group of counties;
(c) by integrating these special education units with
regular elementary and high school facilities,
where possible;
(d) by constantly recruiting young people to enter the
field of Deaf Education as a profession, and
(e) by seeking adequate funds from the legislature to
support a proper program; AND BE IT FUR-
THER
RESOLVED, that the Ohio State Medical Association pro-
mote a broad public educational program beamed through
the Parent-Teacher Associations, Mothers’ Club, Child
Conservation Leagues and civic organizations for the pur-
pose of urging an improvement in the education of the
deaf and hard of hearing in the State of Ohio; AND
BE IT FURTHER
RESOLVED, that all physicians, especially those in general
practice and the specialities of pediatrics and ear, nose
and throat, be adequately prepared to advise their patients
as to the scientific techniques and special educational
facilities which are available for the education and re-
habilitation of the deaf or hard of hearing child or adult.
RESOLUTION NO. 40
Condemning Actions Taken By Many
Blue Cross Plans
(By the Huron County Medical Society)
WHEREAS, many state Blue Cross Plans have written
letters to their elderly policyholders suggesting that they
enroll under Part B, Title 18 of Public Law 89-97 (Medi-
care Law) and drop their Blue Cross coverage; and
WHEREAS, there seems to be a nationwide concerted action
by the various group Blue Cross Plans in conjunction
with the Federal Government to coerce these previous
elderly policyholders to sign up for Part B of Medicare;
and
WHEREAS, in many instances these previous elderly low
cost policyholders will be left no alternative but to sign
up (like it or not) under the Medicare Law, and
WHEREAS, indeed the private health insurance industry
has been a very real positive factor in the attainments of
the highest standards of medical care given the American
citizen; and
WHEREAS, this may indeed represent the beginning of the
federalizing of the private health insurance industry; and
WHEREAS, the Blue Cross of Northwest Ohio most naively
and grossly misinformed its policyholders in a recently
published pamphlet — to wit — "Medicare Part A (Hos-
pital Insurance Benefits) is automatic — It costs you noth-
ing”; and
WHEREAS, these pamphlets, letters, and radio broadcasts
raise a question of conspiracy to force the elderly to enroll
under Part B; THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association con-
demn these actions by the various Blue Cross Plans and
indeed sincerely acknowledge the fact that the private
health insurance industry is destroying a most healthy
and beneficial segment of the free enterprise system, which
industry had previously rendered a most worthy service in
making better plans available to the elderly citizens and at
a more competitive price; BE IT FURTHER
RESOLVED, that a copy of this resolution be sent to the
various Blue Cross organizations in the state of Ohio.
RESOLUTION NO. 41
Regarding "Forms” for Participants of
Part B of Medicare
(By the Huron County Medical Society)
WHEREAS, the filling out of forms and papers for each
house call and/or office call for participants of Part B
of Medicare would:
(a) limit the choice of physicians to the patient;
(b) impose on the attending physician, most unreason-
ably, an unsurmountable amount of red tape forms
to process and waste a considerable portion of
his most valuable and critically short time which
he would best be giving to the practice of medicine
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The Ohio State Medical Journal
rather than to the execution of clerical chores;
THEREFORE BE IT
RESOLVED, that insurance and/or hospitalization-like forms
be requested only in:
(a) complicated medical cases which would require 10
calls or more for the same disease;
(b) complicated surgical operative procedures; BE IT
FURTHER
RESOLVED, that in those cases where forms are to be
filled out, the "Insurance Form approved by the Ohio
State Medical Association” be accepted by the Depart-
ment of Health, Education, and Welfare, BE IT FUR-
THER
RESOLVED, that the physician’s signature on this form
shall be the equivalent of a receipted bill.
RESOLUTION NO. 42
Defining "Receipted Bill” for Participants
of Part B of Medicare
(By the Huron County Medical Society)
WHEREAS, there seems to be an understanding that the
Department of Health, Education, and Welfare requests
a receipted doctor’s bill from participants of Part B of
Medicare before it will refund monies to said participants,
and
WHEREAS, a bill cannot be receipted until paid, and
WHEREAS, this request is unreasonable and not in keeping
with the intent and/or spirit of the Medicare Law —
THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association sub-
mit to the Department of Health, Education, and Welfare
that a signed statement from the attending physician to
his participating patients of Part B of Medicare shall
be honored as a receipted bill.
RESOLUTION NO. 43
Direct Billing
(By the Huron County Medical Society)
WHEREAS, it is the accepted practice of the majority of
health insurance carriers to reimburse their insurees spe-
cified sums on a contractual-agreement basis for specified
services purchased; and
WHEREAS, no such contract exists under Part B of Medi-
care between potential patients and the Federal Govern-
ment; and
WHEREAS, acceptance of assignments from Medicare pa-
tients would constitute an agreement by physicians to
accept tax funds in any amount the government carrier
might decide fitting and would waive recourse to the
patient for a possible balance of the physician’s fees; and
WHEREAS, the Department of Health, Education, and Wel-
fare, through Mr. Wilbur Cohen, has previously indeed
favorably suggested that doctors continue the practice of
direct patient billing; THEREFORE BE IT
RESOLVED, that any physician rendering services to any
patient under the Medicare Law continue direct billing to
the patient, rendering an itemized statement, and said pa-
tient consider it his responsibility to pay same bill - —
using funds from whatever sources might be available
to him — Medicare or other; BE IT FURTHER
RESOLVED, that the House of Delegates of the Ohio State
Medical Association instruct the staff of the Ohio State
Medical Association to make a special effort to inform
each member of the Ohio State Medical Association of
this resolution, if adopted; BE IT FURTHER
RESOLVED, that the Ohio State Medical Association in-
form the Department of Health, Education, and Welfare
of the contents of this resolution, thereby conveying the
terms ethically necessary for the physicians of the state
of Ohio to participate in Medicare.
The Association and The Journal
Have New Columbus Address
After some 35 years in the same building,
the Ohio State Medical Association’s headquar-
ters offices have moved to a new address in
downtown Columbus.
With completely remodeled facilities in the
landmark Huntington National Bank Building,
the new mailing address is:
The Ohio State Medical Association
17 South High Street - Suite 500
Columbus, Ohio 43215
The Journal occupies a part of this same
suite and should be addressed as follows:
The Ohio State Medical Journal
17 South High Street - Suite 500
Columbus, Ohio 43215
New telephone number for both offices is
228-6971 (Area Code 6l4). Entrance to the
new quarters is just a few steps south from
Broad and High Streets, traditional center of
activity in Ohio’s capital city, facing the State-
house grounds from the West. The former of-
fices of the Association and The Journal were
at 79 East State Street, also in the downtown
Columbus area.
RESOLUTION NO. 44
Medical Ethics
(By the Huron County Medical Society)
WHEREAS, the mission and prime purpose of a physician
is to serve the common good and improve the health of
mankind, and
WHEREAS, the prime object of the medical profession is
to render service to humanity, and
WHEREAS, doctors are trustees of medical knowledge and
skill and must dispense the benefits of their special at-
tainments in medicine to ALL who need them, and
WHEREAS, physicians dedicate their lives to the alleviation
of suffering, to the enhancement and prolongation of life,
and to the destinies of humanity, and
WHEREAS, the above are principles of medical ethics of
the American Medical Association and have been the
guiding ethics of physicians for millennia; and
WHEREAS, the Department of Health, Education, and Wel-
fare, through the Ohio State Department of Health, in
essence, has made a mockery of the above principles by
requesting the physicians of the State of Ohio to stamp a
nondiscrimination legend on the statements of welfare
patients; THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association con-
vey to the Department of Health, Education, and Welfare
and the Ohio Department of Public Welfare that the
stamping of this legend on the statements of the Welfare
category patients is futile, contrary to high standards of
Medical Ethics, self-defeating, and not indicative of the
accomplishment of anything worthwhile, AND BE IT
FURTHER
RESOLVED, that the Ohio State Medical Association sug-
gest strongly to both departments, in the interest of
better serving our patients, that said stamping procedure
be discontinued.
for May, 1966
491
Policy Regarding Governmental
Medical Care Programs
IN A RECENT MAILING to members of the
Ohio State Medical Association, three documents
of vital interest regarding governmental agency-
hospital-physician relationships were included with a
covering letter from OSMA President Henry A.
Crawford. The letter and documents follow:
Special Medicare Newsletter No. 3
Dear Doctor:
Included in this letter are the following items:
(1) Jolicy Statement of The Council of the Ohio
State Medical Association Regarding Government
Medical Care Programs.
(2) A highly informative statement, "Composi-
tion and Duties of Hospital Utilization Review Com-
mittees,’’ prepared by George W. Petznick, M.D.,
Shaker Heights, an AMA representative on Technical
Advisory Committee No. 2 — Physician Participation,
one of the committees advising the Department of
Health, Education, and Welfare as to rules, regula-
tions, and policies for Medicare.
(3) An opinion of the Chief of the Legal Section,
Bureau of Workmen’s Compensation, Ohio Industrial
Commission, stating that the Commission and the
Bureau should not make any payments to a hospital
where it is known that there is a fee-splitting arrange-
ment between the hospital and a roentgenologist.
Personally, and on behalf of The Council, I urge
you to study this material carefully and to file it for
future reference. I am firmly convinced that, if all
physicians follow the principles stated in the follow-
ing presentation, our present system of medical care
can be preserved.
If we do not follow the principles established by
and for our profession, then they become nothing
more than words written on a piece of paper.
Sincerely,
(Signed) Henry A. Crawford, M.D., President
Ohio State Medical Association
Policy Statement of The Council of OSMA Regarding
Government Medical Care Programs
INASMUCH AS government has announced that
it has assumed, under Public Law 89-97, respon-
sibility for financing the medical care of certain seg-
ments of the population, The Council of the Ohio
State Medical Association has adopted certain policies
for the information and guidance of its members.
For emphasis, reference is made to Title XVIII-
Health Insurance Benefits for the Aged, and Title
XIX-Grants to States for Medical Assistance Pro-
grams.
It is recommended and urged that every physician
follow these policies in the conduct of his individual
practice of medicine.
Policies Recommended for
Individual Physicians
Once the physician accepts a person as his patient,
regardless of what third party might be involved, the
physician’s primary and sole obligation, his contract
and his relationship are with the patient.
Any arrangement between government and a citi-
zen whereby the government agrees to pay for the
citizen’s medical care does not, directly or indirectly,
or by inference, involve the physician in a contract
with the government.
The physician will continue, even as before, to pro-
vide those persons he accepts as patients the best pos-
sible medical care at his command.
The physician is requested and urged to deal di-
rectly and only with the patient, both in providing
medical care and in billing for just and reasonable
compensation for the medical care provided.
It is recommended, inasmuch as the agreement for
financial responsibility is between the patient and
the government, that the physician not accept any
assignment form.
It is recommended, in accordance with the Princi-
ples of Medical Ethics and the Statutes of Ohio re-
garding corporate practice of medicine, that each and
every member of this Association submit to the pa-
tient his own bill and receive on his own behalf,
compensation for his professional medical services.
It is the official policy of this Association that every
physician bill and receive for his professional medical
492
The Ohio State Medical Journal
sendees his usual, customary, and reasonable fee.
"Usual, customary, and reasonable fee’’ is defined as
follows:
Usual — The "usual” fee is that fee usually
charged for a specific sendee provided by an indi-
vidual physician for his patient.
Customary — A fee is "customary” when it prop-
erly reflects the extent and nature of the sendees
provided the patient.
Reasonable — A fee is "reasonable” when it
meets the "usual and customary” criteria or, in the
opinion of a duly constituted medical society review
committee, is justified under what is considered a
complexity of treatment which merits special con-
sideration.
In cases where review or mediation may be re-
quested, it is recommended that the standard media-
tion or review mechanism of the county medical so-
ciety be utilized. Further, it is recommended that no
special review or mediation committee be appointed
solely to handle cases involving Public Law 89-97.
Requirement of Pledges or
Statements Objectionable
The Profession finds objectionable and distasteful
any regulation or requirement that a physician sign
pledges or produce statements that he will abide or
has abided by the laws in providing his professional
sendees. Such requirement or regulation is, of itself,
an act of discrimination against the profession, and is
degrading.
The propriety of the conduct of members of this
Association is determined by the Principles of Medi-
cal Ethics, to which all members of this Association
willingly and freely pledge themselves.
For emphasis, reference is made specifically to Sec-
tion 4 of the Principles of Medical Ethics:
"Section 4. The medical profession should safe-
guard the public and itself against physicians defi-
cient in moral character or professional competence.
Physicians should observe all laws, uphold the
dignity and honor of the profession and accept its
self-imposed disciplines. They should expose,
without hesitation, illegal or unethical conduct of
fellow members of the profession.”
Adopted by the Council of the
Ohio State Medical Association
March 20, 1966
A Statement on: Composition and Duties of Hospital
Utilization Review Committees
By GEORGE W. PETZNICK, M. D., Shaker Heights
Member, Representing AMA, of HEW Technical Advisory Committee No. 2 —
Physician Participation; Past President, OSMA, and Member of Ohio
Delegation to AMA House of Delegates
IF YOUR HOSPITAL expects reimbursement from
the fiscal agent of the government for "Medicare”
patients, then the medical staff of your hospital is
required to have a utilization review committee.
If you have a utilization review committee in your
hospital, it is necessary for your hospital to indicate
that such a committee is functioning to the Ohio State
Director of Health. The director will then certify to
the government (HEW) that your hospital has quali-
fied to be reimbursed for "Medicare” patients.
Further, all accredited hospitals are required to
have functioning utilization committees.
There is no stereotype form required for any utili-
zation review committee and, if your hospital staff
decides on a committee that will serve the purpose in
your hospital, stay with it and insist that this is the
form of utilization that best serves the purposes for
your patients, their medical care and your hospital.
Not "Claims” Review
There is much confusion among many physicians,
hospitals, and fiscal agents when the term "utilization”
is used. This is because the fiscal agents (Blue Cross,
voluntary and private insurers and labor unions)
think in terms of "claims” review. Such "claims”
reviews are not now and should not be the function
of a hospital review committee; rather they are ad-
ministrative.
The real purpose of utilization review committees
is solely educational for a given medical staff in a
given hospital and controlled by the members of the
for May, 1966
493
medical staff. It is not impossible for a hospital med-
ical staff utilization committee to, unknowingly, be
used for "utilization claims” review when hospital
administrative activities become involved.
Publications Listed
There has been much written and many people
have discussed utilization review plans but may I
suggest a few important publications that will help
to guide anyone who is interested in such activities.
1 — The "Marshall Plan” of Pittsburgh — prob-
ably one of the first well-organized utilization plans
in this country.
2 — The AMA pamphlet "Utilization Review,” a
handbook for the medical staff that was written by
the Council on Medical Service.
3 — "Conditions of Participation for Hospitals” —
printed by the Department of Health, Education, and
Welfare.
4 — "AMA Advisory Committee’s Report No. 9”
— published by the AMA.
5 — "AMA Advisory Committee’s Report No. 10”
— published by the AMA.
6 — "Medical Economics” — Feb. 21, 1966, issue.
Medical utilization review committees are compara-
tively new. However, it will be your committee, not
the government’s, and it should be a function of your
medical staff and not the hospital administrative staff.
Good and purposeful medical review committees
can be and are educational to many physicians and
much good can be accomplished in health care by an
efficient, effective medically controlled and medically-
staffed committee.
In conclusion, it cannot be emphasized too
strongly that the official policy of the American Medi-
cal Association and the Ohio State Medical Associa-
tion is this: "Hospital utilization review committees
shall be composed of practicing physicians.”
Opinion of Chief, Legal Section,
Compensation Inter-Office
Bureau of Workmen’s
Communication
Date: March 7, 1966
To: Dr. Raymond B. Hudson, Chief Deputy
Administrator, MEDICAL SECTION
From: Thomas E. Brock, Chief Deputy
Administrator, Legal Section
You have requested my opinion on the question of
whether or not the Industrial Commission of Ohio
and the Bureau of Workmen’s Compensation can pay
for x-rays taken by a roentgenologist where said pay-
ment is collected by the hospital and in turn is paid
in whole or in part to the roentgenologist.
1. Section 1701.03 R.C. prohibits the practice of a
profession by a lay-corporation or association of
any type.
2. These entities cannot do indirectly what is pro-
hibited by statute, namely, through the hiring of
a licensed physician.
3. There is no legal duty placed upon the Industrial
Commission of Ohio or the Bureau of Workmen’s
Compensation to ascertain initially whether a cor-
poration or an association mentioned above is
practicing medicine.
4. No state department such as the Industrial Com-
mission of Ohio or the Bureau of Workmen’s
Compensation should subscribe, aid or abet know-
ingly in any illegal practice or in any violation of
a code of ethics adopted by a professional body
for the public good.
Therefore it is my opinion that the Industrial Com-
mission of Ohio and the Bureau of Workmen’s Com-
pensation should not make any payments to a hospital
where it knows that there is a fee splitting arrange-
ment between the hospital and a roentgenologist.
This opinion does not apply where a charge is
made (by the hospital solely) for the use of equip-
ment or space.
(Signed) Thomas E. Brock
Chief Deputy Administrator
Legal Section
494
The Ohio State Medical journal
Candidates for the Office of President-Elect of OSMA
UNDER revised Section 1 (a) of the OSMA Bylaws, the following names of candidates for
the office of President-Elect have been filed with the Executive Secretary 60 days prior to
the meeting of the House of Delegates at which the election is scheduled to take place,
that is on May 27, during the 1966 Annual Meeting of the OSMA in Cleveland:
ROBERT E. HOWARD, M. D.
Cincinnati, Ohio
Dr. Robert E. Howard who is nominated for Presi-
dent-Elect of the Ohio State Medical Association for
1966-67, has served as Councilor of the First District
of the OSMA from 1962-66. Dr. Howard has also
served for the Academy of Medicine of Cincinnati
as Trustee, Secretary-Treasurer and its 103rd Presi-
dent. He has been President of the Cincinnati Medi-
cal-Dental-Hospital Bureau and the Cincinnati Speech
and Hearing Center. His Pre-medical studies were
taken at Ohio Wesleyan University and he graduated
with four degrees from the University of Cincinnati
in 1925, 1926, 1927, and 1928. Dr. Howard is Asso-
ciate Professor of Otolaryngology at the University of
Cincinnati and lectures in Otology and the Clinical
Anatomy of the Head and Neck. He is First Grand
Vice-President of the International Alpha Kappa
Kappa Medical Fraternity.
Dr. Howard is a certified board member of the
American Board of Otolaryngology, practicing in a
partnership and serving on the staffs of nine Cincin-
nati hospitals.
During the last year he has been chairman of two
important committees of the OSMA — the Medical
Advisory Committee for the Ohio State Society of
Medical Assistants, and chairman of the OSMA’s
Auditing and Appropriations Committee.
He has three sons and a daughter, and his wife
Betty is a graduate nurse from Bethesda School of
Nursing in Cincinnati.
His greatest concern is the continuance of the high
quality of medical care, in spite of the invasion and
threatening control of medicine by Federal and State
Departments of Health, Education and Welfare, and
the future Government so-called "Social Progress
Program.”
BENJAMIN C. DIEFENBACH, M. D.
Martins Ferry, Ohio
Dr. Benjamin C. Diefenbach, who is nominated
for President-Elect of the Ohio State Medical Asso-
ciation, was born in Bluffton, Indiana, November 2,
1911, the second son of Howard Berleman and
Josephine Zartman Diefenbach. His maternal grand-
father was a clergyman, as was his father.
His grade school education was quite scattered be-
cause of the travels of his father. He graduated from
grade school in Akron in 1925 and graduated from
West High School, Akron, in 1929. He received an
A.B. degree from Heidelberg College, Tiffin, Ohio,
in 1933 and received his M.D. degree from Western
Reserve University School of Medicine in 1937.
Dr. Diefenbach interned at Akron City Hospital
on a rotating sendee. He was House Doctor at Mar-
tins Ferry Hospital for approximately 18 months and
has been in family practice in Martins Ferry since.
He was president of the Belmont County Medical
Society in 1956 and has been a member of the OSMA
House of Delegates ever since. He has sensed on the
Rural Health Committee and has been Councilor for
the Seventh District, Ohio State Medical Association,
since I960.
The House of Delegates of the Ohio State Medical
Association will meet twice during the OSMA An-
nual Meeting. The first session is on Tuesday eve-
ning, May 24, beginning with a dinner at 6:00 P. M.
Refer to the April issue of The Journal, page 354,
for the agenda of this meeting, including presentation
of Resolutions. Resolutions Committees will meet
on Wednesday, May 25, and, if necessary, on Thurs-
day, May 26, to hear discussions on Resolutions pre-
sented. Final House session is on Friday, May 27, at
9:00 A. M. Refer to April issue, page 363.
for May, 1966
495
Medical Society Officers’ Conference . . .
OSMA Is Host in Columbus to County Officers and Committeemen
For a Discussion of Matters of Vital Interest to the Profession
THE Annual County Medical Society Officers Conference, held in Columbus on Sunday, Feb-
ruary 27, was well attended, with 196 persons registered and 185 in attendance at the luncheon.
All Eleven Councilor Districts were well represented, with the Tenth District having a total
attendance of 29. Persons were present in some official capacity from 75 per cent of Ohio’s 88
County Medical Societies. The meeting was held in the Pick-Fort Hayes Hotel in downtown Co-
lumbus, where luncheon was served with the compliments of the Ohio State Medical Association.
Morning Session
Dr. Henry A. Crawford, President of the Ohio
State Medical Association, gave the keynote address
of the conference which centered around a discussion
of the medical profession’s responses to the impact
of various governmental programs upon hospitaliza-
tion and the practice of medicine. Dr. Crawford
presided during the remainder of the morning session.
Dr. William R. Schultz, Wooster, Councilor of the
Eleventh District of the OSMA, and chairman of the
OSMA Committee on Hospital Relations, spoke on
the topic "The Physician and Hospital Relations.”
Dr. Schultz discussed the increasing concern of the
medical profession over the encroachments of hospi-
tals into the practice of medicine, and stressed the
need of alertness on the part of medical staffs to
draw definite lines between responsibilities of physi-
cians and those of hospital personnel. He further
urged that ’members of medical staffs maintain close
liaison with administrators and hospital trustees.
In regard to the Medicare program, Dr. Schultz
described the various problems that face the medical
profession in regard to physician-hospital relation-
ships under the plan to become effective July 1.
Dr. William H. Holloway, Akron, a member of
the OSMA Committee on Mental Health, and for-
mer secretary-treasurer of the Summit County Medi-
cal Society, discussed the responsibilities, relationships
and goals of the County Medical Society in regard to
community and areawide mental health planning
and development.
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The Ohio State Medical Journal
Dr. John H. Budd, Cleveland, chairman of the
Ohio Delegation to the American Medical Associa-
tion, spoke on the topic "OSMA Delegation Acti-
vities at the 1965 AMA Clinical Convention.” A
report on the AMA Convention and highlights of
Ohio’s part in proceedings was published in the
January issue of The Journal, beginning on page 58.
Dr. Budd described in more detail the actions of
Ohio Delegates in Philadelphia and some practical
aspects of the AMA House of Delegates in action.
Hart F. Page, Executive Secretary of the OSMA,
explained "Congressional Redistricting and Legisla-
tive Reapportionment in Ohio,” and told the audience
what reapportionment might mean in the Ohio Gen-
eral Assembly as far as its outlook on medical and
health legislation is concerned. Mr. Page also em-
phasized the need for continuing liaison between
county medical societies and members of the Ohio
General Assembly.
Councilor District Conferences
An important part of the day’s activities was the
time devoted to individual conferences of the 11
Districts. Each District conference was presided
over by the Councilor and discussions were held on
matters of particular interest locally.
A luncheon, compliments of the Ohio State Medi-
cal Association, was served in the Regency Ballroom
of the Pick-Fort Hayes Hotel.
Dr. Hudson Addresses Group
One of the highlights of the conference was a
talk by Dr. Charles L. Hudson, Cleveland, President-
Elect of the American Medical Association, whose
topic was "The American Medical Association in
1966.”
Dr. Hudson, who will be installed as President
of the AMA at the June Annual Convention in Chi-
cago, described the AMA’s goals and projects for
the coming year, drawing on the background of in-
formation he has accumulated in his present office
and as former member of the AMA Board of
Trustees.
Dr. Henry P. Worstell, chairman of the OSMA
Committee on Workmen’s Compensation, discussed
"The Workmen’s Compensation Usual and Cus-
tomary Fee Plan.” The Industrial Commission and
the Bureau of Workmen’s Compensation changed
for May, 1966
497
from a fixed fee schedule to the "usual and customary
fee” basis last October, after long negotiations on
the part of the State Association.
Dr. Worsted explained that the "usual and cus-
tomary fee” is the fee that the individual doctors
usually charges his private patients for the service
indicated. More than 99 per cent of Ohio physicians
are cooperating with the state agency in charging their
"usual and customary fee” for services performed for
Ohio workers, the speaker declared.
Dr. Drew L. Davies, Columbus, chairman of the
OSMA Military Advisory Committee, spoke on the
topic, "The Doctor Draft and the County Military
Advisory Chairman.” He discussed the alarming
drain on Ohio physicians because of the Vietnam
conflict, but pointed out that Selective Service has
cooperated with state and local military advisory
committees in calling doctors to active service. He
urged local committees to function realistically so
that this cooperation will continue.
Presiding at the afternoon session was Dr. Lawr-
ence E. Meredith, Elyria, President-Elect of the State
Association.
Dr. Frank H. Mayfield, Cincinnati, Past President
of OSMA, and chairman of OMPAC, gave a prog-
ress report on the Ohio Medical Political Action
Committee. Dr. Mayfield urged support of this pro-
gram whose purpose is to help elect persons to Con-
gress who will consider the medical profession’s
viewpoint when national legislation is before the law-
makers.
There has been a substantial upsurge in member-
ship, Dr. Mayfield pointed out, but there is need for
much more support, especially in view of Ohio’s
growing importance as a major battleground in the
coming Congressional elections.
Dr. Samuel Saslaw, Columbus, chairman of the
OSMA Committee on Scientific Work, gave some
highlights of the coming OSMA Annual Meeting in
Cleveland, May 24-28, and urged county officers
and committeemen to promote interest in the meeting
in every way possible.
498
The Ohio State Medical Journal
"Contract Practice”
A Large Project
By S. H. MOUNTCASTLE, Executive Secretary
Summit County Medical Society
N A MODERN SENSE, the project aiming at
the ultimate observance of the fee-for-service
principle in all contracts signed by Summit
County, Ohio, physicians for the provision of their
professional sendees had its beginning in June, 1963,
in the actions of a combined meeting of hospital-
based specialists. This meeting was called by the
county medical society’s Committee on Medical Eco-
nomics and Contract Practice after a local path-
ologist had asked for a resolution to separate pay-
ments for laboratory services from Blue Cross
contracts.
More historically, endorsement and implementa-
tion of the fee-for-service principle in just hospital
contracts dates back to a statement adopted by the
general membership meeting in 1953. This was on
the occasion of one hospital demanding a salary rela-
tionship in pathology. Then in, 1958, with the
United Mine Workers moving toward panel practice,
action extending the concept to other medical sendee
contracts and contractors in addition to hospitals was
taken by the general membership meeting. This
led to the formation that year as part of the Medical
Economics Committee of the so-called "Contract
Practice” Committee of the Society mentioned first
above.
Background of Committee
Although this committee’s functions were to deter-
mine if the Principles of Medical Ethics were ob-
served in contract practice, the Committee on Profes-
sional Ethics as such was maintained separately and
retained the disciplinary functions.
The new "contract practice” responsibility being
tied to the old Medical Economics Committee dem-
onstrates that, initially, contract practice was looked
upon more as a problem of medical care distribution
and prepayment economics than as a matter of ethics
and, later, of law.
Continuing the evolutionary basis for the current
activities and concepts in this committee, it is note-
A bout the Author . . .
S. H. Mountcastle has served the Summit County Medical
Society as executive secretary since January, 1958. A
graduate of Kent State University with an A. B. in public
relations, his major academic studies were in economics,
the social sciences and journalism.
worthy that the jurisdiction was again enlarged in
1963 — this time to include contracts between cor-
porations of physicians and physicians. Such a
contract was referred and found to be unethical
in December of that year — providing as it were for
fee splitting and restraints on free choice of physi-
cian. The committee’s decision was "checked” at
its request by the Judicial Council of the American
Medical Association, confirmed as correct, and the
members concerned complied. Further reflecting its
dual role, however, as a Committee on Medical Eco-
nomics, the contract practice body concurrently hand-
led development of a statement reaffirming the So-
ciety’s adherence to the indemnity principle in the
field of prepayment plans. This was germane to
labor negotiations in the rubber industry in process
at the time.
By the spring of 1964, this committee was again
enlarged in perspective and assignment by receiving
for review the first new contract offered by a corpora-
tion of physicians formed for arranging hospital
emergency room staffing on an hourly wage basis. This
contract eventually was approved. It is noteworthy
that still no specific review of a contract in radiology
or pathology had been done by the committee al-
though a year had passed since these specialists had
demanded full recognition as physicians, governed by
the universal Principles of Medical Ethics. This, in
turn, is a third reflection of the slow, cautious and
at times "trial and error” approach being intention-
ally and wisely made by the new committee.
Field of Investigation
The Council of the Society, in August of 1964,
encouraged the committee to investigate hospital con-
tracts of specific members in cardiology, neurology,
radiology, medical education and two more emergency
room plans. Concurrently again, the committee was
involved in further pressures from rubber negotia-
tions, and it was not until October, 1964, that, as a
preparation for its new work, discussions were sched-
uled with each of the five medical executive com-
mittees of the staffs in local hospitals by the com-
mittee chairman. The extensive research and devel-
opment of the guidelines done for those presentations
for May, 1966
499
provided the cornerstone of knowledge and apprecia-
tion for all that was to follow.
One very important by-product came out of these
staff sessions that was to be the basis in turn for
implementing the Society’s position in the months
ahead. I refer here to the suggestion adopted by the
Council of the Society that, starting January 1, 1965,
every membership application must include an
answer as to whether or not a physician was en-
gaged in contract practice. The statement incor-
porated on the application form for membership was
as follows:
"Do you have any contractual arrangements, ex-
pressed or implied, for the provision of your
professional services with any hospital, corpora-
tion of physicians, corporation of laymen or lay
body by whatever name called? (If so, please
submit a copy and/or terms of such contract
with this application.)
Society activity in this field always had been fully
publicized and was well known to the membership
and hospital officials. It was repeatedly emphasized
that reinstatement of the fee-for-service principle, free
choice of physician and free competition among
physicians to the long-run benefit of good patient
care was the object of the effort.
Early in 1965, this general knowledge led to a
written request from a group representing 48 mem-
bers for specific investigation of a contract scheduled
for consummation with a new head-of-department in
pathology at a local hospital. This particular con-
tract has, of this writing, not been implemented and
has not been reviewed in that the department head
concerned will not arrive until mid 1966 and has not
yet applied for membership.
We will leave entirely for the remainder of this
discussion the committee’s activities in the field of
medical economics and comment only on its contract
practice ethics activity beginning with January 1,
1965. It did seem important, however, to establish
first that this group, concerned as it was now with
medical ethics, was related initially to material ques-
tions involved in economic issues and thus avoided
the "ivory tower’’ image.
Number of Applicants
Between January 1, 1965, and March 15, 1966, 62
applicants for membership were presented to the
Credentials Committee of the Summit County Medi-
cal Society, requiring an answer to the question on
contract medicine.
These included applications not only of new asso-
ciate members applying for the first time, but also
the applications of those men completing their year
of associate membership and applying for full active
membership status. Of these 62 applicants, 17 re-
ported that they had contracts for the provision
and/or resale of their professional services.
Three of the 17 were for full-time work at state
mental institutions, and the committee tabled action
on these applications for the time being, recommend-
ing that the Credentials Committee proceed with
membership while laws establishing these situations
were studied. Two contracts involved, once again,
a corporation of physicians as one party and new,
probationary members as the second party. Action
was deferred until these men applied for active mem-
bership in June, 1966, group practice contracts being
scheduled with a later priority. The other 12 were
handled as follows:
One contract was approved in the EKG and EEG
concession field with suggestions for billing process
changes that could be brought about with the hospital;
one, establishing a hospital in the emergency room
business, was completely unacceptable and member-
ship was denied the participant. This contract then
was rewritten by a committee of the medical staff
involved to meet the committee’s requirements, the
hospital accepted, and membership was granted. An-
other emergency room contract developed on the basis
of decisions in the foregoing troublesome case was
approved.
Two hospital straight-salary employees for general
duty were denied membership entirely. The hospital
still employs these men and calls them "fellows.”
One additional man refused membership offered
conditionally to changing his contract. Finally, in
the other eight cases, all of hospital employment in
radiology and pathology, the committee found the
contracts unacceptable in relation to the Principles.
In these instances it was duly noted that an entire de-
partment of physicians was involved in the unethical
situation tied to a basic contract. It seemed unfair
to deny the new physician probationary membership
and to do nothing about the basic, department-wide
problem. Therefore, conditional membership was
granted pending department-wide solution by July 1,
1966, and education was begun.
The Broader View
To digress, it is important to note that in these
very months when these cases accumulated, action
unfolded in the College of American Pathology, the
American College of Radiology and the House of
Delegates of the American Medical Association which
greatly reinforced the position of the county medical
society and this particular committee in interesting
further the hospital-based specialists. More impor-
tant, it encouraged the specialists themselves to rectify
their agreements and hospital relationships, as part-
ners with the Society — as indeed they most always
have been.
It is common knowledge that both colleges acted in
September and October, 1965, to require disentangle-
ment by their members from salary and percentage ar-
rangements with hospitals. Concurrently, the AM A
House called on these physicians in October, 1965,
"to rejoin the mainstream of American medicine,”
as it was phrased by Wallace D. Buchanan, M. D.,
500
The Ohio State Medical Journal
radiology college president during an Akron address
in October.
The combination of these actions of bringing Dr.
Buchanan to town and, later, a leader from the
American College of Pathology, along with the real-
ization that it would be discriminatory "to treat the
symptoms and ignore the disease” led to the decision
on the following policy with these eight cases:
1. Meetings to educate the 40 men directly and
indirectly involved to the principles concerned and
to ways and means of separate billing, separate re-
ceiving, leasing, etc. These meetings were con-
ducted on November 24, December 15 and Jan-
uary 12.
2. To establish the date of July 1, 1966, for the
installation of ethical contracts in both departments
of all five (local) hospitals or to show cause why
action should not be taken by the Society.
3. To give the eight young men associate mem-
bership. This appeared fair to everyone.
The reader can readily observe implications to
industrial medical practice as well as to group medical
practice from the activity centering just now on hos-
pital-based contract practice. Already, and in two
instances, the committee has had submitted to it
(voluntarily) local physicians’ contracts with nursing
homes. In both of these cases, the contracts were
found to be unacceptable and, after extended work
together, were rewritten to conform to the Principles
of Medical Ethics.
One case involving a group practice has just re-
sulted in an applicant being placed on notice that his
contract will not be acceptable after July 1, 1966
but, again, probationary membership was granted on
the condition of rectifying it. The assistance of the
committee will be given in drafting the new plan as
usual — tapping for consultations OSMA, AMA and
legal resource people as necessary.
Industrial Medicine Group
To return to the industrial medicine group, no
contract review has taken place in this field to date.
The beginnings of this are demonstrated, however,
by an offer of cooperation and an indication from at
least one senior member in that specialty that he
would like the advice and counsel of the committee
in the near future. This, like the nursing home re-
views requested and current initiative by radiologists
establishing separate billing particularly, illustrates an
encouraging sign of enthusiasm for this effort by the
men in contract medicine themselves. The success
of the program depends entirely on this factor in the
long run.
It is important to observe that an arbitrary7 review
of the roster of active members in this Society of
approximately 500 men indicates 197 who are prob-
ably, if not definitely, contracting for one percentage
or another of their professional sendees. All of these
men will be informed by the county committee of the
rules, and of the wisdom of the rules, governing con-
tract practice as time goes on. It is the opinion
of the present Council of the Summit County Medi-
cal Society that this project, aimed at a return to
more strict observance of the laws constituting the
professionalism of medicine, must be continued. Such
opinion has now received major support from the
legal and ethical review distributed by the President
of the Ohio State Medical Association and prepared
by the legal counsel of the OSMA in February. There
is evidence that the House of Delegates, OSMA, also
will express itself in favor of this kind of program
for all counties when it convenes May 24.
The chairman of the committee in Summit County
is Dr. James W. Parks whose field of practice is
orthopaedic surgery7. Dr. Parks has been a member
of the Council of the county medical society and a
delegate to the House of Delegates, OSMA, since
1962. The members of his committee are: U. T.
Jensen, M. D., internist; R. M. Lemmon, M. D.,
general practitioner and a past president; F. W.
Crocker, M. D., pediatrician; D. M. Evans, M. D.,
surgeon; R. G. McCready, M. D., urologist and a
past president; and D. W. Mathias, M. D., ophthal-
mologist and current SCMS secretary.
They will take as the basis for their May and June
discussions of the two deferred contract reviews in
group practice the following AMA actions on group
practice. The time each committee member has de-
voted to studying such rulings has given him a new
kind of "medical specialty.” Here’s what the AMA
has had to say about groups hiring physicians ac-
cording to the committee:
PRINCIPLES APPLY TO MEMBERS OF
GROUP OR PARTNERSHIP
The ethical principles controlling group practice
are the same as for the individual. Since the prin-
ciples of ethics for private practice absolutely forbid
the splitting of fees under any and all circum-
stances, the same rule applies to group practice and
the group formed must be a real partnership in
which the total income is divided not equally but
according to the individual income earned by the
member. ( House of Delegates, AMA, 1947)
CLINIC
The Principles of Medical Ethics are themselves
the criteria by which the ethical nature of profes-
sional conduct is determined. In connection with
any definition of the word "clinic,” it should be
clear that regardless of how clinic is defined each
physician-member of the clinic must act, in his rela-
tions with his patients and his colleagues, in accord
with all the Principles of Medical Ethics. No
physician member of a clinic may permit the clinic
to do that which he may not do. Each physician
must observe all the Principles of Medical Ethics.
Under the ethical principles of medicine no use
may properly be made of the word clinic that
for May, 1966
501
would mislead or deceive the public, or would tend
to be a solicitation of patients to the particular
group of physicians holding themselves out as a
"clinic.” (judicial Council, AMA, 1957)
GROUPS AND CLINICS
The ethical principles actuating and governing a
group or clinic are exactly the same as those appli-
cable to the individual. As a group or clinic is
composed of individual physicians, each of whom,
whether employer, employee or partner, is subject
to the principles of ethics herein elaborated, the
uniting into a business or professional organization
does not relieve them either individually or as a
group from the obligation they assume when enter-
ing the profession. (Principles of Medical Ethics,
1955 edition, Chapter I, Section 3)
DIVISION OF INCOME BY MEMBERS
OF A GROUP
The 1946 report of the Judicial Council states,
in part, that "The division of income given to
members of a group practicing jointly or in a
partnership must be in proportion to the value of
the services contributed by each individual partici-
pant.” The 1947 report of the Council states,
"Since the principles of eithics for private practice
absolutely forbid the splitting of fees under any
and all circumstances, the same rule applies to
group practice; and the group formed must be a
real partnership in which the total income is di-
vided not equally but according to the individual
income earned by the member.”
In order to clarify its position with respect to
the division of group or partnership income the
Judicial Council approves and publishes the fol-
lowing rephrasing of its 1946 and 1947 reports
on this subject:
The division of income among members of a
group, practicing jointly or in partnership, may be
determined by the members of the group and may
be based on the value of the professional medical
services performed by the member and his other
services and contributions to the group. (Judicial
Council, 1959)
* * *
Contract Practice — voluntary and compulsory ad-
judication — a delicate balance of both. It’s work-
ing—-but for how long? Reaction is present from
hospitals who want reference to society membership
taken out of staff by-laws. They say this is illegal,
based on certain court decisions elsewhere. There
have been none in Ohio. The Society proposes "re-
quiring certification by the society.” This is legal.
Trustees seem to agree. Comments by Joint Com-
mission inspectors, far from the front lines of cur-
rent private enterprise medicine and its problems,
consciously or unconsciously fan the flames with typi-
cal academic ignorance.
Insurance companies could be upset by split bills,
social and personal pressures, dig in their heels and
refuse direct billing payments. Hospital manage-
ment, JCAH, insurance companies, an unfriendly
public press — all or any could destroy the delicate
balance. Yet, all could gain a great deal by be-
friending this honest effort for integrity, and some
are showing that they’re wise enough, equally dedi-
cated and understanding. If nothing else, even if
the precipitous plunge into inflationary third party
medicine cannot be reversed and the diving doctors
and contractors brought back up, it seems the plunge
can be checked. It certainly is fair to assume, at
worst, that new contracts will be approached with
new insight and caution by all everywhere.
As always, it takes action, dedication and sacrifice
at the county level, but outsiders think county societies
are ridiculous unless they can point to state and na-
tional policies and actions of similar intent. Neither
is lacking in the case of contract practice.
Maternal and Child Care Conference
Scheduled in San Francisco
A National Conference on Infant Mortality is be-
ing sponsored by the American Medical Association’s
Committee on Maternal and Child Care on Au-
gust 12-13 at the Fairmont Hotel in San Francisco,
California.
An open invitation to attend is being extended to
chairmen and members of all state and county Mater-
nal and Child Care; Perinatal and Maternal Mortality
Committees; State Health Department Directors of
Maternal and Child Health; medical school faculty
members in Departments of Obstetrics and Gyne-
cology, Pediatrics, and Preventive Medicine. Other
interested physicians and representatives of groups
concerned with the problems of infant mortality are
also invited to attend.
Those interested in receiving further information
about registration for the Conference should write
the Secretary, Committee on Maternal and Child
Care, American Medical Association, 535 North Dear-
born Street, Chicago, Illinois 60610.
Dr. Clement F. St. John, vice president of Uni-
versity of Cincinnati and director of the university’s
medical center, has been named president-elect of the
Ohio State University Medical Alumni Association.
Dr. G. Adolph Ackerman, associate professor of
anatomy in the Ohio State University College of
Medicine, presented a paper during a symposium on
"The Lymphocyte in Immunology and Haemopoiesis”
April 13-16 in Bristol, England. The symposium
was sponsored by the department of anatomy of the
Medical School at Bristol.
502
The Ohio State Medical Journal
The Ohio State Surgical Association presents . . .
Medicare:
Another
Viewpoint”
by THOMAS L. DWYER, M.D
Mexico, Missouri
President
Association of American
Physicians and Surgeons
THURSDAY, MAY 26th
CLEVELAND
Dr. Dwyer will speak at a banquet in the Cleveland Room of the Sheraton Cleveland Hotel which
is open to non-members of OSSA by pre-registration. Dr. Dwyer’s appearance is the Association's
contribution to the combined medical meeting idea actively sought by OSMA. We regret that Dr.
James Z. Appel, President of the American Medical Association, could not appear on the program
with Dr. Dwyer, but we have announced to our membership that the earlier talk by Dr. Charles L.
Hudson, President-Elect of the AMA, on “Medicare’s Rules and Regulations and Their Effect on
the Practice of Medicine,” as well as the Friday speech by Dr. Edward R. Annis, Past President of
AMA, on “Care of the Patient, 1966,” should be considered a part of our Association’s total pro-
gram. From these three offerings on the Medicare program, it is hoped that our membership can
obtain the information they need to arrive at an individual decision on the matter of Medicare
participation or non-participation. The Association itself has not taken a stand. -Please com-
plete and mail the form below if you wish to attend the banquet at which Dr. Dwyer will speak.
ROBERT G. SMITH, M. D.
President
Please reserve.
.tickets at $10.00 each for the Ohio State Surgical Association reception and banquet at which Dr.
Thomas L. Dwyer, President of the Association of American Physicians and Surgeons, will speak.
Enclosed is my check for
reception hour preceding the banquet.
I will pay upon arrival.
Thank you.
understand that there will be no additional charges during the
name (please print or use stamp)
address
member non-member
Mail to: Ohio State Surgical Association
526 E. Dunedin Rd.
Columbus, Ohio 43214
Obituaries
Ad Astra
Fred W. Dixon, M. D., distinguished Cleveland
physician and surgeon of long standing, and Past
President of the Ohio State Medical Association, died
on April 11 at the age of 77.
First elected to The Council of OSMA in 1944,
Dr. Dixon served as Councilor of the Fifth District
for six years before he was named President-Elect
in 1950. He served on The Council respectively as
President-Elect for the 1950-1951 term, President for
1951-1952, and Immediate Past President for 1952-
1953. Before being named to The Council, he was
for five years on the OSMA
Committee on Scientific
Works and prior to that ser-
ved as secretary and chair-
man, respectively, of the Sec-
tion on Eye, Ear, Nose and
Throat.
Dr. Dixon received his
medical degree from the
University of Pennsylvania
Medical School in 1917,
and, after the internship in
Youngstown, went into mil-
Dr. Dixon itary service during World
War I. After the war he located in Leetonia where
he engaged in general practice for four years. He
studied at the New York Eye and Ear Infirmary and
in Vienna before opening his practice in Cleveland
for specialization in otolaryngology.
He was certified by the American Board of Oto-
laryngology, was a member of the American Academy
of Ophthalmology and Otolaryngology, a member
and past president of the American Laryngological
Association, member of the American Laryngology,
Rhinology and Otology Society; member of the
American Broncho-Esophagological Association and
editor of its publication; Fellow of the American
College of Surgeons, and former member of its
board of governors.
He served on the faculty of Western Reserve Uni-
versity School of Medicine and wrote extensively for
medical publications in his specialty field.
Survivors include his widow, a sister, a brother,
George Dixon, D. D. S., of Struthers.
Joseph Henry Clouse, M. D., Somerset; Ohio State
University College of Medicine, 1921; aged 68; died
March 16; member of the Ohio State Medical Asso-
ciation and the American Medical Association. A
native of the Somerset area, Dr. Clouse returned
there to practice after completing his medical train-
ing. He was stricken while attending a patient and
died before reaching the hospital. A veteran of
World War I, he was a member of the American
Legion. Other affiliations include membership in the
Catholic Church. Survivors include a daughter, a
son, two sisters, and two brothers.
Charles Kenneth Ervin, M. D., Cincinnati; Uni-
versity of Cincinnati College of Medicine, 1910;
aged 86; died March 26; former member of the Ohio
State Medical Association. A practicing physician of
long standing in Cincinnati, Dr. Ervin retired in 1947.
He served in the Army Medical Corps during World
War I and attained the rank of major. A member of
the Presbyterian Church, he is survived by his widow,
a daughter and a sister.
Thomas D. Hunnicutt, M. D., Cincinnati; Uni-
versity of Cincinnati College of Medicine, 1943;
aged 47; died March 23; member of the Ohio State
Medical Association and the American Academy of
General Practice. Dr. Hunnicutt entered practice
after serving in the Armed Forces during World
War II. He was a general practitioner for about 19
years in the College Hill area. Surviving are his
widow, a son, a daughter, his parents and a sister.
Lawrence Neff Irvin, M. D., Lima; Ohio State
University College of Medicine, 1930; aged 60; died
March 17; member of the Ohio State Medical Asso-
ciation, the American Medical Association, the Amer-
ican College of Physicians, and the American Society
of Internal Medicine; diplomate of the American
Board of Internal Medicine. A native of Lima,
Dr. Irvin returned there to practice internal medi-
cine in 1949. He previously was engaged in gen-
eral practice at Ohio City. He was a past president
and former secretary of both the Van Wert County
Medical Society and Academy of Medicine of Lima
and Allen County. Other affiliations included mem-
berships in several Masonic bodies. Surviving are
his widow, a son, three brothers and a sister.
Bela Klein, M. D., Cincinnati; Friedrich Wilhelms
University Faculty of Medicine, 1930; aged 63; died
April 3; member of the Ohio State Medical Associa-
tion, the American Medical Association, and the
American Psychosomatic Society. A native of Hun-
gary, Dr. Klein came to this country after receiving
his medical education in Europe, and practiced for
about 30 years in Cincinnati. Survivors include his
widow and a son; also two sisters who are residents
of Israel.
Carl Allinger Koch, M. D., Cincinnati; Univer-
sity of Cincinnati College of Medicine, 1930; aged
504
The Ohio State Medical Journal
64; died March 14; member of the Ohio State Medi-
cal Association, the American Medical Association,
and the American Academy of Pediatrics; diplomate
of the American Board of Pediatrics. A Cincinnati
physician since 1929, Dr. Koch was a veteran of
World War II, during which he served in the Air
Force Medical Corps. He was a past president of
the Child Health Association and the Cincinnati
Pediatrics Society. Surviving are his widow, a son
and a daughter; also a sister.
Orville J. Lighthizer, M. D., Ashtabula; New York
University School of Medicine, 1936; aged 61;
died March 5; member of the Ohio State Medical
Association and the American Medical Association.
A physician and surgeon in Ashtabula since 1941,
Dr. Lighthizer accepted the post as city health com-
missioner six years ago and has held it since. He
was a member of the Episcopal Church. Survivors
include two sons, two brothers and two sisters.
Warren L. Strohmenger, M. D., Cincinnati; Uni-
versity of Louisville School of Medicine, 1931; aged
59; died March 21; member of the Ohio State
Medical Association and the American Academy of
General Practice. A practicing physician for many
years in Cincinnati, Dr. Strohmenger was deputy
Hamilton County coroner for 19 years. He was
an officer in the Naval Reserve and during World
War II served in active duty in the South Pacific. A
member of the Masonic Lodge, he is survived by
his widow and a daughter.
Sigmund Henry Smedal, M. D., Mansfield; Har-
vard University Medical School, 1936; aged 54; died
March 23; member of the Ohio State Medical As-
sociation, the American Medical Association, Ameri-
can Society of Anesthesiologists, and the International
Anesthesia Research Society. A physician in Mansfield,
specializing in anesthesiology since 1949, Dr. Smedal
served in the Army Medical Corps during World War
II, and served 30 months in the Mediterranean Theater.
In addition to his professional affiliations, he was a
member of the Chamber of Commerce. Survivors
include his widow and a sister.
Rose Symmes, M. D., Toledo; Cincinnati Medical
College, 1903; aged 95; died March 22. Dr. Symmes
practiced in Dayton until she married in 1908, when
she and her husband moved to Cygnet, Ohio. When
her husband died in 1951, she moved to Toledo.
The dmg concern which first devised a method of
making cortisone from cattle bile used over 32 proces-
sing steps and 20 patented inventions and lost money
selling the arthritis drug at $200 per gram in 1949.
By the end of 1951, further processing improvements
made it possible to reduce the price of cortisone to
45 cents per gram.
Where do you do
your banking
Your Credit Bureau is a clear-
ing house of credit facts upon
which you can, and should draw
— facts carefully maintained
and listed by families in your
community.
The family credit record is an
asset to both creditor and bor-
rower or credit seeker. It makes
credit or financing available to
those whose character, depend-
ability, employment record and
paying habits warrant. It pre-
vents the seeker “getting in
too deep” — to his own detri-
ment and his creditors’ loss.
Each family creates its own set
of facts through its credit
actions and the recording of
those actions by your Credit
Bureau . . . Those facts are
available to help you give credit
where credit is due — to with-
hold it where it isn’t, thereby
protecting your business and
profits.
Make your local Credit Bureau
your Bank of Credit Facts.
ASSOCIATED
CREDIT BUREAUS
OF OHIO
P. 0. Box 1114, Lima, Ohio 45802
for May, 1966
505
Honors to Dr. Platter
• • •
118th OSMA Annual Meeting Will Be Dedicated
To Patriarch of Medical Profession in Ohio
THE 118th Annual Meeting of the Ohio State
Medical Association will be dedicated to Herbert
Morris Platter, M. D., who retired on January 1,
1966, after 48 years of service to the medical profes-
sion and the public as Secretary of the State Medical
Board of Ohio.
Dr. Platter will be appropriately honored during
the First Session of the Association’s House of Dele-
gates on Tuesday, May 24, at the Sheraton-Cleveland
Hotel. The session will open at 6:00 p. m. (d. s. t.)
Honors will be bestowed by representatives of the
Association, the State Medical Board and the State
of Ohio. Participating in the ceremonies will be
Henry A. Crawford, M. D., OSMA President, and
John W. Brown, Ohio’s Lieutenant Governor.
Below is an excerpt from an editorial which was
published in the June, 1931 issue of The Ohio State
Medical journal upon the occasion of Dr. Platter’s
election to the office of President-Elect of the Asso-
ciation:
"By selecting Dr. H. M. Platter of Columbus as Presi-
dent-Elect, the House of Delegates again followed the long-
established precedent that none but the best deserve the
honor or are capable of meeting the requirements of the
presidency.
"For many years, Dr. Platter has been a wheelhorse in
organized medicine in Ohio, serving as counsel and adviser
for many who have found the numerous problems and ques-
tions of organization activities confusing and perplexing.
While serving as treasurer of the State Association for the
past 14 years, Dr. Platter has never confined his active in-
terest in organized medicine to that particular office, but,
at all times, has been willing to give his time, splendid
judgment and experience to the Council and the various
Association Committees. His advice on matters of public
policy has been solicited time and time again and found
of immeasurable value to those faced with the responsibility
of making important decisions on matters involving prin-
ciples and procedure. His knowledge on questions relative
to medical education and licensure, obtained in part from
many years of active participation in licensure activities as
secretary of the State Medical Board and as an official and
former President of the National Federation of State Licens-
ing Boards, has stamped him a nation-wide authority in
this particular field.
"Dr. Platter’s keen understanding of social and economic
problems affecting medicine has made him a most valuable
conferee for committees studying these questions. His ex-
perience in public health work has given him a broad in-
sight into the innumerable problems in that field of medicine.
His modest, courteous, kindly, sincere, gentlemanly and
gracious manner, coupled with his loyaltv to the ideals of
medicine and his unselfish desire to serve in every way
possible to advance the cause of his profession and to work
for the best interests of the public generally, have marked
him a peer among the outstanding citizens of his community,
home city and state, and established his ability to serve as a
leader among his professional colleagues.”
This excerpt summarizes Dr. Platter’s life as a
citizen and a physician and makes clear the reasons
for honoring him by dedicating the Annual Meeting
to him. A resolution formalizing this action will be
presented at the First Session of the House of Dele-
gates. That resolution is printed on page 481 of this
issue.
Set forth below is the complete schedule of events
for Tuesday night, May 24:
TUESDAY, MAY 24
5 :00 p. M. (d. s. t.)
House of Delegates
Registration
(Gold Room Assembly, Mezzanine Floor)
6:00 p. ,M (d. s. T.)
House of Delegates
Complimentary Dinner for Delegates,
Alternates, and OSMA Council
(Whitehall Room, Mezzanine Floor)
7 :30 p. M. (d. s. t.)
House of Delegates
First Business Session
(Gold Room, Mezzanine Floor)
Invocation — The Reverend Frederick T. Schumacher,
The First Church in Oberlin, Oberlin.
Welcome by David Fishman, M. D., Cleveland, Acad-
emy of Medicine of Cleveland and Cuyahoga
County.
Introduction of President Henry A. Crawford, M. D.,
Cleveland.
Roll Call of Delegates.
Consideration of the Minutes of the last Annual
Meeting (July, 1965 issue of The journal).
506
The Ohio State Medical Journal
Dr. Crawford Lt. Gov. Brown
Introduction of honored guests.
Presentation of AMA-ERF checks to representatives
of the University of Cincinnati College of Medi-
cine; Western Reserve University School of Medi-
cine; and Ohio State University College of Medicine
— Robert S. Martin, M. D., Chairman, Ohio Com-
mittee on AMA-ERF.
Presentation of plaques honoring physicians serving
with Project Viet Nam — Dr. Crawford.
Ceremonies honoring Herbert Morris Platter, M. D.,
Secretary of the Ohio State Medical Board for 48
years, to whom the entire 1966 Annual Meeting
is dedicated. Participating in the ceremonies will
be: Dr. Henry A. Crawford, President of the
Ohio State Medical Association, Lt. Governor John
W. Brown and others.
Report by the President of the Woman’s Auxiliary — -
Mrs. Herbert F. VanEpps, Dover.
Appointment of Reference Committees by the Presi-
dent:
Credentials
President’s Address
Resolutions
Tellers and Judges of Election
Nomination and election of Committee on Nomina-
tions: (Nominations from the floor. One represen-
tative (delegate) from each Councilor District.
The Committee shall report to the Final Session,
Friday, May 27, 9:00 A. M., its recommendations
in the form of a ticket containing nominees for
offices to be filled at this meeting as required under
the Constitution and Bylaws.)
Introduction of Resolutions:
(Resolutions must be introduced at this session
of the House of Delegates, referred to the Ref-
erence Committees on Resolutions, and reported
back to the House of Delegates at the Friday
morning session before any action can be taken.
All resolutions must be typewritten and sub-
mitted in triplicate.)
Announcement of meeting places of Reference Com-
mittees.
Miscellaneous business.
Announcements of Annual Meeting events.
Recess.
Ohioans Have Special Interest in
Coming AMA Annual Convention
Ohioans will have a particular interest in the com-
ing 115th American Medical Association Annual Con-
vention in Chicago, June 26-30. During the Con-
vention, Dr. Charles L. Hudson, of Cleveland, who is
now serving as AMA President-Elect will be installed
as President for the coming year. Watch for the
June issue and additional information on the in-
auguration and other highlights of the convention.
This year the AMA Annual Convention presents
an even wider and greater range of medical subjects
than before, even though the scope of subjects cov-
ered has been increasing from year to year.
This year’s convention will be held in the magni-
ficient McCormick Place, one of the largest and most
modern facilities available anywhere. Among features
will be six general scientific meetings; 23 medical
specialty programs; 800 scientific and industrial ex-
hibits; lectures, panel discussions, motion pictures
and color television.
The May 9 issue of The Journal of the AMA will
contain the complete program.
The American College of Chest Physicians will
again join the AMA Section on Diseases of the
Chest in an all day program.
The American College of Cardiology and the Amer-
ican Heart Association will join the AMA Section
on Internal Medicine in a half-day session.
The American Society of Clinical Pathologists
will join the AMA Section on Pathology and Physi-
ology in a half-day session on Computers in Medicine.
The foregoing are only a few examples of the
many specialty organizations that are cooperating in
the AMA program. Medical Motion Pictures and
Color Television programs will be presented daily,
and some of the Sections will participate in these
programs.
House of Delegates functions will be in the Pal-
mer House. Watch for May 9 JAMA and details.
A special feature of the AMA Convention will be
a guided tour of the AMA headquarters facilities at
535 N. Dearborn Street, and the new Institute for
Biomedical Research. All physicians, their wives and
guests are invited to tour the building.
The Woman’s Auxiliary to the AMA will hold
its 43rd annual convention June 26-30. On June 26,
a reception will honor the Auxiliary president and the
president-elect. On Tuesday, June 28, national past
presidents and AMA officers, trustees, and their
wives will be guests of honor at a luncheon.
Persons planning to attend the convention are
advised to refer to advance registration forms and
housing accommodation forms now appearing in
AMA publications. Advance registrations save pre-
cious time at the convention. Advance housing re-
servations are a must for any convention as exten-
sive as the AMA Annual Convention.
for May, 1966
507
'Wtafae fyo-cvi
HOTEL RESERVATIONS -NOW
FOR THE
1966 OSMA ANNUAL MEETING
CLEVELAND
Leading Downtown Cleveland Hotels
and Prevailing Rates
SHERATON-CLEVELAND HOTEL
(Headquarters)
Public Square
Singles to $12.50
Doubles $14.50-16.50
Twins 17.00-22.50
AUDITORIUM HOTEL
1315 East 6th Street
Singles $ 6.00 - 1 0.50
Doubles 8.50-12.50
Twins 12.50-13.50
STATLER HILTON HOTEL
Euclid & East 12th Street
Singles $ 8.00 - 15.50
Doubles 14.00-17.50
Twins 16.00-30.00
All of the above rates
are subject to change
If you plan to share a room, please indicate name
of ro ommate so the hotel may avoid duplicate
reservations.
MAY 24-28
HOTEL RESERVATION BLANK
(Mail to Hotel of Choice)
(NAME OF HOTEL)
Cleveland, Ohio
(ADDRESS)
Please reserve the following accommoda-
tions during the period of the Ohio State
Medical Association Annual Meeting,
May 24 - 28 (or for period indicated)
j | Single Room
I | Double Room
] Twin Room
Other accommodations
Price range
Arriving May at A.M P.M.
PLEASE VERIFY MY RESERVATION
Name
Address
508
The Ohio State Ale die al Journal
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for May, 1966
509
W Oman’s Auxiliary Highlights . . .
By MRS. S. L. MELTZER, Publicity Committee
Chairman, 2442 Dorman Dr., Portsmouth 45662
T
"THE YEAR is drawing to a close for Mrs. Her-
bert F. Van Epps as president of the Woman’s
Auxiliary to the Ohio State Medical Assocition.
It has been a good year, and she has been a good
president. For those of us who have had the priv-
ilege of working with her, that previous statement
did not need to be said, because we are all well aware
of it. But to the many doctors’ wives throughout
the state to whom the name of the State president is
better known than the lady herself, it seems fitting
at this time to point out that we have had a consci-
entious, interested, competent, keenly aware leader
who has never spared herself, and who has always
had a sympathetic ear for anyone — and everyone !
It has not been customary to give accolades to re-
tiring presidents in this column, which has been a
serious oversight, I think (and one of which I myself
have been guilty). Any woman who assumes the
presidency of the State Auxiliary gives so much of
herself to the job that it is difficult to comprehend
and appreciate it fully. We — the members of the
Auxiliary — owe her a deep debt of gratitude. We
owe it to her too to be present at her Convention —
to show her, by our very presence, that we have been
and are behind her and that we are truly grateful for
all she has done. To Mary Louise Van Epps — our
own printed orchid for a job well done !
Come to Convention, won’t you? It’s in Cleveland
this year, at the Sheraton-Cleveland Hotel — May 24
through 27. It will be a time of accomplishment
and a time of fun. You can’t afford to miss it.
The OMPAC Luncheon
This is a Convention "must” — on Wednesday,
May 25, in the Gold Room, Mezzanine Floor, Sher-
aton-Cleveland Hotel, the luncheon at 12:00 noon
sponsored by the Ohio Medical Political Action Com-
mittee. Cost of the luncheon — $5 per person.
Dr. Frank Mayfield, chairman of OMPAC, will be
the presiding officer and will present vital legislative
and political problems confronting the medical pro-
fession as well as present a progress report on
OMPAC. Dr. Hoyt Gardner, member of the Board
of Directors of AMPAC, will speak on "Success Can
Be Ours.” Dr. Gardner is a diplomate of the Ameri-
can Board of Surgery and a Fellow of the American
College of Surgeons who practices in Louisville,
Kentucky. His outstanding activity in the KEMPAC
and AMPAC organizations qualifies him well to
present the story on Political Action. Following Dr.
Gardner’s talk, there will be a period for questions
and answers.
All you local legislative chairmen — take note !
Do everything you can to help sell tickets for this
luncheon. This occasion is far more than a lunch-
eon — it is a school of instruction for every doctor’s
wife — an opportunity to learn so that you in turn
can pass on information that is vital. Whether you
like it or not, politics is your business ! ! Every
citizen has a duty to promote good government.
People like us have a special responsibility to be well
informed and prepared to answer others on affairs of
government and politics.
Don’t by-pass this important luncheon. The
most valuable thing you can shop for Wednesday,
May 25, at noon, is KNOW-HOW. And that
KNOW-HOW is yours for the taking in the Gold
Room of the Cleveland-Sheraton Hotel.
Around the State
From the Clermont County auxiliary has come an
interesting "bird’s-eye” view of its activities this year
that included an all-out campaign on a hospital bond
issue, a Community Service Program from Home
Health Aids and Family Service of the Cincinnati
area, and a Safety in the Home program.
THE WOMAN’S AUXILIARY TO THE OHIO STATE MEDICAL ASSOCIATION
President : Mrs. Herbert F. Van Epps
425 E. 15th St., Dover 44622
Vice-Presidents : 1. Mrs. A. L. Kefauver
4421 Aldrich PI., Columbus 43214
2. Mrs. M. W. Sloan, II
415 Towerview Rd., Dayton 45429
3. Mrs. Edward L. Doerman
3605 Laskey Rd., Toledo 43623
Past-President and Nominating Chairman:
Mrs. John D. Dickie
2146 Shenandoah Rd., Toledo 43607
President-Elect: Mrs. James Wychgel
3320 Dorchester Rd., Cleveland 44120
Recording Secretary : Mrs. J. W. Loney
15450 Hemlock Point Rd., Chagrin Falls
Corresponding Secretary : Mrs. C. Raymond Crawley
1507 Seven Mile Dr.,
New Philadelphia 44663
Treasurer : Mrs. R. L. Wiessinger
2280 W. Wayne St., Lima 45805
510
The Ohio State Medical Journal
To raise funds for AMA-ERF, the Clermont
women have come up with a novel idea — to have
a "surprise packet” at each meeting to be chanced
off. Each person attending buys a slip of paper for
a dollar. On each slip is written something in the
same category as the packet. At one meeting, it was
20 pounds of apples and the slips were written in
French. At another, a book "Design with Flowers”
was the surprise. At still another time, the surprise
packet was an outstanding centerpiece that featured
a huge square white and gold candle. Recently, in
keeping with the season, a "Breath of Spring” gift
package featured the AMA-ERF gimmick. No end,
seems like, to the ingenuity of doctors’ wives !
The Hamilton County group has come up with
some more of its outstanding newspaper publicity —
this time the Cincinnati Post and Tbnes-Star has de-
voted almost two-thirds of a page to a terrific story
on the Apple Tree (you recall that is the unusual
children’s day-care center run by the auxiliary to
enable mothers who are nurses and other important
hospital personnel to continue to work in the hospitals
that need their sendees so badly). The group held
a highly successful "Flower Basket of Fashion” at
the Fookout House on March 15, following a lunch-
eon. Daytime clothes, sportswear, casuals and eve-
ning gowns by famous designers were modeled by
23 physicians’ wives in cooperation with Gidding-
Jenny of Cincinnati.
With flowers still holding the center of the stage,
the Hamilton women came up with something new at
their April meeting — creating floral arrangements
in containers from the medical laboratory! It hap-
pened on April 19 and the place was, fittingly enough,
the Cincinnati Art Museum. Mrs. Francis Gleason,
accredited flower judge, discussed "Fleurs d’Avant
Garde.” Mrs. Gleason is a teacher on abstract ar-
rangements at the Garden Center and is the author
of "Think a Theme,” a book of ideas for flower
shows. Importance of flowers in man’s pharmaceuti-
cal progress prompted Mrs. John Toepfer, local presi-
dent, to invite members of the Pharmaceutical Asso-
ciation Auxiliary to share the program. The wives
of foreign physicians serving internships and resi-
dencies in Cincinnati hospitals were also Auxiliary
guests. Mrs. John Marioni, chairman of interna-
tional hospitality, was in charge of those arrange-
ments. Garden hobbyists who contributed the "avant
garde” floral arrangements included: Mrs. Charles
D. Feuss, Mrs. Kenneth Frederick, Mrs. J. Philip
Fox, Mrs. N. G. Amato, Mrs. Robert J. Anzinger,
Mrs. Joseph M. Casper, Mrs. Edward J. Devins,
Mrs. Fowell E. Goiter, Mrs. Maurice D. Marsh,
Mrs. James S. Mills, Mrs. Robert E. Khuon, Mrs.
Fester W. Sanders, Mrs. Carl H. Wendel, Mrs. Wal-
ter B. Wildman and Mrs. F. F. Zacharis, Mrs. E. A.
Kindel, Jr., was in charge of arrangements for the
luncheon.
Goings-On in Lucas
Here is another auxiliary group always doing some-
thing that smacks of the unusual. In early March,
the Lucas County group and the Academy held a
joint meeting about the current water pollution prob-
lem. "Apathy or Action” was the program’s title.
Mrs. Paul Findlay and Dr. G. Harrison Orians, of the
Toledo University faculty, presented the case for a
cleaner Maumee.
The spring session of the Adoptive Parents Classes
started in March at the Board of Education building.
Mrs. Burton Nelson is chairman of the project.
The annual Bridge Luncheon of the Lucas women
was held on April 19 at the Academy. This is an
annual AMA-ERF event with a door prize, indi-
vidual table high score gifts and chances on additional
prizes. Mrs. John Van der Veer was chairman, with
Mrs. Harvey Muehlenbeck serving as cochairman.
The annual recognition luncheon for CDC volunteers
was held on April 25. This year’s theme, as an-
nounced by Mrs. A. J. Kuehn, was a "Royal Lunch-
eon for Citizen’s Day Care Queens.” Mrs. Spencer
Northup was chairman of the day’s activity. Mrs.
Daniel Wolff, Health Careers chairman, was in
charge of the annual field trip on April 23 to Henry
Ford Hospital in Detroit. An invitational dessert
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for May, 1966
511
meeting in March featured a talk on contemporary
poets by the interim pastor at First Unitarian Church,
Dr. Herbert Hitchen. Mrs. Brian Bradford and Mrs.
Jack Burnheimer served as cochairmen, assisted by
Mrs. Max Schnitker and Mrs. J. M. Hobbs.
At a recent ''Aircade for Citizenship Action,” the
auxiliary was represented by Mrs. John Dickie and
Mrs. Daniel Sullivan. The Aircade is an annual
event sponsored by the U. S. Chamber of Commerce,
during which a group of panelists is flown in char-
tered planes to various cities across the nation. This
year, Toledo was host to the third of a series of 15
such meetings. The panel urges political action and
is well set up to handle questions from the floor.
They covered such current topics as urban renewal,
medicare, regional development, farm legislation, the
Appalachia program, minimum wage increase, and so
on. The Lucas County auxiliary, like its sister auxi-
liary in Hamilton County, is particularly fortunate in
its excellent newspaper coverage. Mrs. Charles M.
Klein, whose job it is to keep this column informed
on her group’s doings, never fails to have a batch
of clippings to send each month. Could I possibly
be — hinting — that perhaps other groups have plenty
of clippings too, only they’re not coming my way?
REMEMBER — all roads lead to Cleveland and
a wonderful convention.
Ohio State University Offers
Courses for Physicians
Ohio State University College of Medicine, Colum-
bus, offers a number of postgraduate courses of in-
terest to physicians. Information on these courses
may be obtained by contacting the Center for Con-
tinuing Medical Education at the Medical Center.
Among courses offered in the near future are the
following:
Third Annual Professional Symposium on Kid-
ney Disease, May 11, jointly sponsored by the Cen-
tral Ohio Chapter of the National Kidney Foundation.
Fourth Annual Occupational Medicine Post-
graduate Course, June 20-24.
Library Photoduplication Service
Offered to Research Groups
The library of the National Society for Crippled
Children and Adults has initiated a library photo-
duplication service to persons engaged in rehabilita-
tion research. As a research project, the service is
supported in part by a one-year grant of $10,902
from the U. S. Vocational Rehabilitation Administra-
tion.
The service is available without charge to personnel
in any educational or research institution and any
health or welfare agency, public or private, who may
be engaged in rehabilitation research. When a need-
ed journal reference is not available from local re-
sources, the person may request a photocopy from the
library of the National Society, at 2023 W. Ogden
Ave., Chicago.
A Future in Family Medicine
Is Topic for OSU Lecture
Dr. Robert E. Carter, assistant dean of the Uni-
versity of Iowa College of Medicine, spoke on the
topic, "A Future in Family Medicine” at a recent
Ohio State University College of Medicine lecture
program.
Dr. Carter, who is also a professor of pediatrics,
served his internship at Cleveland City Hospital and
received his residency training at the University of
Chicago Clinic.
He was a Markle Scholar in the Medical Sciences
from 1957-62, is a fellow of the American Academy
of Pediatrics, and a member of the Society for Pediat-
ric Research.
Hobbyists are warned by the USPHS to use silver
solder containing cadmium metal only with caution.
Vapors resulting when this product is overheated can
be dangerous. Cadmium is used only in certain types
of silver solder. The commonly used tin-based sol-
ders do not present this hazard, the report states.
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JOHN H. NICHOLS, M. D., Medical Director G. PAULINE WELLS, R. N., Admin. Director HERBERT A. SIHLER, Jr., Pres.
MEMBER: American Hospital Association — National Association of Private Psychiatric Hospitals — Ohio Hospital Association
512
The Ohio State Medical Journal
State Association Officers and Committeemen
Headquarters Office: 17 South High Street, Suite 500, Columbus 43215. Telephone 228-6971 (Code 614)
Henry A. Crawford, President
1058 Hanna Bldg., Cleveland 44115
Lawrence C. Meredith, President-Elect Robert E. Tschantz, Past-President
205 Elyria Block, Elyria 44035 515 Third Street, N. W., Canton 44703
Philip B. Hardymon, Treasurer
350 East Broad St., Columbus 43215
Mr. Hart F. Page, Executive Secretary
Mr. W. Michael Traphagan, Administrative Assistant
Mr. Charles W. Edgar, Director of Public Relations
and Assistant Executive Secretary
Mr. Herbert E. Gillen, Administrative Assistant
Perry R. Ayres, Editor
Mr. R. Gordon Moore, Executive Editor
THE COUNCIL
First District, Robert E. Howard, 2600 Union Central Bldg., Cincinnati 45202 ; Second District, Theodore L. Light, 2670 Salem Ave.,
Dayton 45406 ; Third District, Frederick T. Merchant, 1051 Harding Memorial Pky., Marion 43305 ; Fourth District, Robert N. Smith,
3939 Monroe St., Toledo 43606 ; Fifth District, P. John Robechek, 10525 Carnegie Ave., Cleveland 44106 ; Sixth District, Edwin R.
Westbrook, 438 North Park Ave., Warren; Seventh District, Benj. C. Diefenbach, 30 S. 4th St., Martins Ferry; Eighth District, Robert
C. Beardsley, 2236 Maple Ave., Zanesville; Ninth District, George N. Spears, 2213 So. Ninth St., Ironton ; Tenth District, Richard
L. Fulton, 1211 Dublin Rd., Columbus 43212 ; Eleventh District, William R. Schultz, 1749 Cleveland Rd., Wooster 44691.
COMMITTEES
Committee on Education — Thomas E. Rardin, Columbus, Chair-
man (1966) ; Clyde W. Muter, Warren (1970) ; Thomas S. Brow-
nell, Akron (1969) ; John G. Sholl, Cleveland (1968) ; Elmer R.
Maurer, Cincinnati (1967).
Judicial and Professional Relations Committee — Frank F. A.
Rawling, Toledo, Chairman (1968) ; Homer A. Anderson, Colum-
bus (1970) ; Chester H. Allen, Portsmouth (1969) ; David Fish-
man, Cleveland (1967) ; Paul A. Mielcarek, Cleveland (1966).
Committee on Public Relations and Economics — Frederick P.
Osgood, Toledo, Chairman (1969) ; Luther W. High, Millers-
burgh (1970) ; John H. Budd, Cleveland (1968) ; John J. Cranley,
Cincinnati (1967) ; Horace B. Davidson, Columbus (1966).
Committee on Scientific Work — Samuel Saslaw, Columbus,
Chairman (1968) ; Jack Schreiber, Canfield (1970) ; Walter J.
Zeiter, Cleveland (1970) ; John D. Battle, Jr., (1969) ; Harold
J. Schneider, Cincinnati (1969); Isador Miller, Urbana (1968);
William Hamelberg, Columbus (1967) ; F. A. Simeone, Cleveland
(1967) ; Ralph K. Ramsayer, Canton (1966) ; G. Douglas Talbott,
Dayton (1966).
Committee on Care of the Aging — Charles W. Stertzbach,
Youngstown, Chairman; James O. Barr, Chagrin Falls; Dwight
L. Becker, Lima ; Robert A. Borden, Fremont ; Edwin W.
Burnes, Van Wert; Philip T. Doughten, New Philadelphia;
Robert B. Elliott, Ada ; George T. Harding, Sr., Worthington ;
Roger E. Heering, Columbus ; M. Robert Huston, Millersburg ;
John S. Kozy, Toledo ; Francis M. Lenhart, Defiance ; Harold
E. McDonald, Elyria ; H. W. Porterfield, Columbus ; Elliot W.
Schilke, Springfield ; Bernard A. Schwartz, Cincinnati ; Clar-
ence V. Smith, Canton; Joseph B. Stocklen, Cleveland; Don P.
VanDyke, Kent; William M. Wells, Newark; Roger Williams,
Columbus.
Committee on Cancer — Arthur G. James, Columbus, Chairman ;
Thomas D. Allison, Lima ; Andrew M. Barone, Lima ; William
F. Boukalik, Cleveland; William J. Flynn, Youngstown; Douglas
P. Graf, Cincinnati; Stanley O. Hoerr, Cleveland; William A.
Newton, Jr., Columbus; W. D. Nusbaum, Lancaster; Arthur E.
Rappoport, Youngstown ; Carl A. Wilzbach, Cincinnati.
Committee on Eye Care — Arthur D. Collins, Cleveland, Chair-
man ; Martin J. Cook, Springfield ; Thomas L. Edwards, Lima ;
Robert H. Magnuson, Columbus ; Russell J. Nicholl, Cleveland ;
Claude S. Perry, Columbus; Norman W. Pinschmidt, Gallipolis;
Barnet R. Sakler, Cincinnati ; Robert L. Willard, Toledo.
Committee on Hospital Relations — William R. Schultz, Woo-
ster, Chairman ; L. A. Black, Kenton ; L. Fred Bissell, Aurora ;
Oscar W. Clarke, Gallipolis ; Robert M. Craig, Dayton ; John
V. Emery, Willard; Harvey C. Gunderson, Toledo; Philip B.
Hardymon, Columbus ; Middleton H. Lambright, Cleveland ;
Lloyd E. Larrick, Cincinnati; Joseph S. Lichty, Akron; James
C. McLarnan, Mt. Vernon ; Ben V. Myers, Elyria ; Robert A.
Tennant, Middletown ; V. William Wagner, Port Clinton ; Wil-
liam A. White, Canton.
Committee on Insurance — David A. Chambers, Cleveland,
Chairman ; William F. Bradley, Columbus ; Walter A. Daniel,
Tiffin ; Chester R. Jablonoski, Cleveland; William A. Knapp,
Zanesville; Marvin R. McClellan, Cincinnati; William Neal,
Archbold ; Oliver Todd, Toledo ; Robert E. Tschantz, Canton ;
Allan L. Wasserman, Dayton; John W. Wherry, Elyria; Wil-
liam A. White, Canton.
Committee on Laboratory Medicine — Horace B. Davidson, Co-
lumbus, Chairman ; William H. Benham, Columbus ; John B.
Hazard, Cleveland ; Melvin Oosting, Dayton ; Arthur E. Rap-
poport, Youngstown ; William Sinclair, Cleveland; Gilbert B.
Stansell, Toledo; Philip B. Wasserman, Cincinnati.
Committee on Legislation — James T. Stephens, Oberlin, Chair-
man ; Donald R. Brumley. Findlay ; George D. J. Griffin, Cin-
cinnati; Jack L. Kraker, Lancaster; Maurice F. Lieber, Canton;
Ralph F. Massie, Ironton ; James C. McLarnan, Mt. Vernon ;
Robert E. Rinderknecht, Dover; John H. Sanders, Cleveland;
Carl R. Swanbeck, Sandusky; William W. Trostel, Piqua.
Committee on Maternal Health — Anthony Ruppersberg, Co-
lumbus, Chairman ; Otis G. Austin, Medina ; Raymond E. Bar-
ker, Columbus ; William D. Beasley, Springfield ; Keith R.
Brandeberry, Gallipolis ; Thomas E. Byrne, Mentor ; C. Ray-
mond Crawley, Dover ; Mel A. Davis, Columbus ; Marion F.
Detrick, Jr., Findlay; John P. Garvin, Columbus; Richard P.
Glove, Cleveland; Robert A. Heilman, Columbus; John F. Hil-
labrand, Toledo; Robert E. Johnstone, Cincinnati; Albert A.
Kunnen, Dayton; James F. Morton, Zanesville; Ralph K. Ram-
sayer, Canton; Robert E. Swank, Chillicothe ; Densmore Thomas,
Warren ; Robert S. VanDervort, Elyria.
Committee on Medicine and Religion — George W. Petznick,
Cleveland, Chairman ; John D. Albertson, Lima ; Eugene F.
Damstra, Dayton; Francis M. Lenhart, Defiance; Ralph W.
Lewis, Portsmouth ; J. Kenneth Potter, Cleveland ; Charles A.
Sebastian, Cincinnati ; John R. Seesholtz, Canton ; William B.
Smith, Zanesville; James T. Stephens, Oberlin; Donald J. Vin-
cent, Columbus ; Don G. Warren, West Lafayette.
Committee on Mental Health — Wendell A. Butcher, Columbus,
Chairman ; Homer A. Anderson, Columbus ; Max D. Graves,
Springfield ; Charles W. Harding, Worthington ; Warren G.
Harding, II, Columbus ; Henry L. Hartman, Toledo ; J. Robert
Hawkins, Cincinnati ; William H. Holloway, Akron ; Nathan
B. Kalb, Lima ; Thomas E. Rardin, Columbus ; Philip C. Rond,
Columbus; Victor M. Victoroff, Cleveland; John A. Whieldon,
Columbus.
Committee on Disaster Medical Care — Thomas D. Allison,
Lima, Chairman ; Thomas P. Bowlus, Toledo ; Nino M. Cam-
ardese, Norwalk ; Drew L. Davies, Columbus ; John H. Davis,
Cleveland ; Gregory G. Floridis, Dayton ; Robert D. Gillette,
Huron ; Robert S. Heidt, Cincinnati ; N. J. M. Klotz, Wads-
worth ; Thomas W. Morgan, Gallipolis ; Sterling W. Obenour,
Jr., Zanesville; Vol K. Philips, Columbus; Elden C. Weckesser,
Cleveland; (Liaison with the American Medical Association)
Wendell A. Butcher, Columbus.
Military Advisory Committee — Drew L. Davies, Columbus,
Chairman ; A. A. Brindley, Maumee ; Ralph G. Carothers, Cin-
cinnati ; Homer D. Cassel, Dayton ; Henry A. Crawford, Cleve-
land ; Walter L. Cruise, Zanesville ; Charles R. Keller, Mans-
field ; Ralph W. Lewis, Portsmouth ; Edward L. Montgomery,
Circleville ; Frank T. Moore, Akron ; Earl Rosenblum, Steuben-
ville.
Committee on Occupational Health — Rex H. Wilson, Akron,
Chairman ; Drew J. Arnold, Columbus ; William W. Davis, Co-
lumbus ; Winfred M. Dowlin, Canton ; Harold M. James, Day-
ton ; H. W. Lawrence, Middletown ; Daniel M. Murphy, Marion ;
Anthony M. Puleo, Cleveland; George W. Wright, Cleveland;
H. P. Worstell, Columbus.
Committee on Poison Control — John A. Norman, Akron,
Chairman: William G. Gilger, Cleveland; Mason S. Jones, Day-
ton: James H. Bahrenburg, Canton; Edward V. Turner, Co-
lumbus; William M. Wallace, Cleveland; Hugh Wellmeier,
Piqua; John A. Williams, Cincinnati.
Committee on Radiation — Charles M. Barrett, Cincinnati,
Chairman ; Eldred B. Heisel, Columbus ; George F. Jones, Lan-
caster; Carey B. Paul, Jr., Columbus; Thomas C. Pomeroy, Co-
lumbus ; Denis A. Radefeld, Lorain ; Eugene L. Saenger, Cin-
cinnati; Robert E. Schulz, Wooster; John P. Storaasli, Cleve-
land; Robert P. Ulrich, Troy; Robert L. Wall, Columbus; John
Robert Yoder, Toledo: James G. Kereiakes, Ph. D. (Advisory
Member, Special Consultant), Cincinnati.
for May, 1966
513
State Association Officers and Committeemen (Continued)
Committee on Rural Health — Robert E. Reiheld, Orrville,
Chairman ; Chester J. Brian, Eaton ; J. Martin Byers, Green-
field ; Walter A. Campbell, Coshocton ; E. Joel Davis, East Can-
ton ; Victor R. Frederick, Urbana ; Benjamin W. Gilliotte, Zanes-
ville; Jerry L. Hammon, West Milton; Jasper M. Hedges, Circle-
ville ; Luther W. High, Millersburg ; E. D. Mattmiller, Athens ;
John R. Polsley, North Lewisburg ; Leonard S. Pritchard, Co-
lumbiana; Harold C. Smith, Van Wert; Kenneth W. Taylor,
Pickerington ; Edmond K. Yantes, Wilmington.
Committee on Scientific and Educational Exhibit — Charles V.
Meckstroth, Columbus, Chairman ; Harvey C. Knowles, Jr., Cin-
cinnati ; W. Arnold McAlpine, Toledo ; Arthur E. Rappoport,
Youngstown; Arnold M. Weissler, Columbus; Walter J. Zeiter.
Cleveland ; Robert E. Zipf, Dayton.
Committee on School Health — Charles H. McMullen, Loudon-
ville. Chairman; Walter Felson, Greenfield; Paul D. Hahn, New
Philadelphia ; Howard H. Hopwood, Cleveland ; Dale A. Hudson,
Piqua ; Howard J. Ickes, Canton ; Charles L. Kagay, Dayton ;
Lawrence L. Maggiano, Warren ; Robert C. Markey, Bowling
Green ; Robert J. Murphy, Columbus ; Carey B. Paul, Jr., Colum-
bus; Carl L. Petersilge, Newark; William H. Rower, Ashland;
Thomas E. Shaffer, Columbus ; Aubrey L. Sparks. Warren ;
Albert E. Thielen, Cincinnati ; Homer B. Thomas, Gallipolis.
Committee on Traffic Safety — N. J. Giannestras, Cincinnati,
Chairman; Howard W. Brettell, Steubenville; Drew L. Davies,
Columbus; Clark M. Dougherty, New Philadelphia: Wesley L.
Furste, Columbus ; Thomas W. Morgan, Gallipolis ; Lester G.
Parker, Sandusky ; Thomas N. Quilter, Marion ; Stewart M.
Rose, Columbus; John F. Tillotson, Lima; Robert C. Waltz,
Cleveland; Paul L. Weygandt, Akron; Robert E. Zipf, Dayton.
Committee on Workmen’s Compensation — H. P. Worstell, Co-
lumbus, Chairman; A. L. Berndt, Portsmouth; Thomas H.
Brown, Jr., Toledo; Charles A. Browning, Jr., Bellefontaine ;
Oscar W. Clarke, Gallipolis : Frederick A. Flory, Columbus ;
Lawrence T. Hadbavny, Cleveland; Clyde O. Hurst, Portsmouth;
Edmund F. Ley, Tiffin ; Joseph Lindner, Sr., Cincinnati ; John
D. Osmond, Jr., Cleveland ; James G. Roberts, Akron ; George
L. Sackett, Sr., Painesville ; Joseph H. Shepard, Columbus ;
William V. Trowbridge, Cleveland ; Rex H. Wilson, Akron ;
Frederick A. Wolf, Cincinnati; James N. Wychgel, Cleveland.
OSMA Members of the Joint Advisory Committee on Athletic
Injuries — Robert J. Murphy, Columbus; John R. Jones, Toledo;
Sol Maggied, West Jefferson ; Charles H. McMullen, Loudonville :
Carey B. Paul, Jr., Columbus ; Thomas E. Shaffer, Columbus ;
Don A. Kelly, Cleveland; Marvin R. McClellan, Cincinnati;
Walter A. Hoyt, Jr., Akron.
OSMA Members of the Joint Committee on School Bus Driver
Examinations — Carey B. Paul, Jr., Columbus ; Thomas N. Quil-
ter, Marion ; Stewart M. Rose, Columbus.
DELEGATES AND ALTERNATES
Delegates and Alternates to the American Medical Association
— George W. Petznick, Cleveland; H. T. Pease, Wadsworth, alter-
nate ; Carl A. Lincke, Carrollton ; Robert S. Martin, Zanesville,
alternate ; Theodore L. Light, Dayton ; Kenneth D. Arn, Dayton,
alternate ; Edmond K. Yantes, Wilmington ; Harry K. Hines,
Cincinnati, alternate; John H. Budd, Cleveland; P. John Robe-
chek, Cleveland, alternate ; Richard L. Meiling, Columbus ; Rob-
ert E. Tschantz, Canton, alternate ; Frederick F. Osgood, Toledo ;
Robert N. Smith, Toledo, alternate ; Charles A. Sebastian, Cin-
cinnati ; J. Robert Hudson, Cincinnati, alternate ; Edwin H.
Artman, Chillicothe ; Philip B. Hardymon, Columbus, alternate.
County Societies’ Officers and Meeting Dates
First District
Councilor: Robert E. Howard, Cincinnati 45202
2600 Union Central Bldg.
ADAMS — Gary J. Greenlee, President, Manchester 45144 ; Stan-
ley H. Title, Secretary, Manchester 45144.
BROWN — Charles H. Maly, President, Sardinia 45171 ; Charles
W. Hannah, Secretary, Sardinia 45171. 1st Monday monthly.
BUTLER — Robert Johnson, President, 500 S. Breiel Boulevard,
Middletown 45042 ; Mr. Charles G. Greig, Executive Secretary,
110 North Third Street, Hamilton 45011. 4th Wednesday
monthly.
CLERMONT — Cecil F. Barber, President, State Route 133, Feli-
city 45120 ; Phillips F. Greene, Secretary, Route 1, Box 509,
New Richmond 45157. 3rd Wednesday monthly, except July
and August.
CLINTON — Richard R. Buchanan, President, 115 West Main,
Wilmington 45177 ; Mary Ranz Boyd, Secretary, Box 629,
Wilmington 45177. 4th Tuesday monthly.
HAMILTON — Robert M. Woolford, President, 320 Broadway,
Cincinnati 45202 ; Mr. Edward F. Willenborg, Executive
Secretary, 320 Broadway, Cincinnati 45202. Monthly meet-
ing dates, 1st Tuesday; Academy, 3rd Tuesday, except June,
July and August.
HIGHLAND — Thomas L. Jones, President, 528 South St., Green-
field 45123 ; Walter Felson, Secretary, 357 South St., Greenfield
45123. 3rd Tuesday bimonthly.
WARREN — O. Williard Hoffman, President, 20 East Fourth
Street, Franklin 45005 ; Ray E. Simendinger, Secretary, 901
North Broadway Street, Lebanon 45036. 2nd Tuesday monthly.
Second District
Councilor: Theodore L. Light, Dayton 45406
2670 Salem Ave.
CHAMPAIGN — Myron J. Towle, President, 848 Scioto Street,
Urbana 43078 ; Fred R. Denkewalter, Secretary, 848 Scioto
Street, Urbana 43078. 2nd Wednesday monthly.
CLARK — Henry M. Tardif, President, 2608 E. High Street,
Springfield 45505 ; Mrs. Marion L. Wilcoxson, Executive
Secretary, Hotel Shawnee, Room 207, Springfield 44501. 3rd
Monday monthly, except June, July and August.
DARKE— ^William A. Browne, President, 722 Sweitzer St.,
Greenville 45331 ; Delbert D. Blickenstaff, Secretary, 552 S.
West St., Versailles 45380. 3rd Tuesday monthly.
GREENE— Clement G. Austria, President, 1142 North Monroe
Drive, Xenia 45385 ; Mrs. C. K. Elliott, Executive Secretary,
225 Pleasant Street, Xenia 45385. 2nd Thursday monthly
except July and August.
MIAMI — David Brown, President, 1060 North Market Street,
Troy 45373 ; Jack P. Steinhilber, Secretary, 145 Sunset Drive,
Piqua 45356. 1st Tuesday monthly.
MONTGOMERY— Charles E. O’Brien, President, 600 Fidelity
Building, Dayton 45402 ; Mr. Robert F. Freeman, Executive
Secretary, 280 Fidelity Medical Building, Dayton 45402. 1st
Friday monthly October through May — 1st Wednesday June.
PREBLE — John D. Darrow, President, 228 N. Barron St., Eaton
45320 ; Willard C. Clark, Jr., Secretary, 228 N. Barron, Eaton
45320. Irregular meetings.
SHELBY — George J. Schroer, President, 322 Second Ave., Sidney
45365 ; Alfonsas Kisielius, Secretary, Ohio Bldg., Sidney 45365.
Third District
Council : Frederick T. Merchant, Marion 43305
1051 Harding Memorial Pky.
ALLEN — Carl H. Zinsmeister, President, 729 W. Market Street,
Lima 45801 ; Thomas D. Allison, Secretary, 401 Metropolitan
Bank Building, Lima 45801. 3rd Tuesday monthly.
AUGLAIZE — Robert Sobocinski, President, 75 Blackhoof Street,
Wapakoneta 45895 ; J. F. Bowling, Secretary, 319 West Spring
Street, St. Marys 45885. 1st Thursday monthly except July.
CRAWFORD — Don E. Ingham, President, 201 N. Market Street,
Galion 44833 ; Johnson H. Chow, Secretary, 1040 Devonwood
Drive, Galion 44833. Called meetings.
HANCOCK — Raymond J. Tille, President, 801 S. Main St., Find-
lay 45840 ; Herbert L. Queen, Secretary, 828 Woodworth Dr.,
Findlay 45840.
HARDIN — William D. Dewar, President, 405 North Main Street,
Kenton 43326 ; John J. Roget, Secretary, Belle Center 43310.
2nd Tuesday monthly.
LOGAN — Thomas Seitz, President, 223 E. Columbus Street,
Bellefontaine 43311 ; Glen Miller, Secretary, R. D. 2, West
Liberty 43357. 1st Friday monthly.
MARION — Ransome Williams, President, 1035 Harding Me-
morial Parkway, Marion 43302 ; Alice Fisher, Secretary, 1040
Delaware Avenue, Marion 43302. 1st Tuesday monthly.
MERCER — R. Duane Bradrick, President, Rockford 45882 ; R. L.
Dobbins, Secretary, 5402 State Route 29 East, Celina. 3rd
Thursday, monthly.
SENECA — Olgierd C. Garlo, President, 53 Clay Street, Tiffin
44883 ; Leonard M. Gaydos, Secretary, 233 South Monroe
Street, Tiffin 44883. 3rd Tuesday monthly.
VAN WERT — Norman L. Marxen, President, Medical Arts Bldg.,
Fox Road, Van Wert 45891 ; W. L. Iler, Secretary, Medical
Arts Bldg., Fox Road, Van Wert 45891. 4th Friday monthly.
WYANDOT — Herschel A. Rhodes, President, 777 N. Sandusky
Ave., Upper Sandusky 43351 ; J. J. Browne, Secretary, 777 N.
Sandusky Ave., Upper Sandusky 43351. 2nd Tuesday monthly.
Fourth District
Councilor: Robert N. Smith, Toledo 43606
3939 Monroe St.
DEFIANCE — L. F. Berry, Jr., President, 1400 East Second
Street, Defiance 43512 ; W. S. Busteed, Secretary, Box 218,
Defiance 43512.
FULTON — B. H. Reed, Jr., President, Delta 43515 ; R. L. Davis,
Secretary, Wauseon 43567. 2nd Tuesday quarterly March,
June, September, December.
HENRY — J. J. Harrison, President, 113 East Clinton Street,
Napoleon 43545 ; Gamble S. Hall, Secretary, 834 Strong
Street, Napoleon 43545. 1st Tuesday monthly.
LUCAS — E. L. Doermann, President, 2001 Collingwood Blvd.,
Toledo 43620 ; Mr. Robert W. Elwell, Executive Secretary, 3101
Collingwood Blvd., Toledo 43610. 3rd Tuesday monthly except
July and August.
OTTAWA— V. Wm. Wagner, President, 122 East Perry, Port
Clinton 43452 ; William Coon, Secretary, 120 East Perry, Port
Clinton 43452. 2nd Thursday monthly.
PAULDING- — Roy R. Miller, President, 220 W. Perry, Paulding
45879 ; D. Paul Ward, Secretary, Box 416, Oakwood 45873.
Meetings called.
PUTNAM — Arthur P. Daniel, President, 144 N. Walnut, Ottawa
45875 ; Oliver N. Lugibihl, Secretary, Pandora 45877. 1st
Tuesday monthly.
514
The Ohio State Medical Journal
SANDUSKY — J. L. Zimmerman, President, Memorial Hospital
of Sandusky County, Fremont 43420 ; Mrs. Patsy J. Askins.
Executive Secretary, Memorial Hospital of Sandusky County,
Fremont 43420. 3rd Wednesday monthly.
WILLIAMS— John E. Moats, President, Central Drive, Bryan
43506 ; Neil T. Levenson, Secretary, 907 Noble Drive, Bryan
43506. 2nd Tuesday monthly.
WOOD — Roger A. Peatee, President, 140 S. Prospect Street,
Bowling Green 43402 ; William B. Elderhrock, Secretary,
Health Service, Bowling Green State University, Bowling
Green 43402. 3rd Thursday monthly.
Fifth District
Councilor: P. John Robechek, Cleveland 44106
10525 Carnegie Ave.
ASHTABULA — J. R. Nolan, President, 2736 Lake Avenue, Ash-
tabula 44004 ; Richard Millberg, Secretary, 430 West 25th
Street, Ashtabula 44004. 2nd Tuesday monthly.
CUYAHOGA — William F. Boukalik, President, 20030 Scottsdale
Boulevard, Cleveland 44122 ; Mr. Robert A. Lang, Executive
Secretary, 10525 Carnegie Avenue, Cleveland 44106.
GEAUGA— Bruce F. Andreas, President, 400 Downing Drive,
Chardon 44024 ; Arturo J. Dimaculangan, Secretary, 8400 May-
field Road, P. O. Box 277, Chesterland 44026. 2nd Friday
monthly.
LAKE — Robert W. Colopy, President, 89 E. High Street, Paines-
ville 44077 ; Mrs. Owen A. McLaren, Executive Secretary,
7408 Cadle Avenue, Mentor 44060. 4th Wednesday evening
monthly, January, May, March, September and November
unless otherwise ordered by Council.
Sixth District
Councilor: Edwin R. Westbrook, Warren 44481
438 North Park Ave.
COLUMBIANA — Edith S. Gilmore, President, 432 W. 5th St.,
E. Liverpool 43920 ; Fraser Jackson, Secretary, 205 W. 6th
St. 3rd Tuesday monthly.
MAHONING — F. A. Resch, President, Doctors Park, Canfield
44406 ; Mr. Howard C. Rempes, Jr., Executive Secretary, 245
Bel-Park Building, 1005 Belmont Avenue, Youngstown 44504.
3rd Tuesday monthly except July and August.
PORTAGE — David Palmstrom, President, 124 North Prospect
Street, Ravenna 44266 ; William R. Brinker, Secretary, 141
East Main Street, Kent 44240. 3rd Tuesday monthly.
STARK— A. R. Furnas, Jr., President, 420 Lake Avenue, N. E.,
Massillon 44646 ; Mr. John H. Austin, Executive Secretary,
405 4th Street, N. W., Canton 44702. 2nd Thursday monthly.
SUMMIT — James G. Roberts, President, 655 West Market Street,
Akron 44303 ; Mr. Sidney H. Mountcastle, Executive Secretary,
437 Second National Building, 159 South Main Street, Akron
44308. 1st Tuesday monthly.
TRUMBULL — John F. McGreevey, President, 297 Hawthorne
Lane N. E., Warren 44484; Mrs. Kay Ticknor, Executive
Secretary, 280 North Park Avenue, Warren 44481. 3rd
Wednesday monthly September through May.
Seventh District
Councilor: Beni. C. Diefenbach, Martins Ferry 43935
30 S. 4th St.
BELMONT — James Sutherland, President, 9 North 4th Street,
Mai’tins Ferry 43935 ; Bertha M. Joseph, Secretary, 100 South
4th Street, Martins Ferry 43935. 3rd Thursday of February,
March, April, June, September, October, November and
December.
CARROLL— Glen C. Dowell, President, 207 West Main, Car-
rollton 44615 ; Thomas J. Atchison, Secretary, 292 East
Main, Carrollton 44615. 1st Thursday monthly.
COSHOCTON — Don Warren, President, 600 East Main Street,
West Lafayette 43845 ; Harold Lear, Secretary, 133 South
Fourth Street, Coshocton 43812. 2nd Tuesday monthly.
HARRISON — Charles D. Evans, President, 159 South Main
Street, Cadiz 43907 ; G. E. Vorhies, Secretary, Scio 43988,
Quarterly.
JEFFERSON — Jacob R. Cohen, President, 341 Market Street,
Steubenville 43952 ; Irving Dreyer, Secretary, Ohio Valley
Hospital, Steubenville 43952. 4th Tuesday monthly except
December, January, February.
MONROE — Byron Gillespie, Secretary, Woodsfield 43793.
TUSCARAWAS — Robert J. Kuba, President, 319 Grant St., Den-
nison 44621 ; Thomas E. Ogden, Secretary, 138 E. Main St.,
Gnadenhutten. 2nd Thursday monthly.
Eighth District
Councilor: Robert C. Beardsley, Zanesville 43705
2236 Maple Ave.
ATHENS — D. R. Johnson, President, 52 West Washington
Street, Nelsonville 45764 ; L. A. Hamilton, Secretary, 400 East
State Street, Athens 45701. 2nd Tuesday monthly except July
and August.
FAIRFIELD — George W. LeSar, President, 216 Harmon Avenue,
Lancaster 43130 ; Stephen R. Hodsden, Secretary, 1423 West
Market Street, Baltimore 43105. 2nd Tuesday monthly.
GUERNSEY — A. C. Smith, President, 1115 Clark Street, Cam-
bridge 43725 ; Dayle O. Snyder, Secretary, 840 Wheeling
Avenue, Cambridge 43725. 1st Tuesday monthly.
LICKING — Carl L. Petersilge, President, 104 Hudson Avenue,
Newark 43055 : Robert P. Raker, Secretary, 317 N. Granger
Street, Granville 43023. 4th Tuesday monthly.
MORGAN — A. H. Whitacre, President, Chesterhill 43728 ; Henry
Bachman, Secretary, Box 199, Malta 43758.
MUSKINGUM — Paul A. Jones, President, 838 Market Street,
Zanesville 43701 ; Myron Powelson, Secretary, 2825 Maple
Avenue, Zanesville 43705. 2nd Tuesday monthly.
NOBLE — Frederick M. Cox, President, Caldwell 43724 ; Edward
G. Ditch, Secretary, 415 Main Street, Caldwell 43724. 1st
Tuesday monthly.
PERRY — Charles B. McDougal, President, 319 High St., New
Lexington 43764; Michael P. Clouse, Secretary, West Main St.,
Somerset 43783.
WASHINGTON — Mary L. Whitacre, President, Rt. 6, Marietta
45750; G. E. Huston, Secretary, 328 Fourth St., Marietta
45750. 2nd Wednesday monthly.
Ninth District
Councilor : George N. Spears, Ironton 45638
2213 S. 9th St.
GALLIA — Quentin Korfhage, President, Gallipolis Clinic, Gal-
lipolis 45631 ; John Groth, Secretary, Holzer Clinic, Gallipolis
45631. Monthly meetings at called times.
HOCKING — Jan S. Matthews, President, 9 East Second Street,
Logan 43138 ; H. M. Boocks, Secretary, Route 3, Logan 43138.
2nd Tuesday monthly.
JACKSON — John M. Cook, President, Box 316, Oak Hill 45656 ;
Earl J. Levine, Secretary, 120 N. Ohio Ave., Wellston 45692.
LAWRENCE — Frank W. Crowe, President, 2110 South 9th
Street, Ironton 45638 ; George Newton Spears, Secretary, 2213
South Ninth Street, Ironton 45638. Quarterly at called times.
MEIGS — Charles J. Mullen, President, 210 y2 E. Main St., Pome-
roy 45769 ; Edmund Butrimas, Secretary, 204 E. Main St.,
Pomeroy 45769.
PIKE — Robert T. Leever, President, 100 East Third St., Waverly
45690 ; Albert M. Shrader, Secretary, East Water St., Waverly
45690. 1st Tuesday monthly.
SCIOTO — Chester H. Allen, President, 1405 Offnere Street,
Portsmouth 45662 ; Erich Spiro, Secretary, 1735 Waller Street,
Portsmouth 45662. 2nd Monday in February, April and Octo-
ber ; December meeting and summer meeting decided by the
Council and members notified one month in advance.
VINTON — Richard E. Bullock, President, 203 South Market St.,
McArthur 45651.
Tenth District
Councilor: Richard L. Fulton, Columbus 43212
1211 Dublin Rd.
DELAWARE — Don K. Michel, President, 98 W. Villiam, Dela-
ware 43015 ; Tennyson Williams, Secretary, Box 265, Delaware
43015. 3rd Tuesday monthly.
FAYETTE- — R. D. Woodmansee, President, 403 East Market
Street, Washington C. H. 43160 ; M. H. Roszmann, Secretary,
1005 East Temple Street, Washington C. H. 43160. 2nd
Friday monthly
FRANKLIN — Joseph A. Bonta, President, 3100 Olentangy River
Road, Columbus 43202 ; Mr. W. “Bill” Webb, Jr., Executive
Secretary, 79 East State Street, Room 601, Columbus 43215.
3rd Tuesday monthly.
KNOX — Richard L. Smythe, President, 812 Coshocton Road,
Mt. Vernon 43050 ; Robert E. Sooy, Secretary, Box 470, Mt.
Vernon 43050. 1st Wednesday evening monthly.
MADISON — Sol Maggied, President, 15 East Pearl Street, West
Jefferson 43162 ; Michael Meftah, Secretary, 11 East 2nd
Street, London 43140. 1st Wednesday monthly.
MORROW — Francis W. Kubb, President, 140 North Main, Mt.
Gilead 43338 ; William S. Deffinger, Secretary, Box 8, Marengo
43334. 1st Tuesday monthly.
PICKAWAY — V. D. Kerns, President, 143 E. Main Street,
Circleville 43113 ; Carlos Alvarez, Secretary, 147 Pinckney
Street, Circleville 43113. 1st Friday evening monthly, except
months of July and August.
ROSS — Joseph McKell, President, 174 W. Main Street, Chilli-
cothe 45601 ; Lowell O. Smith, Secretary, 217 Delano Avenue,
Chillicothe 45602. 1st Thursday evening monthly.
UNION — Malcolm Maclvor, President, 110 N. Court St., Marys-
ville 43040 ; May B. Zaugg, Secretary, 225 Stockdale Drive,
Marysville 43040. 1st Tuesday, February, April, October,
December.
Eleventh District
Councilor : William R. Schultz, Wooster 44691
1749 Cleveland Road
ASHLAND — Henry C. Chalfant, President, 309 Arthur Street,
Ashland 44805 ; H. W. Smith, Secretary, 414 Samaritan Ave-
nue, Ashland 44805. 1st Thursday monthly.
ERIE— Clinton F. Lavender, President, 1218 Cleveland Road,
Sandusky 44870 ; R. D. Gillette, Secretary, P. O. Box 127,
Huron 44839. Alternate Tuesday and Thursday monthly.
HOLMES — Charles H. Hart, President, 109 South Clay Street,
Millersburg 44654 ; William A. Powell, Secretary, 8 West
Adams Street, Millersburg 44654. Monthly meeting date to
be determined later.
HURON — W. R. Graham, President, 15 Main Street, Wakeman
44889 ; E. R. McLoney, Secretary, 257 Benedict Avenue, Nor-
walk 44857. 2nd Wednesday of February, April, June, Au-
gust, October, and December.
LORAIN — Joseph A. Cicerrella, President, 209 6th Street, Lorain
44052 ; Mrs. Gladys Davidson, Executive Secretary, 428 West
Avenue, Elyria 44035. 2nd Tuesday monthly except June,
July and August.
MEDINA — Myrl A. Nafziger, President, Albrecht Building,
Wadsworth 44281 ; Mr. A. Dana Whipple, Executive Secretary,
320 East Liberty Street, Medina, Ohio 44256. 3rd Thursday
monthly.
RICHLAND — C. J. Shamess, President, 74 Wood Street, Mans-
field 44903 ; Harold F. Mills, Secretary, 70 Madison Road,
Mansfield 44905. 3rd Thursday monthly except June, July and
August.
WAYNE — Howard MacMillan, President, 1740 Cleveland Road,
Wooster 44691 ; R. J. Watkins, Secretary, 1736 Beall Avenue,
Wooster 44691. 2nd Wednesday monthly, January, February,
April, September, November and December.
(Continued on page 517)
for May, 1966
517
Activities of County Societies . . .
First District
(COUNCILOR: ROBERT E. HOWARD, M. D„ CINCINNATI)
BUTLER
Dr. Kenneth I. E. Macleod, Cincinnati health com-
missioner, was principal speaker at the regular meet-
ing of the Butler County Medical Society in Middle-
town on March 23. His discussion was in regard to
advances in the field of immunization.
The dinner meeting was held at the Elks Club.
CLINTON
Dr. Richard Witt, director of pulmonary physiology
research at Cincinnati General Hospital, spoke at the
meeting of the Clinton County Medical Society Tues-
day night (March 22) at Clinton Memorial Hospital,
Wilmington. He gave an illustrated lecture on pul-
monary function studies in various types of lung dis-
eases. — Wilmington News- Journal.
HAMILTON
At the March 1 5 meeting of the Academy of Medi-
cine of Cincinnati, Dr. David C. Sabiston, Jr., profes-
sor and chairman of the Department of Surgery at
Duke University, spoke on the topic, "Recent Devel-
opments in the Diagnosis and Management of Pul-
monary Embolism.”
As cosponsor of program to combat venereal dis-
ease, the Academy of Medicine of Cincinnati was host
for a meeting where a VD film was shown and panel
discussion held on March 29.
Second District
(COUNCILOR: THEODORE L. LIGHT, M. D., DAYTON)
GREENE
The Greene County Medical Society has undertaken
the sponsorship of three programs of venereal disease
education for high school and junior high school
students, parents, and teachers.
The program included showing of the films "The
Innocent Party” and "Dance, Little Children,” as well
as discussions by local physicians.
Third District
(COUNCILOR: FREDERICK T. MERCHANT, M. D„ MARION)
ALLEN
Dr. William H. Saunders, who is associated with
the otolaryngology service at Children’s Hospital in
Columbus, spoke at the March 15 dinner meeting
of the Academy of Medicine of Lima and Allen
County, where he discussed problems related to
deafness.
AUGLAIZE
Dr. Robert Sobocinski was principal speaker at the
March meeting of the Auglaize County Medical So-
ciety. He reported on the meeting held in Columbus
of County Medical Society Officers and Committee-
men, stressing latest developments in regard to Medi-
care and utilization committees in hospitals.
Fourth District
(COUNCILOR: ROBERT N. SMITH, M. D., TOLEDO)
LUCAS
The Section on Pathology of the Academy of Medi-
cine of Toledo met on April 15. Dr. Harry Weis-
berg, associate professor at the Chicago Medical
School, spoke on the topic "Clinical Aspects of Water
and Electrolite Metabolism.”
The Toledo Medical Library Association held its
annual meeting on April 21 at the Academy Build-
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The Ohio State Medical Journal
ing. The evening’s activities consisted of a social
hour, dinner and program.
The Inter-Hospital Postgraduate Lecture Series, pre-
sented by the Medical Advancement Trust of Maumee
Valley Hospital, is scheduled on May 12 and 13. Dr.
Robert D. Johnson, associate professor at the Uni-
versity of Michigan, will speak on recent advances in
medicine, especially in regard to diabetes mellitus,
diabetic coma, hypertension, primary aldosteronism
and hypercalcemia.
Fifth District
(COUNCILOR: P. JOHN ROBECHEK, M. D., CLEVELAND)
CUYAHOGA
The April issue of The Bulletin of the Academy of
Medicine of Cleveland contained photographs of
candidates for election to the Board of Directors of
the Academy.
Sixth District
(COUNCILOR : EDWIN R. WESTBROOK, M. D., WARREN)
MAHONING
The inclusion of physicians under Social Security
was the subject for discussion at the February 15
meeting of the Mahoning County Medical Society.
Featured speaker was William J. McCauley, district
manager of the Youngstown Social Securirty office.
The interest of members in the subject was indicated
by an increase in attendance.
At the March 15 meeting, Dr. Nicholas Nyaradi,
director of the School of International Studies at
Bradley University, and a former minister of finance
of Hungary, spoke on world communism. The oc-
casion was the 12th annual joint meeting of the
Mahoning County Medical Society and the Mahon-
ing County Bar Association. Because of the general
interest in the speaker, wives of the physicians and
attorneys were guests. More than 200 persons heard
Dr. Nyaradi, a strong anticommunist and supporter
of the free enterprise system.
Both programs were arranged by Dr. Jack Schre-
iber, program chairman and past president. Dr. F.
A. Resch, president, presided.
sjs
The Mahoning County Medical Society presented
a $50 scholarship and a trophy for the best project
related to the field of medicine at the Tri- County
(Mahoning, Trumbull, Columbiana) High School
Science Fair, held at Austintown Fitch High School
recently.
Winner was Karen Wattenbarger, a 17 year-old
Junior, whose project demonstrated the effect of an
overdose of vitamin A on mice. Dr. John Melnick,
chairman of the medical society’s youth committee,
judged the more than 50 medical exhibits and pre-
sented the award to the winner.
This marked the first year that the Mahoning
County Medical Society entered the science fair.
Dr. John Melnick presents the Mahoning County
Medical Society trophy to Miss Karen Wattenbarger.
Society members were pleased with the results and
plan to make a yearly awrard to encourage interest
in medicine among high school students.
STARK
The importance of a hobby was portrayed to mem-
bers of the Stark County Medical Society on March
10 when Marc Moon discussed the rewarding satisfac-
tion of water color painting while demonstrating his
talent. A resident of Cuyahoga Falls, Mr. Moon is a
member of the American Water Color Association
and has exhibited his work both regionally and
nationally.
SUMMIT
The Summit County Medical Society held its
monthly membership meeting on April 5 in the Chil-
dren’s Hospital auditorium in Akron. Among subj-
ects on the program for consideration were resolu-
tions to be presented at the OSMA Annual Meeting
Medicare, the accreditation concept, mass cancer
detection, and moving the society office.
TRUMBULL
The regular monthly meeting of the Trumbull
County Medical Society was held on April 20 at
Trumbull Country Club. A social hour and dinner
were followed by the program. Guest speakers were
Dr. and Mrs. Julius Weil of the Montefiore Home
for the Aged in Cleveland. Dr. Weil is executive
director of the home and Mrs. Weil is director of
social sendees.
Dr. and Mrs. Weil gave their conceptions of a
well-run home for the aged. Recent articles in the
Cleveland Plain Dealer reported work being done in
the homes-for-the-aged field by the couple.
Seventh District
(COUNCILOR: BENJAMIN C. DIEFENBACH, M. D„
MARTINS FERRY)
CARROLL
Members of the Carroll County Medical Society
entertained their wives and out-of-town guests from
for May, 1966
519
Canton and Alliance at a dinner meeting held in
March at the Atwood Lake Lodge, Dr. Carl A.
Lincke, of Carrollton, presented an illustrated trave-
logue based on a recent tour of Europe by Dr. and
Mrs. Lincke. Mrs. Velma Griffin, of Dellroy, pro-
vided dinner music.
TUSCARAWAS
Hart F. Page, Executive Secretary of the Ohio State
Medical Association, addressed 22 Tuscarawas County
Medical Society members at the regular monthly meet-
ing last evening (March 9) at Bonvechio’s.
Mr. Page, a former Midvale resident whose par-
ents reside in RD 1, Dennison, addressed the group
on the implications of Medicare and its effect on
medical practice.
He also conducted a spirited discussion on their
government legislation effecting medical practice.
During the business meeting, discussion was con-
ducted on the draft law and how it will effect local
physicians. — Evening Chronicle, Uhrichsville.
Eighth District
(COUNCILOR: ROBERT C. BEARDSLEY, M. D.,
ZANESVILLE)
FAIRFIELD
Members of the Fairfield County Medical Society
passed a resolution at the meeting on April 12 com-
mending The Council of the Ohio State Medical
Association for its stand in regard to direct billing
on the part of physicians. The action taken by The
Council was at its meeting on March 20. The state-
ment appears elsewhere in this issue of The Journal
under the heading "Policy Regarding Governmental
Medical Care Programs.’’
Hart F. Page, Executive Secretary of the Ohio
State Medical Association, was one of the guest
speakers at the meeting where he discussed the in-
creasing importance of organized medicine in view
of current developments in the medical and health
fields.
James Imboden, who is stationed in Columbus as
area field representative of the American Medical
Political Action Committee (AMPAC), discussed de-
velopments on the political scene in view of the com-
ing elections, and stressed the importance of backing
this program.
FRANKLIN
The Academy of Medicine of Columbus and Frank-
lin County held its annual Specialty Societies program
on March 15 in the Neil House Hotel. A social
hour and dinner preceded a business meeting of the
Specialty Societies. Programs were presented by the
Columbus Society of Anesthesiologists, Central Ohio
Radiological Society, Neuropsychiatric Society of Cen-
tral Ohio, and the Central Ohio Academy of General
Practice.
The ninth annual joint dinner meeting of the
Academy of Medicine of Columbus and the Columbus
Bar Association was held at the Neil House Hotel on
April 19.
Program speaker was William D. Hitt, Ph. D.,
chief of the Psychological Sciences Division of the
Battelle Memorial Institute, who discussed auto-
mation and its applications to law and law enforce-
ment, medical diagnosis and care, economic control,
education, and work organization.
WASHINGTON
Dr. John D. Guyton, associated with the Ohio State
University Department of Physical Medicine, dis-
cussed physical medicine in the general hospital at a
meeting of the Washington County Medical Society.
The meeting in the Lafayette Motor Hotel, Marietta,
was presided over by Dr. Mary L. Whitacre, society
president.
Eleventh District
(COUNCILOR: WILLIAM R. SCHULTZ, M. D„ WOOSTER)
LORAIN
Lorain County Medical Society held its Nineteenth
Annual Medical Symposium at Oberlin Inn on
Wednesday afternoon and evening, April 13. A
total of 70 doctors of medicine and osteopaths, with
interns and residents from Elyria Memorial Hospital
and Lorain St. Joseph Hospital, took advantage of
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The Ohio State Medical Journal
this educational opportunity. Theme of the Sym-
posium was "Therapeutic Conference’’ and the interns
and residents were invited as guests of the Society.
President J. A. Cicerrella, M. D., welcomed all pre-
sent, introducing participants, guests, and Dr. W. R.
Schultz, Councilor of the Eleventh District.
Whilst the afternoon session was in progress, the
wives enjoyed a conducted tour of Oberlin College
Art Museum and a visit to the Intermuseum Labora-
tory, following which they rejoined their husbands
for the social hour and dinner and the evening ses-
sion. This brought the total attendance to 111.
The Symposium, arranged by the Education & Sym-
posium Committee under the chairmanship of Rudy
G. Moc, M. D., included Albert C. Lammert, M. D.,
James S. Hewlett, M. D., and Bruce H. Stewart,
M. D., from the Cleveland Clinic, as the afternoon
participants. Leonard L. Lovshin, M. D., Head of the
Department of Internal Medicine at the Clinic, was
the featured after-dinner speaker.
Following the social hour and dinner, Dr. J. A.
Cicerrella conducted a brief business meeting. He
announced that the State of Ohio Department of
Health advises approval of "grant-in-aid’’ funds for
the Uterine Cancer Detection Program currently un-
derway under the leadership of the Cancer Commit-
tee. Dr. Bennett reported on the recent meeting of
his Insurance Committee with representatives from
Blue Shield of Northeast Ohio relative to the sup-
plementary Blue Shield 6 5 Contracts.
John R. Peffer, M. D., of Lorain, was elected to
Associate Membership in the Society, and Shan A.
Mohammed, M. D., of Elyria, to Active Membership.
In the unavoidable absence of Dr. Rosenbaum,
secretary-treasurer, John B. McCoy, M. D., read a
Memorial Address to the late Lothar Z. Hoffer, M. D.,
of Lorain, and all members stood in silent tribute to
the memory of their respected colleague.
Dr. Lovshin’s topic on "The Surgical Mystique”
was illustrated by slide presentations. In offering a
vote of thanks to the team from Cleveland Clinic, Dr.
Cicerrella noted how successful the Symposium had
been, and how enthusiastically it had been received.
Denver, Colorado, is once again the site of the
20th Annual Rocky Mountain Cancer Conference,
July 15-16, at the Brown Palace Hotel. The two-
day Conference will feature some of the nation’s
most distinguished speakers on the subject of cancer.
Further information may be obtained by writing
Rocky Mountain Cancer Conference, 1809 East 18th
Avenue, Denver, Colorado 80218.
Dr. Cecil Striker, Cincinnati, was among the first
rotation of physicians serving on the S. S. Hope
during its current stay in Nicaragua. The hospital
ship has been bringing modern medicine to various
areas of the world since I960.
OSU Assistant Dean Named
To State Medical Board
Dr. Lloyd R. Evans, associate professor of medicine
and assistant dean, Ohio State University College of
Medicine, has been appointed to serve on the State
Medical Board of Ohio for a term ending in 1973.
A graduate of Harvard Medical School, Dr. Evans
was a fellow and house officer at Peter Bent Brigham
Hospital until entering the U. S. Army Medical
Corps in 1942. His rank was that of major with
the 105th General Hospital (Harvard Unit) in the
Southwest Pacific.
Dr. Evans served a residency at Ohio State Uni-
versity Hospitals in internal medicine from 1945-47.
He then was a fellow of the U. S. Public Health
Sendee at Massachusetts General Hospital in cardi-
ology. He was certified by the American Board of
Internal Medicine in 1949.
Until joining the faculty at Ohio State in Septem-
ber, 1963, Dr. Evans was in private practice in Lar-
amie, Wyoming. While in Wyoming he also was
a lecturer at the University of Wyoming, a member
of the Wyoming State Board of Health, commis-
sioner of the Western Interstate Commission for
Higher Education and chairman of the Rhodes Schol-
arship Selection Committee for Wyoming.
Dr. Evans succeeds Dr. John N. McCann, Youngs-
town, whose term expired.
for May, 1966
521
JOURNAL ADVERTISERS
Advertisers in The Journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The Journal,
and help make it a quality publication. In return we
place their messages on the desks of Ohio's physicians.
Please familiarize yourself with their services and pro-
ducts, and let them know that you see their advertising
in The Journal.
In This Issue:
Abbott Laboratories 435 - 436- 437 - 438
Allergy Laboratories of Ohio, Inc 433
Ames Company, Inc Inside Back Cover
Appalachian Hall 439
Associated Credit Bureaus of Ohio 505
Ayerst Laboratories 419-420-421-422-423
Blessings, Inc 511
The Brown Pharmaceutical Co 408
Buckeye Federal Savings and
Loan Association 509
Burroughs Wellcome & Co. (USA) Inc 477
Cooper, Tinsley Laboratories Inc 515 - 516
Daniels-Head & Associates, Inc 520
Dorsey Laboratories, a division of
The Wander Company 413 - 4l4 - 415 - 416
Elder, Paul B. Company 442
Geigy Pharmaceuticals, Division of
Geigy Chemical Corporation 432
Harding Hospital 424
Hynson, Westcott & Dunning, Inc 405
Lederle Laboratories, A Division of American
Cyanamid Company .. 418, 428 - 429, 434, 524
Lilly, Eli, and Company 446
The Medical Protective Company 439
Merck Sharp & Dohme, Division of
Merck & Co., Inc 444
North, The Emerson A., Hospital Inc 445
The Ohio State Surgical Association 503
Parke, Davis & Company Inside Front Cover
Pharmaceutical Manufacturers Association .... 430
Philips Roxane Laboratories 440 -441
The Readjustment Center 412
Robins, A. H., Company, Inc 425 - 426 - 427
Roche Laboratories, Division of
Hoffmann-La Roche Inc Back Cover
Roerig, J. B., and Company
Division, Chas. Pfizer & Co., Inc 443
Searle, G. D., & Company 472 - 473
Smith Kline & French Laboratories 417
Squibb, E. R., & Sons 410
Turner & Shepard, Inc 518
Tutag, S. J., & Co 408
The Vale Chemical Company, Inc 411
Wallace Laboratories 409, 431
The Wendt-Bristol Company 412
Windsor Hospital 512
Winthrop Laboratories 406
Table of Contents
(Continued From Page 407)
Page
412 Corporate Medical Laboratories — A Policy
Statement of AAGP
424 Current Comments in the Field of the Drug
Manufacturers
428 New Members of the Association
442 M. D.’s in the News
491 State Association and The Journal Have New
Columbus Address
502 Maternal and Child Care Conference
504 Obituaries
507 Ohioans Have Special Interest in Coming
AMA Conference
508 Hotel Reservation Form for 1966 OSMA
Annual Meeting
510 Woman’s Auxiliary Highlights
512 Ohio State University Offers Courses
512 Library Photoduplication Service
512 A Future in Family Medicine Is Topic for
OSU Lecture
513 Roster of State Association Officers and
Committeemen
514 Roster of County Medical Society Officers and
Meeting Dates
518 Activities of County Medical Societies
521 OSU Assistant Dean Named to State Medical
Board
522 Three Ohioans Awarded Fellowships
522 The Journal’s Advertisers in This Issue
Three Ohioans Awarded Fellowships
For Overseas Hospital Tours
Joe D. Hollingshead, a senior at Ohio State Uni-
versity College of Medicine, and his wife, a nurse,
have been awarded fellowships which enable them
to serve two months at the Garkida General Hospital,
Nigeria.
Another Ohio student, Mary D. McCarthy, senior
at Western Reserve University School of Medicine,
will serve three months at Maria Assumpta Hospital,
Ado Ekiti, Nigeria. Both fellowships are approved
by the Association of American Medical Colleges and
sponsored by Smith Kline & French Laboratories,
pharmaceutical manufacturers.
In all, 35 American medical students were selected
to receive fellowships under the program.
522
The Ohio State Medical Journal
^ke
OHIO STATE MEDICAL
journal
VOL. 62 JUNE, 1966 NO. 6 |j
OSMA OFFICERS j
President =
Lawrence C. Meredith, M. D. j§§
205 Elyria Block, Elyria 44035 U
Past President |1
Henry A. Crawford, M. D. g
1058 Hanna Bldg., Cleveland 44115 ^
Treasurer - \
Philip B. Hardymon, M. D. g
350 E. Broad St., Columbus 43215 §H
EDITORIAL STAFF §j
Editor g§
Perry R. Ayres, M. D. §§
Managing Editor and g
Business Manager m
Hart F. Page |
Executive Editor and H
Executive Business Manager ^
R. Gordon Moore g
OSMA EXECUTIVE STAFF ■
Executive Secretary g
Hart F. Page l-
Director of Public Relations and gj
Assistant Executive Secretary g
Charles W. Edgar H
Administrative Assistants §H
W. Michael Traphagan g
Herbert E. Gillen g
Address All Correspondence:
The Ohio State Medical Journal
17 South High Street, Suite 500 g
Columbus, Ohio 43215 g
Published monthly under the direction of the
Council for and by members of The Ohio State =|
Medical Association, 17 South High Street, Suite =
500, Columbus, Ohio 43215, a scientific society,
nonprofit organization, with a definite member- =
ship for scientific and educational purposes. =
Subscription, $6.00 per year to non-members;
single copy, 50 cents (outside Continental U.S., =e
$7.50 and 75 cents).
Entered as second class matter July 5, 1905, at g
the Postoffice at Columbus, Ohio, under the Act
of Congress of March 3, 1879; Acceptance for =
mailing at special rate of postage provided for in =
Section 1103, Act of Oct. 3, 1917. Authority =
July 10, 1918.
The Journal does not assume responsibility for §H
opinions expressed by the essayists. Advertisers m
must conform to policies and regulations estab- §H
lished by The Council of the Ohio State Medical
Association.
Table of Contents
p“g<-‘ Scientific Section
563 Birth Defects Registry. Evaluation of a New Program
in Cincinnati. Chris Holmes, B. A., Kenneth I. E.
Macleod, M. D., M. P. H., and Winslow Bashe, M. D.,
M. P. H., Cincinnati.
570 Polycystic Liver Disease. Report of a Case Employing
Needle Biopsy and Liver Scanning. R. Thomas
Holzbach, M. D., and Marvin Rollins, M. D., Cleve-
land.
572 Liver Biopsy. A Report of Experience in 151 Cases.
C. Joseph Cross, M. D.; William A. Millhon, M. D.;
Judson S. Millhon, M. D., and Donald E. Hoffman,
M. D., Columbus.
575 Diagnosis of Obscure Splenic Cyst by Aortography. A
Case Report. Charles D. Hafner, M. D., and Majid
A. Qureshi, M. D., Cincinnati.
577 Bilateral Congenital Lumbar Hernia. Benjamin W. But-
ler, M. D., and Alan D. Shafer, M. D., Dayton.
580 A Clinicopathological Conference from The Ohio State
University Hospital, Columbus, Ohio.
585 Maternal Health in Ohio: Maternal Mortality Report
for Ohio — 1963. By the OSMA Committee on
Maternal Health.
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
News and Organization Section
592 Proceedings of The Council; Meeting of April 23-24
600 Medical Staffing of Emergency Rooms; Legal and Ethical
Considerations
604 Official OSMA Policy Statement on Staffing Emergency
Rooms
606 AMA Annual Convention, Chicago, June 23-30:
Ohio’s Dr. Hudson To be Installed as President;
Candidacy of Dr. Budd for Office of AMA Vice-
Speaker (page 607)
608 Audit of Books — Ohio State Medical Association and
The Journal
611 Malpractice Insurance Rates; New Authorized Scale
( Continued on Page 624 )
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The Ohio State Medical Journal
528
Ohio Medical Society Executives
Move to Strengthen Ties
The first annual meeting and educational confer-
ence of the Association of County Medical Executives
(ACME) was held in Columbus on February 26. The
meeting at the Fort Hayes Hotel was on the day pre-
ceding the Conference of County Medical Society Of-
ficers and Committeemen.
The newly formed organization is composed of
members of the executive staffs of County Medical
Societies in Ohio, the Ohio State Medical Association,
and allied groups.
Persons attending the first annual meeting were the
following:
Mrs. Patsy J. Askins, Sandusky County; John H.
Austin, Stark County; Miss Jean Armour, Academy of
Medicine of Franklin County; Mrs. C. K. Elliott,
Greene County; Robert W. Elwell, Lucas County;
Robert F. Freeman, Montgomery County, Robert A.
Lang, and Donald Mortimer, Cuyahoga County;
Sidney H. Mountcastle, Summit County; Howard
C. Rempes, Mahoning County; W. "Bill” Webb,
Franklin County; A. Danna Whipple, Medina County;
Edward F. Willenborg, Hamilton County; Hart F.
Page, Charles W. Edgar, Herbert Gillen, Michael
Traphagan, and Gordon Moore, OSMA headquar-
ters; and James S. Inboden, AMPAC.
Organization of the group followed a conference
held in Chicago in August of 1965 (see October,
1965 issue of The Journal, page 934) also attended
by Ohio executive staff members. Mr. Willenborg
was named president of the organization; Mr. Webb,
vice-president; and Mr. Mountcastle, secretary-treas-
urer.
The purposes of the organization are to further the
working relationship between the staffs of County
Medical Societies and between organizations on the
county and state levels; to discuss matters of common
interest, and to develop educational programs in fields
related to medical organization work in Ohio.
Members of this group have been meeting for in-
formal discussions over a period of many years.
Formation of the organization is to promote closer
ties among members and to establish more definite
working principles. Formation of the organization
was previously approved by The Council of OSMA.
Dr. Herbert L. Pariser, Columbus, participated in
the eighth annual Mental Health Workshop, "Dial
M for Mental Help,’’ presented on April 20 in Jack-
son, under sponsorship of the Jackson County Mental
Health Association.
The Southwestern Ohio Society of Family Physi-
cians, in collaboration with the University of Cin-
cinnati College of Medicine, presented a seminar on
"Hematology’’ on April 3.
Right there
where he’s needed
. . .due to
LEPTINOL
Improvement of mental alertness and aware-
ness in the management of the senility syndrome
requires a comforting environment, a stimulating
dietary regimen and concomitant drug therapy.
LEPTINOL® is a non-addictive stimulant which
is a useful adjunct in elevating the mood of the
elderly patient who displays apathy, mental con-
fusion or memory lapses.
LEPTINOL® is a combination of pentylenet-
etrazol, niacin, thiamin and ascorbic acid which
acts as a central nervous stimulant and which
exerts its primary effect on the mid-brain and the
medullary center. LEPTINOL® may be pre-
scribed for patients with mild hypertension or
other organic diseases.
Each LEPTINOL® bi-layer tablet contains: PENTYL-
ENETETRAZOL, 100 mg., NIACIN, 50 mg., THIAMINE
HYDROCHLORIDE, 1 mg., ASCORBIC ACID, 20 mg.
DOSE one or two tablets, 3 times daily.
Side Effects: overdosage may produce tremor, convulsions
or respiratory paralysis.
Caution should be taken when treating patients with a low
convulsive threshold. Patients should be warned not to exceed
recommended dose which offers maximum effectiveness.
Write for detailed literature and
starter LEPTINOL® doses.
THE VALE CHEMICAL COMPANY, INC.
Pharmaceuticals
Allentown, Pennsylvania
for June, 1966
531
The older
patient
needs a
special
The geriatric patient is notoriously
prone to constipation— and to an
atonic, 'tired' bowel □ Inadequate
nutrition, chronic diseases,
repeated use of cathartics, plus
the aging process itself all
interfere with the physiology of
elimination.
“Few of the standard laxative agents,
whether long used or recently introduced,
exert fully corrective action on underlying
physiological defects that may be present.”*
5?2
The Ohio State Medical Journal
Ideal for geriatric patients
□ provides gentle, dependable overnight relief
□ offers aid in restoring normal bowel tonicity
and peristalsis
□ no griping or cramping; no added bulk
"In our experience, this combination/Modane/has been more
satisfactory in handling chronic constipation of senile
bedridden patients than most other laxatives ... a 93 per cent
response was obtained in a general hospital population.”"
MODANE'
the broad spectrum laxative
DANTHRON FOR RELIEF
Danthron in Modane acts selectively on the large bowel; its gentle
stimulation assures overnight relief of constipation.
PANTOTHENIC ACID FOR TONICITY AID
Pantothenic acid plays an important role in the formation of
acetylcholine. An adequate level of acetylcholine is necessary for
normal transmission of neural impulses to intestinal muscle.
one tablet daily with evening meal
Modane Tablets— 75 mg. danthron, 25 mg. d-calcium pantothenate.
Modane Mild Tablets— 37.5 mg. danthron, 12.5 mg. d-calcium pantothenate.
Modane Liquid— 37.5 mg. danthron, 12.5 mg. d-calcium pantothenate per teaspoonful
(5 cc.). Dosage: One tablet, or palatable liquid dosage, with evening meal,
or as required by patients.
* Plotnick, M.: Int. Record of Med. 173:262, 1960.
WARREN-TEED PHARMACEUTICALS INC.
(COLUMBUS, OHIO 43215
SUBSIDIARY OF ROHM AND HAAS COMPANY
for June, 1966
533
Health Service Student Loans and
Scholarships Announced
Initial allotments, totaling $12,716,583.15 for fiscal
year 1967 under the Health Professions Student Loan
Program have been made to 196 schools of medicine,
dentistry, osteopathy, optometry, pharmacy, and podi-
atry, it was announced by Surgeon General William
H. Stewart, of the U. S. Public Health Service.
Allotments in Ohio include the following:
Medical Schools — Ohio State Univ., $132,075.00;
University of Cincinnati, $88,656.20; Western Re-
serve University, $76,835.38;
Dental Schools — OSU, $132,984.30; Western Re-
serve, $54,103.01;
Optometry Schools — OSU, $27,000.00;
Pharmacy Schools — University of Cincinnati,
$10,800.00; University of Toledo, $13,500.00;
Podiatry Schools — Ohio College of Podiatry.
❖ ❖ ❖
Scholarship funds totaling $3,807,800 have been
made available for the first time to 227 schools of
medicine, dentistry, optometry, osteopathy, podiatry,
and pharmacy under the new Health Profess ’ons
Scholarship Program of the Public Health Service, the
Surgeon General announced.
Allotments to Ohio schools were the following:
Schools of Dentistry — OSU, $30,000; Western
Reserve, $13,400;
Schools of Medicine — University of Cincinnati,
$20,000; OSU, $30,000; Western Reserve, $17,000;
Schools of Pharmacy — University of Cincinnati,
$18,000; OSU, $14,000; University of Toledo, $5,000.
Schools of Optometry — OSU, $10,000.
Two recent medical films, produced by the motion
picture division of Ohio State University’s department
of photography, will receive Golden Eagle Awards
from the Council on International Non-Theatrical
Events. They are "Kevin Is Four’’ film tracing the
prosthetic development of an amputee child, and
"The Extra-Wide Femoral Nail,’’ sponsored by the
Department of Orthopedic Surgery.
Persons interested in donating instruments, medi-
cal equipment, etc., to the Catholic medical mission
field are invited to write the Catholic Medical Mission
Board, Placement Service, 10 West 17th Street, New
York, N. Y. 10011.
For prompt, emphatic diuresis
(BENZTHIAZIDE)
NEW FROM TUTAG for prompt, comfortable
diuretic action with a balanced excretion
of sodium chloride and a lower potassium
loss under normal dosage and diet regimen
DIURETIC ACTION: Clinically, the oral administration of AQUATAG (benzthi-
azide) results in diuretic activity within two hours with maximal natriuretic,
chloruretic, and diuretic effects occurring during the fourth, fifth and sixth hours.
Maintenance of response continues for approximately 12 to 18 hours. Acidosis
is an unlikely complication since therapeutic doses of AQUATAG (benzthi-
azide) do not appreciably increase bicarbonate excretion. Edematous patients
receiving 50 mg. of AQUATAG (benzthiazide) daily for five days developed a
maximal increase in the rate of sodium excretion on the first day, and main-
tained this high rate until depletion of excessive body stores of sodium.
In congestive heart-failure patients, AQUATAG (benzthiazide) produced the
same weight loss, during a 48-hour treatment period as did a maximally effec-
tive dose of hydrochlorothiazide.
DOSAGE: Diuresis, initially 50 to 200 mg.; maintenance 25 to 150 mg., daily.
Hypertension 50 to 100 mg. initially, adjusted to 50 mg. t.i.d. or downward to
minimal effective dosage level.
PRECAUTIONS AND SIDE EFFECTS: Electrolyte imbalance with hypoka-
lemia, hypochloremic alkalosis and hyponatremia may occur. Other reactions
may include blood dyscrasias, hyperuricemia and gout, nausea, jaundice,
anorexia, vomiting, diarrhea, dizziness, paresthesia, photosensitivity and head-
ache. Insulin requirements may be altered in diabetes.
WARNINGS: Dosage of coadministered antihypertensive agents should be
reduced by at least 50%. Use with caution in edema due to renal disease;
advanced hepatic disease or suspected presence of electrolyte imbalance.
Stenosis or ulcer of small intestine have been reported with coated potassium
formulas and should be administered only when indicated. Until further clinical
experience is obtained, the use of the drug in pregnant patients should be
carefully weighed against possible hazards to the fetus.
CONTRAINDICATIONS: AQUATAG (benzthiazide)
is contraindicated in progressive renal disease or
disfunction including increasing oliguria and azo-
temia. Continued administration of this drug is
contraindicated in patients who show no response
to its diuretic or antihypertensive properties.
Before prescribing or administering, read the package
insert or file card available on request.
Available as 25 or 50 mg. scored tablets.
Request clinical samples and literature on your
letterhead.
S.J.TUTAG
& COMPANY
Detroit, Michigan 48234
534
The Ohio State Medical Journal
Mediatric
Designed for the “metabolically spent”
Nutritional reinforcement for those who can’t
- or won’t- eat properly. . . balanced amounts of
estrogen and androgen to counteract declining
gonadal hormone secretion and its sequelae of
premature degenerative changes... mild
antidepressant for a gentle “mood” uplift...
The estrogen component in MEDIATRIC is
PREMARIN® (conjugated estrogens — equine),
the natural estrogen most widely prescribed for its
superior physiologic and metabolic benefits.
MEDIATRIC also provides nutritional reinforce-
ment—blood-building factors and vitamin supple-
mentation. It contributes a gentle “mood” uplift
through methamphetamine HC1.
Three different dosage forms— Liquid, Tablets, and
Capsules— offer convenience and variety.
MEDIATRIC Liquid
Each 15 cc. (3 teaspoonfuls) contains:
^Conjugated estrogens — equine (Premarin®) 0.25 mg.
Methyltestosterone 2.5 mg.
Thiamine HC1 5.0 mg.
Cyanocobalamin 1.5 meg.
Methamphetamine HC1 1.0 mg.
Contains 15% alcohol
MEDIATRIC Tablets and Capsules
Each MEDIATRIC Tablet or Capsule contains:
'^Conjugated estrogens — equine (Premarin®) 0.25 mg.
Methyltestosterone 2.5 mg.
Ascorbic acid 100.0 mg.
Cyanocobalamin 2.5 meg.
Intrinsic factor concentrate 8.0 mg.
Thiamine mononitrate 10.0 mg.
Riboflavin 5.0 mg.
Niacinamide 50.0 mg.
Pyridoxine HC1 3.0 mg.
Calc, pantothenate 20.0 mg.
Ferrous sulfate exsic 30.0 mg.
Methamphetamine HC1 1.0 mg.
Orally active, water-soluble conjugated estrogens derived from
pregnant mares’ urine and standardized in terms of the weight
of active, water-soluble estrogen content.
MEDIATRIC helps keep the older patient alert anJ active;
helps relieve general malaise, easy fatigability, vague pains in
the bones and joints, loss of appetite, and lack of interest
usually associated with declining gonadal hormone secretion.
contraindication: Carcinoma of the prostate, due to methyl-
testosterone component.
warning: Some patients with pernicious anemia may not
respond to treatment with the Tablets or Capsules, nor is
cessation of response predictable. Periodic examinations and
laboratory studies of pernicious anemia patients are essential
and recommended.
side effects: In addition to withdrawal bleeding, breast ten-
derness or hirsutism may occur.
suggested dosages: Male and female: 3 teaspoonfuls of
Liquid, 1 Tablet, or 1 Capsule, daily or as required.
In the female: To avoid continuous stimulation of breast and
uterus, cyclic therapy is recommended (3 week regimen with
1 week rest period— Withdrawal bleeding may occur during
this 1 week rest period).
In the male: A careful check should be made on the status
of the prostate gland when therapy is given for protracted
intervals.
supplied: No. 910 — MEDIATRIC Liquid, in bottles of 16
fluidounces and 1 gallon. No. 752 — MEDIATRIC Tablets,
in bottles of 100 and 1,000. No. 252 - MEDIATRIC Cap-
sules, in bottles of 30, 100, and 1,000.
Mediatric
steroid-nutritional compound
AYERST LABORATORIES, NEW YORK, N. Y. 10017 • Montreal, Canada
6629
New Members . . .
November Conference on Sports
Scheduled in Las Vegas
Following are names of new members of the Ohio
State Medical Association certified to the Headquar-
ters Office during May. List shows name of physi-
cian, county and city in which he is practicing or
temporary addresses for those taking graduate work.
Butler
Frank C. Palmer, Fairfield
James W. Passino,
Middletown
Tomas R. Yanes, Fairfield
Cuyahoga
Lucina R. Dimaculangan,
Cleveland
Cahit Y. Ergun, Cleveland
Nunzio A. Giotta, Cleveland
Morton S. Light, Cleveland
Wesley Peterson, Cleveland
Casimer F. Radkowski,
Cleveland
Franklin
Norton J. Greenberger,
Columbus
Juergen H. Moslener,
Columbus
Alston M. Quillin, Columbus
Lukas Szabo, Columbus
James I. Tennenbaum,
Columbus
Wigbert C. Wiederholt,
Columbus
Gallia
Lewis A. Schmidt III,
Gallipolis
Hamilton
Pedro P. Ponce, Cincinnati
Licking
Larry Hipp, Granville
Lorain
Ibrahim N. Eren, Lorain
Lucas
Albert R. McKenzie, Toledo
Robert A. Louviaux, Toledo
Montgomery
Thorvald W. Christiansen,
Dayton
Laura E. Pollack, Dayton
Ottawa
George R. Korgeil, Port Clinton
Sandusky
Frank W. Ames, New York,
N. Y. (Military - — Home,
Bellevue)
Stark
Juan A. Gallostra, Canton
Tibor Horvath, Massillon
Summit
Thomas V. Cefalu, Akron
Sanghwan Lew, Barberton
Hector J. Malave-Rosario,
Akron
Leovigildo B. Reyes, Akron
The Eighth National Conference on the Medical
Aspects of Sports, sponsored by the American Medi-
cal Association under the auspices of its Committee
on the Medical Aspects of Sports, will be held in
Las Vegas, Nevada, at Caesar’s Palace on November
27, 1966. The Conference is held annually in con-
junction with and on the first day of the Clinical
Convention of the American Medical Association.
The Conference is open to key nonmedical athletic
personnel as well as interested physicians. Those
who would like to receive further information con-
cerning the Conference should address the Secretary,
Committee on the Medical Aspects of Sports, Ameri-
can Medical Association, 535 North Dearborn Street,
Chicago, Illinois 60610.
Colonel Harold V. Ellingson, Brooks Air Force
Base, Texas, commander of the USAF School of
Aerospace Medicine, has retired from active military
service and accepted a position as professor and chair-
man of the Department of Preventive Medicine at
the Ohio State University College of Medicine.
The population of Ohio was 10,564,144 as of
July 1, 1965, according to the Economic Research Di-
vision of the State of Ohio.
CANDIDATES FOR
“THE MOST EFFECTIVE SUNSCREEN”1 OR WINDSCREEN
ELDER
RVP-Elder, called "the most effective sunscreen,” is also an
ideal windscreen.
RED PETROLATUM
Constant occupational exposure to sun and wind often
causes major discomfort in producing irritating sunburned
and windburned skin . . . commonly found in street workers,
construction workers, and telephone linemen, to mention a few.
There’s reassuring protection and skin comfort for those
outdoor workers who use RVP-Elder. Swimmers, golfers and
others engaged in outdoor activities can have the same skin
protection.
A razor-thin layer of only 10 microns adheres tenaciously
to the skin for hours, yet washes off easily with soap and
water. Virtually invisible, RVP-Elder is odorless, non-staining,
and perspiration and water resistant, even while swimming.
No sensitivity has been encountered.
Supplied in 2 oz. and 16 oz.
Write for clinical trial package and absorption spectrum -
References: (1) Schoch, A. G.: Current News in Dermatology,
August, 1963; (2) Jillson, O. F., and Baughman, R. D.: Arch.
Dermat. 88:409, 1963; (3) Cole, H. N., et al.: J.A.M.A. 130: 1,
1946; (4) MacEachern, W. N., and Jillson, O. F.: Arch. Dermat. 89:
147, 1964.
ALSO AVAILABLE: NEW RVP Aerosol, RVP-2, RVPoque, RVPellent
PAUL B. ELDER COMPANY • Bryan, Ohio
538
The Ohio State Medical Journal
Indications: ‘Miltown’ (meprobamate) is ef-
fective in relief of anxiety and tension states.
Also as adjunctive therapy when anxiety
may be a causative or otherwise disturbing
factor. Although not a hypnotic, ‘Miltown’
fosters normal sleep through both its anti-
anxiety and muscle-relaxant properties.
Contraindications: Previous allergic or idio-
syncratic reactions to meprobamate or
meprobamate-containing drugs.
Precautions: Careful supervision of dose
and amounts prescribed is advised. Consider
possibility of dependence, particularly in pa-
tients with history of drug or alcohol addic-
tion; withdraw gradually after use for weeks
or months at excessive dosage. Abrupt with-
drawal may precipitate recurrence of pre-
existing symptoms, or withdrawal reactions
including, rarely, epileptiform seizures.
Should meprobamate cause drowsiness or
visual disturbances, the dose should be re-
duced and operation of motor vehicles or
machinery or other activity requiring alert-
ness should be avoided if these symptoms
are present. Effects of excessive alcohol may
An eminent role in
medical practice
Clinicians throughout the world con-
sider meprobamate a therapeutic
standard in the management of anxi-
ety and tension.
The high safety-efficacy ratio of
‘Miltown’ has been demonstrated by
more than a decade of clinical use.
Miltown6
(meprobamate)
possibly be increased by meprobamate.
Grand mal seizures may be precipitated in
persons suffering from both grand and petit
mal. Prescribe cautiously and in small quan-
tities to patients with suicidal tendencies.
Side effects: Drowsiness may occur and,
rarely, ataxia, usually controlled by decreas-
ing the dose. Allergic or idiosyncratic re-
actions are rare, generally developing after
one to four doses. Mild reactions are char-
acterized by an urticarial or erythematous,
maculopapular rash. Acute nonthrombocy-
topenic purpura with peripheral edema and
fever, transient leukopenia, and a single
case of fatal bullous dermatitis after admin-
istration of meprobamate and prednisolone
have been reported. More severe and very
rare cases of hypersensitivity may produce
fever, chills, fainting spells, angioneurotic
edema, bronchial spasms, hypotensive crises
(1 fatal case), anuria, anaphylaxis, stoma-
titis and proctitis. Treatment should be
symptomatic in such cases, and the drug
should not be reinstituted. Isolated cases of
agranulocytosis, thrombocytopenic purpura,
and a single fatal instance of aplastic ane-
mia have been reported, but only when other
drugs known to elicit these conditions were
given concomitantly. Fast EEG activity has
been reported, usually after excessive me-
probamate dosage. Suicidal attempts may
produce lethargy, stupor, ataxia, coma,
shock, vasomotor and respiratory collapse.
Usual adult dosage: One or two 400 mg.
tablets three times daily. Doses above 2400
mg. daily are not recommended.
Supplied: In two strengths: 400 mg. scored
tablets and 200 mg. coated tablets.
Before prescribing, consult package circular.
WALLACE LABORATORIES
Cr anbury, N.J.
CM-9761
New IRS Tax Guide Issued for
Income Tax Withholdings
The Internal Revenue Service has issued a revised
Employer’s Tax Guide to be used in connection with
the new graduated system of withholdings adopted by
the Tax Adjustment Act of 1966. Provisions of new
system went into effect May 1. As the IRS points
out, this act makes no change in the amount of tax,
merely in the amount to be withheld.
Physician-employers who have not already made
this adjustment in regard to employees’ withholdings,
are advised to contact the nearest Internal Revenue
Service office for instructions, or to consult a tax
expert.
Following is an official announcement of the IRS
in regard to new provisions in the law:
CIRCULAR E — EMPLOYER’S TAX GUIDE
"The Internal Revenue Service has prepared a re-
vised Circular E, Employer’s Tax Guide, containing
new income tax withholding tables as an aid to em-
ployers in the changeover from Federal income tax
withholding at a flat 14 percent to six rates at 14,
15, 17, 20, 25, and 30 percent. The graduated system
of withholding to go [which went] into effect May 1,
adopted by the Tax Adjustment Act of 1966, Public
Law 89-368, was designed to link the rates at which
taxes are withheld more closely with the rates which
tax liability is computed.
"Elenceforth, the amount of tax deducted from
wages will depend not only on the amount earned
and the number of exemptions claimed on the Form
W-4, but also on whether a person is single or
married.
"New tables in the revised Employer’s Guide have
been prepared for single and married employees for
the following pay periods: Weekly, biweekly, semi-
monthly, monthly, and daily or miscellaneous. The
payroll period and marital status of the employee will
determine the table to be used.
As an additional service to employers, there is in-
cluded in the revised Guide eight copies of Document
5642, a fact sheet for employees. Document 5642
contains information on ( 1 ) how the new tax system
may affect wage withholding; (2) a comparison of
weekly withholding under the old and new system,
and (3) a Form W-4 to be filed with the employer.
"It is suggested that all employees study the new
withholding system fact sheet carefully prior to filing
a new up-to-date W-4. Employers will provide the
employees with the combined fact sheet, Document
5642, and Form W-4. Persons who presently claim
fewer withholding exemptions than the legal number
to which they are entitled or have additional dollar
amounts withheld for tax liability purposes may have
too much deducted from their pay under the grad-
uated withholding. If this is the case, individuals
Stouffer Foundation Posts Award
In Vascular Research Field
What is reported to be the largest medical
prize in the world has been posted to track
down the cause, prevention and treatment of
hardening of the arteries and high blood pres-
sure. A prize of $50,000, together with a
medal and citation, will be awarded annually
by the Vernon Stouffer Foundation, named for
Vernon Stouffer, founder and president of
Stouffer Foods Corporation.
Announcement of the prize was made by
Dr. Irvine H. Page, director of research at the
Cleveland Clinic Foundation, and well-known
authority in the fields of arteriosclerosis and
hypertension.
Announcement of the prize was made at
ceremonies earlier this year in Cleveland, at-
tended by leaders in the medical and health
field from all parts of the nation.
can increase withholding exemptions up to the legal
number.
"Under the new system, married persons will be
treated as single, and thus have more tax withheld,
unless they file a new Form W-4 showing they are
married.
"Some taxpayers, of course, primarily those with
substantial nonwage income, those with two or more
employers, and those whose wives work, may still
want to claim fewer exemptions than the number to
which they are entitled. Otherwise, they may owe tax
money at the end of the year.
"For the remainder of 1966, the new system will
be in effect for only 35 weeks. Consequently, tax-
payers may want to consider filing a new W-4 for
1967.
"The revised guide will be [has been] mailed to
all employers in April and will provide employers
who have fewer than nine employees with sufficient
quantities of Document 5642 for distribution.
"Special packets containing additional copies of
Document 5642 will be mailed to employers with up
to 255 employees. Employers with 256 or more em-
ployees (there are only 16,000 in the United States)
will need to obtain their entire supply of Document
5642 from the nearest Internal Revenue Service Dis-
trict Office.”
Dr. F. Mason Sones, Jr., director of the Depart-
ment of Pediatric Cardiology and Cardiac Laboratory,
Cleveland Clinic Foundation, was named one of ten
recipients of the 1966 Awards for Distinguished
Achievement in medicine given by Modern Medicine
magazine.
540
The Ohio State Medical Journal
Toledo State College of Medicine s
First President Is Appointed
Dr. Glidden L. Brooks, of Brown University, Pro-
vidence, R. I., has been appointed by the Board of
Trustees as the first president of the developing Tol-
edo State College of Medicine. The appointment
becomes effective July 1.
Dr. Brooks is director of
the Institute for Health Serv-
ices at Brown and associate
vice-president for biomedi-
cal development. He is a
native of Pawnee City, Ne-
braska, and graduated from
the University of Nebraska
in 1933. He received the
M. D. degree from Harvard
four years later.
^ „ , From 1937 to 1941 he
Dr. Brooks . „ , „ ..
was on the staff of Chil-
dren’s Hospital, Boston, and was chief resident in
pediatrics the last two years. After a year as in-
structor in pediatrics at Harvard he became director
of pediatrics at the Central Maine General Hospital,
Lewiston.
During World War II, Dr. Brooks was a commis-
sioned officer with the U. S. Public Health Sendee.
After the war he returned to the Lewiston Hospital
as executive director. In 1949 and 1950 he was on
the staff of Children’s Hospital, Philadelphia, and
on the faculty of the University of Pennsylvania.
In addition he was director of the American Academy
of Pediatrics committee for the improvement of
child health. Subsequent appointments include those
at the University of Pittsburgh as professor of hospital
administration, association professor of pediatrics,
and coordinator of hospitals and clinics.
Before going to Brown, he was medical director of
the United Cerebral Palsy Associations.
Opinion on Medical Treatment for
Ohio T outh Commission ards
A recent opinion of Attorney General William B.
Saxbe states that the Ohio Youth Commission "not
only has the authority but has an affirmative duty to
order routine and emergency medical treatment for
children committed to its care when such is required.”
The following communication from Daniel W.
Johnson, chairman of the Ohio Youth Commission,
gives the commission’s policy in this regard as well
as a summary of the Attorney General’s opinion:
"In response to questions raised by several juvenile
courts, we requested an Attorney General’s Opinion
to determine the necessity for obtaining Medical
Waivers from parents of children committed to the
Ohio Youth Commission. Opinion No. 66-045 was
received on February 25, 1966, and states, in sum-
maty, the following:
"1. The Ohio Youth Commission not only has
the authority but has an affirmative duty to order
routine and emergency medical treatment for children
committed to its care when such is required. Sec-
tion 5139.01 (A)(3) and (A)(4), Revised Code.
"2. This authority relates equally to temporary
and permanent commitments. Section 5139.05 (B),
Revised Code.
3. Consultation with parents is frequently desir-
able and should be encouraged. However, no formal
waiver from parents or Juvenile Courts in lieu thereof
is required. There is judicial authority for ordering
medical treatment for children over objections by
parents and guardians. In re Clark, 21 0.0. 2d 86;
30 A.L.R. 2d 1138.
"As a consequence of the above opinion, we have
decided to discontinue the practice of requesting of
Juvenile Courts to submit medical waivers at the time
of commitment, effective March 1, 1966.”
Accredited by The Joint Commission on Accreditation of Hospitals.
WINDSOR HOSPITAL
A NONPROFIT CORPORATION
— ESTABLISHED 1 8 9 8 —
Chagrin Falls, Ohio 44022
247-5300 (Area Code 21 6)
A hospital for the treatment
of Psychiatric Disorders
Booklet available on request.
JOHN H. NICHOLS, M. D.f Medical Director G. PAULINE WELLS, R. N., Admin. Director HERBERT A. SIHLER, Jr.f Pres.
MEMBER: American Hospital Association — National Association of Private Psychiatric Hospitals — Ohio Hospital Association
for Jane, 1966
545
one mid-morning
New 300mg tablel
ForAdults-2 tablets provide a full 24 hours of therap
...with all the extra benefits of DECLOMYCIN.Jowe'
mg intake per day... proven potency... 1-2 days’ “extra
activityto protect against relapse orsecondary infectior
Effective in a wide range of everyday infections— respiratory, urinary
tract and others— in the young and aged— the acutely or chronically
ill— when the offending organisms are tetracycline-sensitive.
Contraindication— History of hypersensitivity to demethylchlortetra-
cycline.
Warning— In renal impairment, usual doses may lead to excessive
systemic accumulation and liver toxicity. Under such conditions,
lower than usual doses are indicated and, if therapy is prolonged,
serum level determinations may be advisable. A photodynamic
reaction to natural or artificial sunlight has been observed. Sm
amounts of drug and short exposure may produce an exaggerat;
sunburn reaction which may range from erythema to severe slj
manifestations. In a smaller proportion, photoallergic reactio
have been reported. Patients should avoid direct exposure to si
light and discontinue drug at the first evidence of discomfort. Ij
Precautions and Side Effects— Overgrowth of nonsusceptible orgc |
isms may occur. Constant observation is essential. If new infil
tions appear, appropriate measures should be taken. Use ;
jed and debilitated
pss confused and moody. Personal care, memory,
motional stability, social attention improve. Fatigue,
pathy and irritability are reduced.
A prescription for 100 tablets of Geroniazol TT will
ermit your patients to enjoy the benefits of time-
rolonged nicotinic acid/pentylenetetrazol therapy,
t an economical price. Dosage is only one tablet every
[2 hours.
Contraindications : There are no known contraindica-
ions.
Precautions : Exercise caution when treating patients
idth a low convulsive threshold.
“ First with the Retro-Steroids”
PHILIPS ROXANE LABORATORIES
Division of Philips Roxane, Inc., Columbus, Ohio
A Subsidiary of Philips Electronics and
Pharmaceutical Industries Corp.
Geroniazol TT
nicotinic acid 150 mg., pentylenetetrazol 300 mg.
Tempotrol® Time Controlled Tablet
Side Effects: Side effects are rarely encountered, how-
ever due to the vasodilatation effect of nicotinic acid,
transitory mild nausea, flushing, tingling and pru-
ritus are possible.
Dosage: One tablet every 12 hours.
Supplied: Prescribe bottles of 100 tablets, to take ad-
vantage of recent price reduction.
References: 1. Report by Nuclear Science & Engi-
neering Corp., Pittsburgh, Pa., in files of Philips
Roxane Laboratories. 2. Connolly, R. : W. Virginia Med.
J. 56: 263 (Aug.) 1960. 3. Curran, T. R., and Phelps,
D. K. : Am. Pract. & Digest Treat. 11 : 617 (July) 1960.
Health Referral Service in Ohio for
Selective Service Rejectees
THE Ohio Department of Health and more than
125 local health departments in Ohio have
joined with the United States Public Health
Service and with other state and local health depart-
ments throughout the country in a new program to
assist individuals who are rejected by Selective Service
or Armed Forces enlistment for medical reasons.
Dr. E. W. Arnold, director of the Ohio Depart-
ment of Health, described the new Health Referral
Service as filling a long-felt need for special services
to the large number of young men being rejected for
military service because of failure to meet medical
standards. He pointed out that about half the young
men called for military duty have failed pre-induction
examinations, and about half who failed were dis-
qualified for medical reasons.
Interviewers Stationed
Under the new program, the Ohio Department of
Health has placed nurse-interviewers at the three Ohio
Armed Forces Examining and Entrance Stations in
Cleveland, Columbus, and Cincinnati. Counseling
and advice to the rejectees starts at these stations
with agreement of the rejectees. Interviews are con-
fidential and medical information is released only with
authorization of the individuals.
When medical care or corrective procedures are
indicated, the individual is referred to the appropriate
medical resources in his home community. Details
are forwarded from the Health Referral Service at
the state level to the designated participating agency
on the local scene.
Follow-up contact is made with the rejectee at
home to assist him in obtaining the medical aid he
needs. This may start with his family physician and
go on to include additional special services. If the
rejectee needs financial help, he is advised about
agencies that offer such help. The project does not
interfere with the private doctor-patient relationship
in the community, but rather tends to improve and
promote this relationship, sponsors declared.
Federal Grant Backing
This program was first recommended by a Presi-
dential Task Force on Manpower Conservation in
1964. Pilot studies indicated that a large percentage
of rejectees had remediable conditions, but were not
aware either of the conditions or the remedies in
many cases. Congress acted to provide grants through
the United States Public Health Service to state and
local health departments to establish the new Health
Referral Service.
Ultimate aim of the Health Referral Service is to
obtain medical help for all medically disqualified
young men who have been rejected for military serv-
ice and to ascertain through follow-up whether these
young men are continuing under appropriate medical
care.
Supervising the Health Referral Service in the Ohio
Department of Health is Dr. Ralph D. Lausa. He is
serving on a part-time basis and maintaining his pri-
vate practice in the City of Columbus.
Grant Will Promote Nursing Program
At WRU and University Hospitals
John S. Millis, president of Western Reserve Uni-
versity, and Stanley A. Ferguson, director of Univer-
sity Hospitals, recently announced the receipt of a
$21 6,1 40 five-year grant from the W. K. Kellogg
Foundation.
The funds will be used to effect a major change
in the relationship between WRU’s Frances Payne
Bolton School of Nursing and the Department of
Nursing at the Hospitals.
The reorganization will promote greater integration
of all nursing activities in the University Medical
Center.
In effect, this move means that faculty members,
who to date concentrated their efforts on education,
will also have responsibility for patient care. Con-
versely, nurses who formerly directed their efforts
mainly toward patients will assume a more active
role in educating students.
School of Allied Medical Services
To Be Established at OSU
The Ohio State University College of Medicine will
establish a school of Allied Medical Services July 1,
according to an announcement from the university.
Degrees to be offered through the school will be
a bachelor of science in medical dietetics, medical il-
lustration, medical technology, occupational therapy
and physical therapy. Certificates will be awarded
in medical technology, nurse anesthesiology, orthoptic
technology and physical therapy.
550
The Ohio State Medical Journal
dextroamphetamine
sulfate and amobarbital
she can say "No thank you"
to the crepes suzette.
'Dexamyl' does more than most anorectics. Be-
cause it curbs appetite and lifts mood, 'Dexamyl'
can encourage the discouraged dieter to stay
on her diet.
The mood lift with 'Dexamyl' can make the dif-
ference between the success or failure of her
diet plan.
Formulas: Each 'Dexamyl' Spansule® Capsule (brand of sustained
release capsule) No. 1 contains 10 mg. of Dexedrine® (brand of
dextroamphetamine sulfate) and 1 gr. of amobarbital, derivative of
barbituric acid [Warning, may be habit forming]. Each 'Dexamyl'
Spansule capsule No. 2 contains 15 mg. of Dexedrine (brand of
dextroamphetamine sulfate) and IV2 gr. of amobarbital [Warning,
may be habit forming].
Principal cautions and side effects: Use with caution in patients
hypersensitive to sympathomimetics or barbiturates and in coronary
or cardiovascular disease or severe hypertension. Insomnia, excit-
ability and increased motor activity are infrequent and ordinarily
mild.
Before prescribing, see SK&F product Prescribing Information.
Smith Kline & French Laboratories
Western Reserve Medical School
Gets Substantial Sears Gift
University Medical Center, in Cleveland, and the
Case Institute of Technology, jointly announced gifts
of $1 million each from Lester M. and Ruth P.
Sears. Mr. Sears is honorary chairman and founder
of Towmotor Corporation.
The gift of $1 million for Western Reserve Uni-
versity School of Medicine is the largest received to
date from a private individual source by the Univer-
sity Medical Center Development Program. It will
be used for the construction of the Administration
Tower which is part of the planned addition of the
School of Medicine. It will be named the Lester M.
and Ruth P. Sears Administration Tower.
The tower will be the focal point between the
existing School of Medicine and the planned East
Wing. Rising five floors above the Health Science
Schools’ Podium, it will serve as the main traffic
artery between the two buildings.
It will house the dean’s offices, administrative of-
fices, conference rooms and meeting areas. The main
entrance to the tower will be at the Podium level,
directly opposite the Health Science Schools’ Library.
The University Medical Center Development Pro-
gram, which seeks $54.8 million for the Schools of
Medicine, Dentistry and Nursing of WRU and the
University Hospitals of Cleveland, was announced
four years ago.
Construction has already begun on two projects.
The $11 million Bishop Building, which is the Hos-
pitals’ general patient service unit, is scheduled for
completion this year. The $2.5 million Hanna House
addition was begun last fall and is to be completed
in 1967.
To date, the UMC has received $33 million and
land is being cleared along Abington and Cumming-
ton Roads to permit construction of the five-acre
Health Science Podium. The five-floor East Wing
of the School of Medicine, which will be connected
to the present building by the Sears Administration
Tower, will contain the Health Science Schools’ Li-
brary, medical students’ classrooms, conference rooms
and laboratories.
* * *
The Trustees of Case Institute of Technology have
chosen to honor Mr. and Mrs. Sears by naming the
largest academic building on the Case campus, The
Lester M. and Ruth P. Sears Library-Humanities
Building. Their names will grace the building which
dominates the Case campus and forms the west en-
trance to the entire University Circle area.
The gift allows the institute to pursue its goal
of excellence in engineering and scientific education.
Since its opening in 1961, the Library-Humanities
Building — which is ultimately designed to hold
250,000 books — has become a center of intellectual
life on the Case campus, providing study space for
446 students.
Bamadex® Sequels®
Contraindications: In hyperexcitability and in agi-
tated prepsychotic states. Previous allergic or
idiosyncratic reactions.
Precautions: Use with caution in patients hyper-
sensitive to sympathomimetic compounds, who
have coronary or cardiovascular disease, or are
severely hypertensive.
Dextro-amphetamine sulfate: Use by unstable in-
dividuals may result in psychological dependence.
Meprobamate: Careful supervision of dose and
amounts prescribed is advised; especially for pa-
tients with known propensity for taking excessive
quantities of drugs. Excessive and prolonged use
in susceptible persons, e.g. alcoholics, former ad-
dicts, and other severe psychoneurotics, has been
reported to result in dependence. Where excessive
dosage has continued for weeks or months, re-
duce dosage gradually. Sudden withdrawal may
precipitate recurrence of pre-existing symptoms
such as anxiety, anorexia, or insomnia; or with-
drawal reactions such as vomiting, ataxia, trem-
ors, muscle twitching and, rarely, epileptiform
seizures. Should meprobamate cause drowsiness
or visual disturbances, reduce dose — operation of
motor vehicles, machinery or other activity re-
quiring alertness should be avoided. Effects of
excessive alcohol consumption may be increased
by meprobamate. Appropriate caution is recom-
mended with patients prone to excessive drinking.
In patients prone to both petit and grand mal
epilepsy meprobamate may precipitate grand mal
attacks. Prescribe cautiously and in small quanti-
ties to patients with suicidal tendencies.
Side Effects: Overstimulation of the central nerv-
ous system, jitteriness and insomnia or drowsiness.
Dextro-amphetamine sulfate: Insomnia, excita-
bility, and increased motor activity are common
and ordinarily mild side effects. Confusion, anx-
iety, aggressiveness, increased libido, and halluci-
nations have also been observed, especially in
mentally ill patients. Rebound fatigue and de-
pression may follow central stimulation. Other
effects may include dry mouth, anorexia, nausea,
vomiting, diarrhea, and increased cardiovascular
reactivity.
Meprobamate: Drowsiness may occur and can be
associated with ataxia, the symptom can usually
be controlled by decreasing the dose, or by con-
comitant administration of central stimulants.
Allergic or idiosyncratic reactions: maculopapu-
lar rash, acute nonthrombocytopenic purpura
with petechiae, ecchymoses, peripheral edema
and fever, transient leukopenia. A case of fatal
bullous dermatitis, following administration of
meprobamate and prednisolone, has been re-
ported. Hypersensitivity has produced fever,
fainting spells, angioneurotic edema, bronchial
spasms, hypotensive crises (1 fatal case), anuria,
stomatitis, proctitis (1 case), anaphylaxis, agranu-
locytosis and thrombocytopenic purpura, and a
fatal instance of aplastic anemia, but only when
other drugs known to elicit these conditions were
given concomitantly. Fast EEG activity, usually
after excessive dosage. Impairment of visual ac-
commodation. Massive overdosage may produce
drowsiness, lethargy, stupor, ataxia, coma, shock,
vasomotor, and respiratory collapse.
556
The Ohio State Medical Journal
First aid for a
button popper
Second aid for a
button popper
Bamadex* Sequels*
d-amphetamine sulfate (15 mg.) Sustained Release Capsules
and meprobamate (300 mg.)
By providing combined anorexigenic-tranquilizing action, BAMADEX SEQUELS
Capsules help your nonshrinking patients to establish new patterns of eating less.
The amphetamine component suppresses the appetite, while the meprobamate
helps allay nervousness and tension. And for most patients, the sustained release
of the active ingredients makes possible convenient one-capsule-a-day dosage.
LEDERLE LABORATORIES • A Division of American Cyanamid Company, Pearl River, New York
6655
for June, 1966
557
Dean of Medical School Named
At Western Reserve
Newly appointed dean of Western Reserve Uni-
versity School of Medicine is Dr. Frederick C. Rob-
bins, professor of pediatrics at the medical school and
director of the Department of Pediatrics and Con-
tagious Diseases at Cleve-
land Metropolitan General
Plospital. Announcement of
the appointment to become
effective September 1 was
made by Dr. John S. Mills,
Western Reserve president.
Dr. Robbins was awarded
the Nobel Prize in 1954 for
his share in development of
a method of growing polio
virus cultures in the labora-
tory, an achievement credited
with setting the stage for de-
velopment of polio vaccine. He shared the honor
with Dr. John F. Enders and Dr. Thomas H. Wel-
ler, his colleagues at Harvard during the research
period.
Born in Auburn, Ala., Dr. Robbins received two
bachelor’s degrees from the University of Missouri
and his medical degree from Harvard, where he
graduated in 1940.
He moved to Cleveland in 1952 as chief of pediat-
rics at City Hospital, now Metropolitan General.
From 1958 to 1962 he was chairman of the Com-
mittee on Medical Education at Western Reserve. In
1964 he was named director of the perinatal center
of the hospital.
Dr. Robbins succeeds Dr. Douglas D. Bond, who
several months ago announced his plans to retire to
devote full time to teaching and research.
Dr. Robbins
Dr. William E. Barratt, Painesville, recently partici-
pated in a tour of service with Project Viet-Nam.
What To Write For
Some booklets, pamphlets, and other published
materials available for the asking or at nominal ex-
pense and suitable for the physician’s office, library
or waiting room or for his personal information.
❖ * *
For Good Dental Health, Start Early. A leaflet
for parents of young children, particularly those in
the preschool years. National Dairy Council, 111 N.
Canal Street, Chicago, Illinois 60606.
* * ❖
Mental Health of Children. This report provides
an overview of the child program of the National
Institute of Mental Health, with a sampling of spe-
cific projects and programs. Public Health Sendee
Publication No. 1396; for sale by the Superintendent
of Documents, U. S. Government Printing Office,
Washington, D. C., 20402; price 40 cents.
^
AMA Health Education Materials — Catalog. A
listing of numerous posters, pamphlets, etc., for pa-
tient education with prices. Available from the
American Medical Association, 535 N. Dearborn
Street, Chicago, Illinois 60610.
H: ^ ^
Mental Health in Appalachia; Problems and
Prospects in the Central Highlands. "This sum-
mary, a departure from the usual type of conference
report, represents an effort to distill the essence of a
meeting rather than report verbatim details. It has
sought to capture the gist of this discussion of a
region’s mental health problems, and reflect the
insights and perspectives of experts familiar with
the region, as helpful background for meaningful
planning of mental health services.’’ Public Health
Service Publication No. 1375. For sale by the
Superintendent of Documents, U. S. Government
Printing Office, Washington, D. C., 20402; price 15
cents.
Protect Your Family — Now — With the OSMA - PLAN
of comprehensive group major medical insurance sponsored by the
- Ohio State Medical Association for its members and their families
NEW —
A ho available to Oliio Physicians:
up to $100,000
D I S A B I L I T Y
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ACCIDENTAL
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EXPENSE
DISABILITY
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INSURANCE
INSURANCE
(All three at low group rates)
Call or write : DANIELS-HEAD & ASSOCIATES, INC.
Daniels-Head Building, Portsmouth, Ohio 45662 Tel. 353-3124
558
The Ohio State Medical Journal
Birth Defects Registry
Evaluation of a New Program in Cincinnati
CHRIS HOLMES, B.A., KENNETH I. E. MACLEOD, M.D., M. P. H.,
and WINSLOW BASHE, M. D., M.P.H.
IN OCTOBER 1964, a Birth Defects Registry
was inaugurated by the Health Commissioner of
Cincinnati. The primary purpose of this Registry
is to obtain a base line incidence value for birth de-
fects occurring in the Cincinnati area. The project
is following in its broad outlines — but with con-
siderable modification — a similar five-year study in
Birmingham, England, reported by McKeown and
Record.1 One significant difference between the two
studies is in the spectrum of defects on which in-
formation is desired. The Birmingham study selected
the defects in which they had special interest, whereas
Cincinnati’s project includes all defects, functional as
well as structural, from the major, life-threatening or
crippling congenital malformations to the seemingly
unimportant birth anomalies. Thus, while the Bir-
mingham report ruled out such defects as pigmented
nevi and congenital umbilical hernia, the Cincinnati
study includes these.
At present the main sources of data for the Cin-
cinnati study are: (1) Hospitals; (2) Birth Registry;
and (3) Death Registry. These sources report their
information on Birth Defect Cards, which are then
sent to the Cincinnati Health Department (see Fig. 1 ) .
All eleven hospitals in the Cincinnati area which
have maternity beds are participating in the Registry-
program. Hospital record room personnel review
each newborn chart, and from the neonatal physical
examination a Birth Defect Card is sent if there is
any evidence of such a defect. In addition, there is
Acknowledgment and thanks are due to the Division of Community
Health Services of the United States Public Health Service for a
grant (AT6) which made this article and the work of the student
possible.
Submitted October 28, 1965.
The Authors
• Mr. Holmes, Cincinnati, is a medical student at
The University of Cincinnati College of Medicine.
• Dr. Macleod, Cincinnati, is Commissioner of
Health, Cincinnati Health Department.
• Dr. Bashe, Cincinnati, is a member of the staff,
Cincinnati General Hospital; Associate Professor
of Preventive Medicine, The University of Cincin-
nati College of Medicine.
a place on the Ohio Birth Certificate where the physi-
cian is to check a box "yes” or "no” for the presence
of a "congenital malformation.” No information
about the type of malformation present is demanded
on the birth certificate, and this part of the certificate
is regarded as confidential; it is never, for example,
duplicated when a record of birth is sent to a family.
A member of the Hamilton County Vital Statistics
Office reviews each month’s birth certificates and
sends a Birth Defect Card to the Health Department
for every- case where "congenital malformation” is
marked "yes.” Information about the type of defect
present must be supplied either by a phone call to
the hospital or by reference to a duplicate defect card
sent from the hospital — if one is present.
There is a similar method of reporting defects
which appear on Death Certificates. Each month a
member of the Vital Statistics Office reviews all the
deaths for that month. On any certificate where the
primary or contributory cause of death has been as-
cribed to a birth defect, a Birth Defect Card is sent
to the Health Department. These cards taken from
563
the death certificates do, of course, contain informa-
tion about the type of defect present, unlike the
cards from the birth certificate.
In addition to these three major sources of data
there are two others, one of which is not yet oper-
ational, and one of which is designed for follow-up
study. Beginning in September, 1965, a pre-entrance
examination of school children, organized by the Cin-
cinnati Health Department, will be established in
the Cincinnati area. It is hoped that this examination
will dislose those defects which do not become evi-
dent until some years after birth. Finally, in order
to obtain more information about a particular, se-
lected case, a Long Form protocol has been created.
The information asked for on this form covers mater-
nal history, delivery history, immediate neonatal
problems, defects in previous children and other per-
tinent information. Answers to these questions are
to come from newborn and maternity hospital charts.
By agreement between the Cincinnati Health Depart-
ment and Cincinnati area physicians, no family con-
tact will be made by Health Department personnel
for follow-up purposes without the M. D.’s knowl-
edge and permission.*
At the time of writing this report, the Birth Defect
Registry has been operational for 10 months. The
purpose of this report is to point out some of the
problems related to the Registry after the first seven
operational months, to evaluate the efficiency and the
effectiveness of the different reporting systems, and
possibly to offer methods for improving the program.
Methodology
First, a birth defect rate (B. D. R.) was calculated
for each hospital.
Total Birth Defects
B. D. R. = X 100/
Total Live Births
Given Unit of Time.
These rates were calculated on a monthly basis and
for the overall seven month period. Since the B.D.R.’s
*N. B.rSome patients become known to the Department by a separate
system — the Handicapped Registiy.
varied considerably from month to month, only the
results of the seven month B. D. R. are expressed. It
was noticed that the B. D. R. of one hospital, Cin-
cinnati General Hospital (C.G.H.), was consistently
higher than all the other hospitals. The question im-
mediately arose whether this difference was a real one
(that is, due to some difference in hospital population,
obstetric procedures, etc.) or whether it was a reflec-
tion of a failure in hospital reporting of birth defects.
And if the latter case were true, was this a failure of
reporting all defects, or were there particular types
of defects not being reported? Were, for example,
only major defects being reported to the neglect of
minor ones?
To answer these questions, several techniques were
employed. First, arbitrary parameters of "major”
and "minor” birth defects were defined from a list of
the types of defects received for the seven month
period. This list was cumulated, categorized, and is
expressed in Tables 1 and 2. Then, using the para-
Table 1. Table of Cumulated Total Minor Defects
System or
Category
Number of
Examples Defects
Cardiovascular
System
Hemangioma
16
Genitourinary
System
Hydrocele, Hypospadias, Cryptorchi-
dism, Imperforate Hymen, Fusion of
Labia Minora, and others.
77
Gastrointestinal
System
Tongue-tie, umbilical hernia, inguinal
hernia, and others.
41
Head and Neck
Bronchial cleft cysts, salivary cysts,
accessory auricle, mal-development of
pinna, nasal deviation, obstructed
tear duct, scalp defects, pre-auricular
sinus or tags and others.
54
Thorax and Abdomen
Supernumerary nipple, inverted nipple,
pilonidal sinus or dimple, and others.
30
Extremities
Syndactyly, digital tags, simian
creases, and others.
20
Defects involving
Pigmentation
Lentigenes, vitiligo, mongoloid spots,
pigmented nevi, and others.
24
meter "minor” defect, the number of minor defects
reported by each hospital was calculated and expressed
as minor defect percentages of total defects for each
CINCINNATI HEALTH DEPT. BIRTH DEFECTS REGISTRY
CHILD SEX COLOR
RESIDENCE MOTHER’S NAME
BIRTHDATE BIRTHPLACE B. C.#
DATE OF DEATH PLACE D. C. #
BIRTH DEFECT PRESENT SUSPECTED HOSP. CASE NO
MAJOR SYSTEM, OR SYSTEMS, AFFECTED
DEFECT:
DIAGNOSING PHYSICIAN
CHILD REFERRED TO:
SIGNATURE OF PERSON REPORTING DEFECT
(If more room is needed for reporting, use reverse side)
Fig. 1. Card Form Used for Reporting Birth Defects
564
The Ohio State Medical Journal
Table 2. Table of Cumulated Total Major Defects
System or
Category
Number of
Examples Defects
Cardiovascular
System
Septal defects, transposition of great
vessels, tetralogys of Fallot, Throm-
bocytopenia, Erythroblastosis fetalis.
Hemolytic disease of the newborn,
and others.
65
Neuromuscular
System
Anencephaly, Arnold-Chiari Malfor-
mations, Meningoceles, Myelomen-
ingoceles, Hydrocephalus, Foot drop,
Microcephaly, Macrocephaly, absence
of muscles anywhere. Paralysis any-
where, and others.
59
Respiratory
Diaphragmatic defects, T.E.F.’s, Re-
spiratory Distress syndrome, congeni-
tal cystic pulmonary malformations,
and others.
33
Genitourinary
System
Chardee, Duplication of Cervix and
uterus. Hydronephrosis, cystic kid-
neys, and others.
it
Gastrointestinal
System
Chalasia, Rupture of a Viscus, mal-
rotation of viscera. Imperforate anus,
congenital meconium ileus, cleft lip,
palate or alveolar ridge, other body
anomalies, and others.
21
Bone Defects and
Extremities
Osteogenesis Imperfecta, Synostosis,
Hemivertebrae, Hyperplasia or Hypo-
plasia of an extremity7. Tight hip
adductor syndrome. Torticollis, Poly-
dactyly club foot. Scoliosis, Pectus
excavatum, Dislocatable hip, and
others.
91
Biliary
System
Hypobilirubinemia, hyperbilirubi-
nemia, Biliary atresia, Hepatosplen-
omegaly, and others.
9
Special Senses
Lack of sight, Lack of ear canal, con-
genital cataracts, and others.
4
Chromosomal Defects
Mongolism and Turner’s syndrome.
15
Neoplasm
Papillomas, Lipomas
6
hospital. Next, three hospitals with low B. D. R.’s
were sampled to determine the efficiency of the hos-
pital reporting system. The sample was 134-150
newborn charts in size, and the names of the newborn
were randomly taken from December 1964 Birth
Certificates. The charts of these newborn were re-
viewed, and noted were any cases where defects were
present but not reported. New after-sample B.D.R.’s
and minor defect percentages were then calculated.
The other two reporting systems, Birth Certificates
and Death Certificates, were also evaluated. First,
an effort was made to see what per cent of the Defect
Cards came from each reporting system and how many
duplicate cards there were for each system. Then,
all Birth Certificates and Death Certificates from the
Hamilton County Vital Statistics Office for the month
of December, 1964 were reviewed, and noted were
any defects present on these certificates which were
not reported by Vital Statistics Office personnel.
Next, an effort was made to look at Stillbirth
Certificates. The Stillbirth Certificate, like the Death
Certificate, has a place to indicate the presence of a
birth defect. This certificate must be completed on
all stillbirths who are older than 20 weeks gestation.
Since the Stillbirth Certificate was not one of the
Health Commissioner’s original sources for birth de-
fects, there was no established routine in the Vital
Statistics Office for reporting them. It was felt,
however, that a potential source of defects was being
missed. And, since the stated purpose of the Registry
was to look at all defects, those in stillbirths — like
those in neonatal deaths — should have been included.
Therefore, all stillbirths from Hamilton County for
the period October 1, 1964 to April 30, 1965 were
reviewed, and those indicating a defect were noted.
Also noted was the number of duplicate defect cards
from hospitals for this period which indicated a
defect in a stillborn.
Finally, to evaluate the Long Form as an instru-
ment for follow-up, five cases from each of eight
hospitals were selected for a follow-up study to see
how much of the information requested by the Long
Form was obtainable from hospital charts alone.
Data
(See accompanying Tables and Figures)
Discussion and Results
Before and After-Sample of Hospital Charts
Fig. 2 and Fig. 3 show the data for the calculated
before-sample B.D.R.’s and minor defect percentages
for June, 1966
565
Fig. 3. Total Minor Defects as % of Total Defects,
October, 1964 - April 30, 1963.
for the seven month period. In both cases Cincinnati
General Hospital (C.G.H.) stands out above the
other hospitals, although hospital D approaches it for
reporting of minor defects. Table 3 shows the re-
sults of the sample of newborn charts from the hos-
Table 3. Comparison of Birth Defects Identified in a
Sample of Hospital Records and Birth Defect Cards. Four
Selected Hospitals, Cincinnati, December, 1964
Hospital A
Hospital D
Hospital I
C. G. H.
Total Live Births
For December, 1964
335
488
221
Total Newborn
Charts Reviewed
134
135
150
Total Defects
Found
16
19
20
Calculated Birth
Defect Rate Before
Sample for 12/64
.89%
1.2%
2.7%
12.8%
Calculated Birth
Defect Rate After
Sample for 12/64
11.8%
14.0%
13.3%
Number of
Minor Defects
7
12
6
Minor Defects
Percentages of
Total Defects
Before Sample
for 12/64
0%
0%
36%
60%
Minor Defects
Percentages of
Total Defects
After Sample
for 12/64
43%
63%
65%
pitals selected. In all three cases both the B.D.R.’s
and the minor defect percentages were considerably
greater in the sample. C.G.H. was, itself, not
sampled, and it is possible that there are still defects
lying unreported from this hospital for the month of
December. But it still seems safe to conclude that
one important reason for the difference in B. D. R.’s
between C.G.H. and the other hospitals is a simple
lack of reporting. This failure in reporting partially
involves reporting of minor defects, since this type
of defect was definitely increased in the sample. But
since the after-sample minor defect percentages were
considerably less than 100 per cent (43 to 65 per
cent), it is not just a lack of reporting minor defects
which is the problem. Rather the basic problem
seems to be a simple lack of reporting of all birth
defects in general, major or minor.
Comparison of The Three Major Reporting Systems
Table 4 is a comparison of the three major report-
ing systems. Theoretically, if the Birth Certificate as
a source of information were 100 per cent effective
Table 4. Comparison of Three Reporting Systems
October 1, 1964 - April 30, 1963
Hospital Cards
Birth Certificates
Death Certificates
or Death Indicated
on Defect Cards
i from Hospitals
Duplicated Cards (From Hospital
and Birth Certificate or from Hos-
28
20
8
pital and Death Certificate)
Unduplicated Cards (From Hospi-
tal with no Duplicates from Birth
380
0
17
Certificate or Death Certificates)
Unduplicated Cards (From Birth
Certificate or Death Certificate with
0
28
65
no Duplicates fiom Hospitals)
566
The Ohio State Medical Journal
there should be an equal number of duplicate defect
cards from both the hospitals and the birth certi-
ficate, since presumably the hospital chart room fills
out a card for every birth defect and the physician
present at birth checks the box marked "congenital
malformation" on the birth certificate. Actually, of
400 Birth Defect Cards from Hamilton County hospi-
tals and Hamilton County Birth Certificates com-
bined, 380 were from the hospitals with only 20 dup-
licates from the birth certificates, which clearly in-
dicates how poor the birth certificate is as a source
of information. But, there were also 28 cards from
the birth certificate which had no duplicates from
the hospitals. Therefore, although reporting on the
birth certificate is poor, it is a necessary supplement
as long as hospital reporting remains poor.
Table 4 also gives the data on Death Certificates
as a source of defects. Of 90 defect cards which
indicated a death, 65 were from the death certificate,
17 from hospitals and eight were duplicates from
both these sources. This indicates (1) that the
death certificate is an important source of defect in-
formation, and (2) that, again, the hospitals are re-
porting poorly defects in live births and neonatal
deaths.
Sample of Birth and Death Cer tipcat es
Table 5 gives the data from the one month sample
of all Birth and Death Certificates from the Hamilton
County Vital Statistics Office. Nine birth certificates
Table 5. Sample of Birth and Death Certificates for
December, 1964
<s
VJ
<D
C3
u £
CD
cau
2 s
Qu
Birth Certificates with "congenital malformation"
checked yes or Death Certificate with birth defect indicated
9
24
Cards
sent by Vital Statistics
8
12
were found which had "congenital malformation"
checked "yes”; eight defect cards were sent by the
Vital Statistics Office for that month. Twenty-four
death certificates were found with defects indicated;
12 defect cards were sent by the Vital Statistics Of-
fice for that month. Therefore, the Birth Certificate
reporting system is much more efficient than the
Death Certificate system.
Efficiency and Effectiveness Ratios
The terms "efficiency” and "effectiveness" have
been used several times in this report. Table 6 is
Table 6. Efficiency and Effectiveness Ratios for
Three Reporting Systems (as %)
Efficiency Ratio (%)
Effectiveness Ratio (%)
Hospital Cards
7.5 to 20.3
77
(For Three Hospitals
Sampled)
Birth Certificates
88
5.9
Death Certificates
50
79
an attempt to give statistical significance to these
terms for the three major reporting systems. Effici-
ency is a measure of the internal functioning of a
reporting system; efficiency ratios were calculated (1)
for the three hospitals sampled by dividing the be-
fore-sample birth defect rate by the after-sample birth
defect rate, and (2) for the birth and death certi-
ficates by dividing the number of Birth Defect Cards
sent from the Vital Statistic Office by the number of
defects actually found in the birth and death certifi-
cates after the one-month sample.
Effectiveness is a measure of what each reporting
system contributes to the over-all program; effective-
ness ratios were calculated for the hospital cards and
the birth certificates by dividing the total number of
unduplicated cards received from each of these sources
by the total number of unduplicated cards received
from all sources combined. For the death certificate
the calculations were slightly different, since we were
measuring defects in deaths here, not in live births.
The effectiveness ratio for this reporting system was
calculated by dividing the total number of undupli-
cated defect cards received from the death certifi-
cate (65) by the total number of unduplicated cards
received from all sources which had death indicated
on them (82). Thus, while the Death Certificate
contributes only a small amount to the total pro-
gram (65/490 = 13 per cent), it does contribute a
large percentage of what can be expected from it (79
per cent).
It can be seen in Table 6 that the hospital card is a
very effective source (that is, it contributes greatly
to the program), but it is very inefficient; only a
small amount of defects are being reported by this
system. The Birth Certificate is a highly efficient
source, but its effect on the program is very small.
The Death Certificate is moderately efficient and highly
effective, contributing a large percentage of the in-
formation on defects occurring in deaths.
Discussion of Some of The Registry’s Problems
While the primary purpose of this report was to
point out some of the Registry’s problems, there was
also an attempt made to understand why these prob-
lems arose. People involved in all aspects of the
program were talked with; hospital record room per-
sonnel, employees of the Health Department and the
Vital Statistics Office, and some few local physicians.
No concrete answers are forthcoming, but some im-
pressions were formed which should be discussed here.
One of the problems with hospital reporting seems
to be a general misunderstanding of what is actually
wanted by the Registry. It is true that enthusiasm
for the program ranged the spectrum from highly
enthusiastic and helpful to a can’t-be-bothered-with-
your-problems attitude, but in those hospitals where
interviews (more informal chats, really) were made,
there was often only a vague awareness of what the
program demanded. Did the Commissioner of Health
for June, 1966
567
really want ALL defects, even the really minor ones,
even those in neonatal deaths? Another problem is
that hospital chart room personnel cannot be expected
to know medical terminology, and in many cases they
didn’t seem to realize that a pigmented nevus, for
example, was considered a birth defect for the pur-
poses of this program, as was erythroblastosis fetalis
(erythro what?). Finally, information on hospital
charts can turn up in unexpected places (not to men-
tion many cases of illegible penmanship) and can
be difficult enough even for a physician to find; for a
person who is not medically trained, who doesn’t really
know what she is looking for, or where to look for
it when it is not where it is supposed to be, the
problems become very great.
The problems with the Birth Certificate system
are even more enigmatic. The efficiency of this
source is very high, but the effectiveness is very low.
Therefore, whoever is responsible for filling out the
medical information of the birth certificate — pre-
sumably the physician attendant at birth — is not do-
ing so. Part of this problem may lie in a mis-
understanding of the phrase "congenital malforma-
tion.” Just where does one draw the line between
a congenital malformation and a birth defect, or a
birth anomaly, or a congenital anomaly? Another
aspect of the problem seems to lie in the desire of
some physicians to protect their patients from some
stigma which might occur if the patient’s defect was
put on public record. Although this position is
legally untenable, it might have some basis in medical
ethics if the birth certificate were, in fact, a public
record. Actually, only people who present good rea-
sons for doing so are allowed to look at these files,
and, as has already been mentioned, the portion of
the Birth Certificate which contains the medical in-
formation is never duplicated when records of birth
are sent to families.
The problems with the Death Certificates may be
simpler ones. Of the 12 death certificates with
defects for the month sampled which were not
reported by the Vital Statistics Office, three were
transpositions of the great vessels and two were he-
mophiliacs. The other seven were more randomly
distributed across the spectrum of defects. The con-
sistency with which these defects were missed sug-
gests that one reason for this failure of reporting is
due, once again, to a lack of a medical vocabulary on
the part of Vital Statistics Office personnel — a fail-
ure to appreciate that transpositions of the great
vessels and hemophilia are defects which should be
reported.
Stillbirth Certificate
There were 185 Stillbirth Certificates for the eight
month period of October 1, 1964 to May 30, 1965.
Twenty-one defects were found. There were no dup-
licate cards from the hospitals which indicated a
defect in a stillborn. The number of Stillbirth certi-
ficates each month is very small, and the time re-
quired to review these certificates for the presence of
defects — by a Vital Statistics Office employee —
would also be small. And, while the total amount
of information which this source could contribute
would be less than the other sources, the stated pur-
pose of the Birth Defect Registry is to obtain informa-
tion on all defects, including those causing or con-
tributing to death. Whether the death is neonatal
or prenatal should not make any difference. There-
fore, it is concluded that the Stillbirth certificate
should be included as another source of defects.
Long Form Evaluation
Table 7 gives the data on the evaluation of the
Long Form as an instmment for follow-up study of
selected cases. The actual data from the Form itself
Table 7. Long Form Evaluation
Number of Newborn Charts looked at (with
corresponding maternal charts) 40
Number of charts showing a previous live birth 29
Number showing a birth defect in a previous live birth .... 1
Number of charts showing a previous stillbirth 0
Number of charts showing abortions 10
Number of charts showing complications in first trimester 9
Number of charts showing complications in second trimester 8
Number of charts showing immediate
prepartum and delivery history 29
Number of charts showing infant
prenatal and natal information 40
have been distributed into nine categories for their
expression in this table. For example, "complications
in the first trimester” may have been infectious dis-
ease, trauma, irradiation, diabetes or other surgical
procedures. In some categories information was al-
most always available from the hospital charts. The
length of labor, length of gestation, type of delivery,
complications of delivery, cyanosis in the newborn,
the presence of toxemia symptoms or vaginal bleed-
ing in the immediate prepartum period were usually
present in maternal or newborn charts. This seemed
to be because the established routine of charting ob-
stetric and newborn care required such information
on the maternal history and physical examination, the
delivery room records, the newborn physical examina-
tion or elsewhere. But other very important informa-
tion, such as the presence of birth defects in previous
births, is practicably unattainable from the hospital
charts. This seems to be because nowhere on the
chart was such information requested.
In one case of a woman who had delivered two pre-
vious children with congenital eye deformities and
had just delivered a third child with the same de-
formity, there was no mention anywhere in the
maternal chart of the previous children’s deformities,
although the present child’s deformity was noted on
his newborn chart. This information on the previous
two children was found out only by a chance phone
conversation with the family pediatrician.
Conclusions
Several conclusions can be drawn from this study:
(1) Hospital reporting of birth defects is poor.
568
The Ohio State Medical Journal
However, at least one hospital, Cincinnati General,
has shown that a high level of performance is pos-
sible. Since the hospitals are the most important
source of information, the performance of C.G.H.
must be imitated by the other hospitals if the purpose
of the Registry is to be realized.
(2) The Birth Certificate contributes relatively
little to the program. Some of the problems with
this source have been pointed out; the solution to
these problems is probably at present unattainable.
However, this source must be continued as long as
hospital reporting remains poor.
(3) The Death Certificate is an effective source
of birth defects in neonatal deaths. This source must
be maintained as long as hospital reporting of defects
in neonatal deaths remains poor.
(4) The Stillbirth Certificate should be included as
a source of defects, for reasons already given.
(5) The Long Form as an instrument for follow-
up study is only partially successful. Much important
information, particularly that relating to defects in
earlier births, is not practicably available in the hos-
pital charts. This information would not become
available unless the charting procedures were modified
or unless family interviews were made by Health
Department personnel; the former condition is very
unlikely, and the latter condition is more or less
prohibited by agreement between the Health De-
partment and local physicians.
Reference
1. McKeown and Record: "Malformations in a Population Ob-
served for Five Years After Birth." Ciba Foundation Symposium
on Congenital Malformations, London, I960, pp. 2-16.
RUBELLA. — A controlled prospective inquiry regarding mothers who had
rubella during the first 16 weeks of pregnancy was begun during 1950-2.
Three follow-up medical examinations of the children resulting from these preg-
nancies were carried out, the first at 2 years (259 children), the second between 3
and 6 years (237 children), and the third between 8 and 11 years (227 children).
Follow-up of the infants showed that when rubella occurred during the first
16 weeks of pregnancy the incidence of congential abnormalities in the children
was significantly raised. When the infection occurred after the 16th week the inci-
dence of abnormalities in the children of the rubella mothers was no higher than
in the controls.
This paper reports the final outcome of the inquiry, with special reference to
the findings of the three examinations.
Major abnormalities, mainly of the eye, ear, and heart, occurred in 15 per
cent of the children, 8 per cent having more than one abnormality. Minor ab-
normalities were present in a further 16 per cent, 4 per cent having more than
one abnormality. These are outside estimates, as it is possible that some of the
abnormalities discovered were due to causes other than maternal rubella.
It has been suggested that rubella children often show emotional instability
and difficult behaviour, but although the information was specifically requested
there was little supportive evidence in the reports. Twelve children were vari-
ously noted as "shy,” "immature,” "lacking in concentration,” or "liable to out-
bursts of temper,” but only one, a blind child, was reported as "psychologically
difficult.” The distribution of intelligence among the children was normal.
The need for long-term follow-up and periodic full reassessment of children
known to be at risk from maternal rubella during the first 16 weeks of pregnancy
was clearly demonstrated. — Mary D. Sheridan, M. A., M. D., D. C. H., British
Medical Journal, 2:536-549, August 29, 1964.
for June, 1966
5 69
Polycystic Liver Disease
Report of a Case Employing Needle Biopsy
And Liver Scanning
R. THOMAS HOLZBACH, M. D., and MARVIN ROLLINS, M. D.
T
THE EARLY identification of polycystic liver
disease is difficult. Only when the cysts and
associated hepatic enlargement become palpable
is clinical detection possible. Combined use of radio-
isotope scanning and directed percutaneous needle
biopsy has been recommended in the diagnosis of lo-
calized lesions.1’2
This report illustrates the diagnostic changes in
liver scans which were obtained before and after
needle biopsy and aspiration of fluid from hepatic
cysts.
Case History
A 50 year old white man entered the hospital on June 11,
1965, with a chief complaint of severe right upper quadrant
pain of sudden onset, but gradually lessened over several
days of observation in the hospital. There was no asso-
ciated fever and no other symptoms. No previous history
of similar complaint was elicited. Past history revealed a
severe chronic anxiety state. The patient had received a
course of electro-convulsive therapy for depression one year
ago.
Physical examination revealed moderate right upper quad-
rant tenderness on deep palpation. No abdominal masses,
organ enlargement, or other abnormalities were detected.
Temperature and other vital signs were normal. The ad-
mitting diagnosis was possible acute cholecystitis but con-
vincing evidence of peritoneal irritation was not detected.
Laboratory Studies: White blood cell count was elevated
to 13,800 per cubic millimeter with a differential count of
84 per cent polymorphonuclear cells, 11 per cent lymphocytes,
and 1 per cent eosinophils on the day of admission. The
following day and subsequently both the white blood cell
count and the differential count were repeatedly normal.
Hematocrit, urinalysis, icterus index, and serum levels of
alkaline phosphatase, proteins: albumin and globulin, and
amylase were normal.
BSP retention was 2 per cent at 45 minutes. The one-
stage Quick-prothrombin time was 17 seconds with a control
of 14 seconds. Radiologic studies, including a chest film,
abdominal scout film, intravenous pyelogram, gallbladder
series, barium enema, and upper gastrointestinal series,
were all within normal limits. A liver scan was obtained
(Fig. 1). This revealed scattered negative defects. The
most prominent area of abnormality was in the inferior
aspect of the anterolateral portion of the right lobe. Dif-
ferential diagnosis included metastatic tumor and multiple
hepatic abscesses.
A percutaneous, transthoracic hepatic biopsy was per-
formed on June 22, 1965. The needle was directed antero-
Submitted November 10, 1965.
The Authors
• Dr. Holzbach, Cleveland, is Chief, Gastroen-
terology, at Lutheran Hospital; Clinical Instructor
of Medicine, Western Reserve University School of
Medicine.
• Dr. Rollins, Cleveland, is Chief, Radiation
Therapy and Nuclear Medicine, Lutheran Hospi-
tal; Assistant Clinical Professor, Radiology, West-
ern Reserve University School of Medicine.
laterally. Upon withdrawal of the obturator of the Vim-
Silverman needle, a clear colorless fluid was observed and
a total of 15 ml. was collected. With the usual technique
a small amount of biopsy material was obtained from the
liver and the procedure was terminated. The tissue ob-
tained at biopsy revealed no histologic abnormality. Analy-
sis of the fluid revealed less than 1.0 Gm. per 100 ml. of
total protein, occasional red blood cells per high power
microscopic field and no evidence of parasites or other or-
ganism. Bacteriologic culture and cytologic study of the
fluid was negative. A repeat liver scan (Fig. 2) was ob-
tained five days after the hepatic biopsy. This revealed an
almost complete disappearance of the previously observed
negative defect on the anteroinferior margin of the right
lobe. It was learned at this point that the patient’s mother
had undergone biliary tract surgery 15 years previously be-
cause of an attack of the right upper quadrant pain. Poly-
cystic liver disease was the sole abnormal finding at that
operation.
Comment
Polycystic liver disease is rarely symptomatic.
Symptoms, if they appear are usually observed in the
fourth and fifth decades of life. Upper quadrant ab-
dominal pain is the most common presenting com-
plaint.3 The health of the patient is mainly in-
fluenced by associated polycystic disease of the kid-
ney or other anomalies such as aneurysm of cerebral
arteries. Typically, there are no laboratory hepatic
function abnormalities.4 Cysts mainly arise from
the anteroinferior surface of the right lobe of the
liver and thus are quite accessible to percutaneous
needle biopsy. The chief importance of early diag-
nosis in polycystic liver disease is to prevent unneces-
sary laparotomy.
570
The Ohio State Medical Journal
Summary
The disappearance of a previous liver scan defect
was observed after puncture and aspiration of fluid
from an area of localized multiple hepatic cysts. The
combined use of liver scanning and directed needle
biopsy-aspiration as illustrated here, is a valuable
tool in the early diagnosis of polycystic liver disease.
l-a
References
1. Leevy, C. M. : Practical Diagnosis and Treatment of Liver Dis-
ease, New York: Paul B. Hoeber, 1957, p. 98.
2. Leevy, C. M., and Greenberg, J.: Radioisotope Scanning as a
Guide to Needle Biopsy of the Liver. Amer. J. Med. Sci., 233:28-
34 (Jan.) 1957.
3. Comfort, M. W.; Gray, H. K.; Dancin, D. C., and Whitesell,
F. B., Jr.: Polycystic Disease of the Liver: A Study of 24 Cases.
Gastroenterology, 20:60-78 (Jan.) 1952.
4. Melnick, P. J.: Polycystic Liver: Analysis of 70 Cases. Arch.
Path., 59:162-172 (Feb.) 1955.
1-b
Fig. 1. (a) and (b).
Anterior and Lateral liver scans revealing scattered negative defects. Arrows indicate the area of
maximal abnormality in the anterolateral aspect of the right lobe.
2-a
Fig. 2.
(a
) and (b). Repeat anterior and lateral liver scans obtained following puncture and aspiration of fluid from
hepatic cysts. Arrows indicate the areas of disappearance of previously marked negative defect.
|||||||||^^ %
POSTERIOR
INTERIOR
for June, 1966
571
Liver Biopsy
A Report of Experience in 151 Cases
C. JOSEPH CROSS, M. D., WILLIAM A. MILLHON, M. D., JUDSON S. MILLHON, M. D.,
and DONALD E. HOFFMAN, M. D.
HP
~^HE practice of puncture and diagnostic aspira-
tion of the liver has been recognized as a
valuable aid in the analysis of liver dysfunction
for many years, yet there remains a reluctance on the
part of many physicians to use this procedure. In
reviewing a relatively small series obtained over a
two-year period in a private hospital, we found that
it was an extremely helpful diagnostic aid in over 40
per cent of the cases. With recognition of the con-
traindications, it is felt that needle biopsy should be
performed more frequently. These contraindications
are well documented and include:
( 1 ) Uncooperative patient
(2) Low prothrombin time
(3) Local infection
(4) Ascites
(5) Intense extrahepatic obstructive jaundice
(6) Severe anemia
(7) Prolonged bleeding from skin at time of
biopsy
METHOD
One hundred and fifty-one liver biopsy specimens
were submitted to the Riverside Methodist Hospital,
Pathology Department, between April, 1961, and
December, 1963. Sixty-four of these biopsies were
obtained at laparotomy and showed no significant
histopathologic abnormalities. These were predomi-
nantly needle biopsies taken at the time of elective
biliary tract surgery and will not be considered in
our discussion. The remaining 87 liver biopsies are
made up of two major groups, including: (1) 43 per-
cutaneous liver biopsies and (2) 44 open liver bi-
opsies showing significant abnormalities.
Percutaneous Needle Biopsy
The 43 percutaneous needle biopsies of the liver
were obtained in the majority of instances with the
Vim-Silverman needle. The Menghini needle and
the Franklin modification of the Vim-Silverman
needle were also used.
The specimens obtained have been considered to
be a positive aid in diagnosis in 56 per cent of cases
(24 cases) and to be of no aid in diagnosis in 44
per cent of cases (19 cases). These figures com-
pare favorably with those obtained in much larger
Submitted July 9, 1965.
The Authors
• Dr. Cross, Columbus, is a member of the Sen-
ior Attending Staff, Riverside Methodist Hospital;
Clinical Instructor, Department of Medicine, The
Ohio State University College of Medicine.
• Dr. William A. Millhon, Columbus, is a mem-
ber of the Attending Staff, Riverside Methodist
Hospital; Clinical Instructor, Department of Medi-
cine, The Ohio State University College of Medicine.
• Dr. Judson S. Millhon, Columbus, is a member
of the Attending Staff, Riverside Methodist Hospi-
tal; Clinical Instructor, Department of Medicine,
The Ohio State University College of Medicine.
• Dr. Hoffman, Columbus, former Resident in
Medicine (1962-1964) Riverside Methodist Hospi-
tal; (1964-1965) Lahey Clinic, Boston, is now in
practice in Columbus.
series. The biopsy was considered to be a positive
aid if it confirmed (11 cases) or corrected (13 cases)
the clinical diagnosis. Normal liver tissue, liver tissue
with negligible alterations, or an inadequate speci-
men were the reasons for considering biopsies of no
aid in diagnosis. Two biopsy specimens showed non-
diagnostic pathologic changes. One of these was
from a patient who ultimately died with Hodgkin’s
disease. The other was from a patient who later had
wedge biopsy at laparotomy with the diagnosis of
granulomatous liver disease, probably sarcoidosis.
The types of clinical diagnoses confirmed or cor-
rected by needle biopsy include a variety of disease
entities. Nearly all known clinical applications of
this procedure are represented by the following case
studies.
(A) Cirrhosis in various stages of activity and
degrees of severity has been demonstrated. Biopsy
of the cirrhotic liver has proven valuable both in the
observation of the natural course of the disease and
in determining the effectiveness of therapy.
Case 1
A 45 year old white man was admitted with chronic easy
fatigability. He had been hospitalized 18 months previously
with diarrhea and had been found to have ascites, hepa-
tomegaly, and laboratory studies indicative of active nutri-
572
The Ohio State Medical Journal
tional liver disease. He admitted to a moderately heavy
ethanol intake over a period of several years. During the
18-month interval between his first and present admission,
he had stopped drinking. Present laboratory data included
prothrombin time 52 per cent of normal; alkaline phos-
phatase 10.6 units; total protein 6.7 grams with albumin
2.8 Gm. and globulin 3.9 Gm.; serum glutamic oxalacetic
transaminase 83 units; cephalin cholesterol flocculation 2
plus; and bromsulfalein retention, 15 per cent at 45 minutes.
Comment: The liver profile was thought to be charac-
teristic of cirrhosis.8 The impression was supported by a
percutaneous needle biopsy of the liver which showed active
portal cirrhosis. Intensification of appropriate medical
management in this case was based on the demonstration of
unsuspected active liver disease.
(B) The purely diagnostic use of liver biopsy in an
unsuspected case of cirrhosis is illustrated by the fol-
lowing example.
Case 2
A 55 year old nurse developed hepatosplenomegaly. She
had noted a sensation of fullness in the upper abdomen
and a tendency to bruise easily. There was a history of
rheumatic heart disease with chronic congestive heart fail-
ure since the age of 48 years managed successfully with
digitalis and diuretics. The liver was palpable 6 cms. below
the right costal margin. There was no history of jaundice,
biliary tract disease, or alcoholism. Numerous diagnostic
possibilities were considered. Laboratory data included
hemoglobin 12.4 Gm. per 100 ml.; white blood cell count
2,500 per cu. mm. with 61 per cent neutrophils, 5 per cent
eosinophils, and 33 per cent lymphocytes; prothrombin time
44 per cent of normal; total protein 6.7 Gm. with albumin
3-9 Gm. and globulin 2.8 Gm.; cholesterol 138 mg.; alkaline
phosphatase 15.4 units; cephalin cholesterol flocculation 4
plus; thymol turbidity 13.2 units.
Needle biopsy of this patient’s liver disclosed active
postnecrotic cirrhosis of the liver and chronic cholangitis.
Comment: The diagnostic efficiency of needle biopsy
in cirrhosis was worked out by Braunstein with the aid of
postmortem sampling.6 He determined that in cases of
nutritional cirrhosis the diagnostic accuracy was 100 per
cent. Cirrhosis secondary to hepatitis and liver necrosis
may be recognized with approximately 96 per cent accuracy.
This patient ultimately died in hepatic coma with massive
ascites and liver failure. She was considered to have post-
necrotic cirrhosis, presumably secondary to nonicteric hepa-
titis, the more common form of viral hepatitis and an
occupational hazard in this patient’s profession.
(C) Percutaneous biopsy has also been helpful in
detecting intrahepatic neoplasm.
Case 3
A 60 year old white woman was admitted with complaints
of weakness and a sensation of fullness in the upper ab-
domen. Her liver was palpable 7 cm. below the right
costal margin with a smooth and firm edge. Chest x-rays,
an upper G. I. series and a cholecystogram were reported
negative. A barium enema revealed a suspicious finding
in the region of the hepatic flexure, but air contrast follow-
up studies were not remarkable. Liver function studies were
abnormal. Laboratory data included prothrombin time 77
per cent of normal; alkaline phosphatase 11.1 units; total
protein 6.8 grams with albumin 4.6 Gm. and globulin 2.2
Gm.; total bilirubin 0.7 mg. with direct acting 0.0 mg.;
serum glutamic oxalacetic transaminase 19 units; cephalin
cholesterol flocculation negative; thymol turbidity, 1.5 units;
and bromsulfalein retention, 19 per cent at 45 minutes.
The patient was suspected of having cirrhosis because of
a history of ethanol ingestion and the findings of hepato-
megaly and altered liver functions. Percutaneous liver biopsy
in this patient demonstrated metastatic adenocarcinoma.
Comment: One series has been reported concerning liver
biopsy on patients subsequently shown to have intrahepatic
neoplasm. The needle biopsy was 74 per cent accurate.7
Another notes that metastatic neoplasms of the liver are
identified in 80 to 90 per cent of established cases.5
Case 4
A 67 year old white male alcoholic was admitted with
light icterus and weakness. Four years prior to this ad-
mission he had undergone exploratory laparotomy and open
liver biopsy that revealed cirrhosis. Presently the liver was
noted to be enlarged 4 cm. and to have a firm irregular
and slightly tender margin. Laboratory data included brom-
sulfalein retention 35 per cent at 45 minutes; serum glutamic
oxalacetic transaminase 238; total protein 6.1 Gm. with al-
bumin 2.6 and globulin 3.5; total bilirubin 2.1 mg. and
direct 1.3 mg.; alkaline phosphatase 57.8 units; and cephalin
cholesterol flocculation 2 plus.
Percutaneous liver biopsy was interpreted as hepatoma.
( D ) The biopsy has also been employed in a
reciprocal manner, i. e., to demonstrate nodular cir-
rhosis in a patient suspected of having metastatic car-
cinoma in the liver.
Case 5
A 63 year old widowed white woman was admitted with
jaundice, ascites, weakness, and anorexia. A multinodular
and indurated liver was palpable 8 cm. below the right costal
margin. The gallbladder was also thought to be enlarged
and indurated. Laboratory data included prothrombin time,
37 per cent of normal; total protein, 5.0 with albumin 2.7
Gm. and globulin 2.3 Gm.; thymol turbidity, 2.6 units;
total bilirubin, 12.2 mg. and direct bilirubin, 8.2 mg.;
alkaline phosphatase, 13-9 units; serum glutamic oxalacetic
transaminase, 138 units; and cephalin cholesterol flocculation
1 plus.
Percutaneous needle biopsy of the liver showed nodular
cirrhosis of the liver.
(E) The distinction between medical and surgical
jaundice has been facilitated by means of liver biopsy.
Case 6
A 66 year old white man was admitted two months after
cholecystectomy for cholelithiasis and empyema of the gall-
bladder. He had received whole blood transfusions at sur-
gery. His hospital course during the current admission was
characterized by recurrent jaundice over a period of several
weeks. Serum bilirubin, alkaline phosphatase, and enzyme
levels fluctuated widely. Controversy existed regarding the
differential diagnosis of intermittent common duct obstruction
from stone or stricture as against "medical jaundice.’’ Per-
cutaneous liver biopsy was performed twice and each was
interpreted as showing "hepatitis.” The patient eventually
died with acute fulminating pancreatitis. No extrahepatic
obstruction to bile flow existed.
Comment: The histologic diagnosis of viral hepatitis by
needle biopsy has been reviewed extensively by Smetana.3
He terms it the only single method which permits an un-
equivocal diagnosis of acute nonfatal hapatitis. Not only
may the histologic picture be seen to change with the stage
of the disease, but also the occasional persistence of active
hepatitis may be determined.
Conversely, extrahepatic obstructive jaundice requiring
surgical intervention is represented by the following case
study.
Case 7
A 60 year old white man was admitted with anorexia and
jaundice. He gave a history of chills, fever, and jaundice
for three weeks preceding his admission. He had had a
cholecystectomy for cholelithiasis seven months previously.
The liver was enlarged 3 cm. and was tender. Laboratory
data included total bilirubin, 5.4 mg. and direct bilirubin,
3.2 mg.; alkaline phosphatase, 14.0 units; serum glutamic
oxalacetic transaminase, 42 units.
The diagnosis of extrahepatic obstructive jaundice and
cholangitis was made. Percutaneous biopsy showed diffuse
increase in bilirubin pigmentation in the liver cells. Small
for June, 1966
573
bile thrombi were present in the canaliculi. There was no
evidence of cholangitis. The patient was operated upon
and a stricture of the common bile duct was repaired. Sub-
sequently the liver function studies have reverted to normal
and the patient has done well.
( F ) Another clinical application of percutaneous
needle biopsy has been the exclusion of hepatic dis-
ease in apparent hepatomegaly.
Case 8
A 54 year old white woman was admitted for evaluation
of hepatomegaly. Physical examination had disclosed descent
of the liver margin below the level of the iliac crest. Her
liver function studies were within normal limits.
Percutaneous needle biopsy disclosed normal liver tissue
with fibrous capsular tissue present at both ends of the
biopsy fragment, suggesting the presence of a Riedel's lobe.
Open Liver Biopsy
Liver biopsy performed at laparotomy undoubtedly
provides the more accurate method of sampling liver
lesions, especially isolated lesions. Laparotomy not
only permits visualization of the liver surface but also
an opportunity to obtain a larger biopsy specimen.
Forty-four open liver biopsies considered in this
study were reported as showing significant histo-
pathologic abnormalities. The liver biopsy itself
was the only operative procedure performed in 32
(72 per cent) of these patients.
Twenty-five of the 44 patients upon whom open
liver biopsy was performed were noted to have pal-
pably enlarged livers preoperatively. Twenty-one of
these 25 patients (80 per cent) had no operative
procedure other than liver biopsy at laparotomy.
DISCUSSION
Numerous articles on percutaneous needle biopsy
of the liver indicate that it is a clinically useful pro-
cedure.1 There are many practical advantages of
needle biopsy, including simplicity of the apparatus,
minimal expense and patient preparation, perform-
ance at the bedside, and minimal patient discomfort.
The value of needle biopsy over wedge-resection
has been questioned by some authors due to the small
size of the specimen. However, the deeper specimen
obtained from the needle will not neglect the non-
specific distortion common in the immediate sub-
capsular areas, or those induced by surgical trauma,
and the specimen obtained is large enough that even
gross inspection can be of diagnostic help.9
Complications of the needle biopsy procedure in-
clude hemorrhage into the peritoneum, which is the
chief fatal complication. Zamcheck reported a mor-
tality of 0.17 per cent after reviewing 20,016 needle
biopsies performed since 1907. 2 Our limited series
of 43 percutaneous needle biopsies include one ap-
parent complication, that being a self-limited hemor-
rhage in a patient with a history of a bleeding
tendency.
Needle biopsy is clearly not indicated in all cases
of liver disease. Enthusiasm for its use should not
serve as a substitute for a complete clinical and labor-
atory investigation. Once obtained, the biopsy speci-
men may fail in interpretation. This is especially
tme in the lack of distinction between primary biliary
(cholangiolitic) cirrhosis and portal or even post-
necrotic cirrhosis.5 Similar difficulties are encoun-
tered in differentiating obstructive jaundice from
chronic parenchymatous jaundice. Perhaps newer
methods of evaluation of the liver cells will help to
eliminate these problems of differentiation.4
Percutaneous needle biopsy of the liver has, how-
ever, proven helpful in a certain limited number of
cases. It is suggested that one area in particular in
which the needle biopsy might be considered favor-
ably, rather than resorting to open liver biopsy, is
in the diagnosis of metastatic malignant tumor in the
liver that is palpably enlarged.
Summary
( 1 ) One hundred and fifty-one liver biopsy speci-
mens have been studied. These include 43 percutane-
ous biopsies and 44 open liver biopsies showing
significant histopathologic abnormalities.
(2) Percutaneous liver biopsy has proven to be a
positive aid in diagnosis in 56 per cent of cases in
which it was employed.
(3) Percutaneous biopsy is useful in a diverse
group of diseases of the liver and biliary system.
(4) The liver biopsy itself was the only operative
procedure performed in 72 per cent of the open liver
biopsies showing histopathologic abnormalities. These
studies should have been performed by percutaneous
liver biopsies.
References
1. Zamcheck, N., and Sidman, R. L.: Needle Biopsy of the Liver.
I. Its Use in Clinical and Investigative Medicine. New Eng. J. Med.,
249:1020-1029 (Dec. 17) 1953.
2. Zamcheck, N., and Klausenstock, O.: Medical Progress: Liver
Biopsy; Risk of Needle Biopsy. New Eng. J. Med., 249:1062-1069
(Dec. 24) 1953.
3. Smetana, H. F.: Histologic Diagnosis of Viral Hepatitis by
Needle Biopsy. Gastroenterology, 26:612-625 (Apr.) 1954.
4. Novikoff, A. B., and Essner, E.: The Liver Cell: Some New
Approaches to Its Study. Amer. J. Med., 29:102-131 (July) I960.
5. Klcckner, M. S., Jr.: Needle Biopsy of the Liver; an Appraisal
of Its Diagnostic Indications and Limitations. Ann. Int. Med., 40:
1177-1193, 1954.
6. Braunstein, H.: Needle Biopsy of Liver in Cirrhosis: Diagnostic
Efficiency as Determined by Postmortem Sampling. Arch. Path., 62:
87-95 (Aug.) 1956.
7. Ward, J.; Schiff, L.; Young, P., and Gall, E. A.: Needle
Biopsy of Liver: Further Experiences with Malignant Neoplasm.
Gastroenterology, 27:300-30 6 (Sept.) 1954.
8. Hoffbauer, F. W. ; Evans. G. T., and Watson, C. J.: Cirrhosis
of the Liver, with Particular Reference to Correlation of Composite
Liver Function Studies with Liver Biopsy. Med. Clin. N. Amer., 29:
363-388 (March) 1945.
9- Terry, R. B.: Macroscopic Diagnosis in Liver Biopsy.
J. A.M.A., 154:990-992 (Mar. 20) 1954.
THYROID SUPPRESSIBILITY. — Knowledge of the thyroid’s suppres-
sibility on salicylate is useful when the diagnosis of thyroid disease is ob-
scured by treatment with salicylates. — British Medical Journal, Jan. 15, 1966.
574
The Ohio State Medical journal
Diagnosis of Obscure Splenic Cyst
By Aortography
A Case Report
CHARLES D. HAFNER, M. D., AND MAJID A. QURESHI, M. D.
The Authors
• Dr. Hafner, Cincinnati, is a member of the
Associate Attending Staff, Good Samaritan Hospi-
tal; Clinician, Cincinnati General Hospital; Clini-
cal Assistant in Surgery, Outpatient Department,
The University of Cincinnati College of Medicine.
• Dr. Qureshi, Cincinnati, is Associate Director
of Medical Education, St. Mary’s Hospital; Teach-
ing Fellow in General Surgery, Good Samaritan
Hospital.
THE PATHOLOGY of nonparasitic splenic cysts
was classified by Fowler1 in 1953, and more re-
cently, the signs and symptoms have been sum-
marized by the authors.2-3 While the majority of
symptomatic splenic cysts will clearly suggest the
correct diagnosis, which then may be readily con-
firmed by routine methods of roentgenology, an oc-
casional splenic cyst may lie in obscurity and make
definitive diagnosis quite difficult. Many newer and
more sophisticated roentgenographic examinations
have been advocated in recent years for this condi-
tion, but to our knowledge, the use of aortography
has not been employed to demonstrate any of the
563 splenic cysts recorded to date in the literature.
The present case report is an example of an obscure
symptomatic splenic cyst, the diagnosis of which was
established by retrograde femoral catheter aortography
which visualized the splenic vasculature. This report
further suggests the use of aortography in the dif-
ferential diagnosis of other elusive intra-abdominal
conditions such as pancreatic cysts, carcinoma of the
pancreas, gastrointestinal angina, neoplasms of the
spleen, kidneys and adrenal glands, and other retro-
peritoneal tumors.
Case Report
A 45 year old woman was admitted to the hospital with
the chief complaint of left upper abdominal pain and dis-
comfort of two years’ duration, with progression in severity
of symptoms over the three months prior to admission.
The pain was quite vague and poorly described. However,
it was primarily localized in the left upper quadrant and
was frequently precipitated by the ingestion of a medium to
large meal. The patient had the sensation of "food hanging
at a point, then going past that point,’’ at which time she
obtained relief. Because of this postprandial discomfort,
she had resorted to more frequent smaller meals and
avoided larger ones. In addition, she experienced fairly
severe pain in the left lower chest and upper abdomen
after walking two to three city blocks. When this occurred,
she was required to sit down and rest until the pain sub-
sided. Occasionally, the discomfort radiated to the left
shoulder and left posterior chest. At times she experienced
aching discomfort in the upper mid-dorsal back, posterior
cervical area and occipital region. This was attributed to
long-standing rheumatoid arthritis for which she had been
receiving steroid therapy. There had been no history of
injury or pancreatitis.
Physical examination revealed a pale, thin, chronically ill
white woman in no acute distress. Physical examination was
From the Department of Surgery, Good Samaritan Hospital, Cin-
cinnati, Ohio 45220. Submitted October 5, 1965.
Reprint requests to 311 Howell Avenue, Cincinnati, Ohio 45220,
(Dr. Hafner).
negative, except for a very soft bruit audible over the mid-
epigastric region.
Laboratory investigation revealed a normal complete blood
count and urinalysis. Gastrointestinal roentgenograms, in-
travenous pyelograms, and chest films were normal. Plain
views of the abdomen revealed a small area of calcific density
in the left upper quadrant, which the radiologist had in-
terpreted as a possible splenic artery aneurysm. A retrograde
femoral catheter aortogram was performed, and this revealed
a figure-of-eight tortuosity in the splenic artery, but no
aneurysm. The angiogram did reveal, however, a distortion
of the primary branches of the splenic artery into a cup-
shaped deformity outlining a splenic mass (figure 1). A
Fig. 1. Splenic cyst outlined by angiography.
for June, 1966
575
small rim of normal splenic tissue at the periphery was
outlined by the resulting splenogram in the later exposures
of the serial angiogram. No parenchymal tissue was seen,
however, in the hilar area where the splenic arterial branches
were displaced. This together with calcification led to the
diagnosis of a splenic cyst.
At the time of operation, a large cystic mass was found
to be replacing most of the spleen, which was about five
times the normal size.
The resected gross specimen is seen in Figs. 2 and 3. The
microscopic sections revealed hyalinization and calcification in
the wall of the cyst. This probably represented a secondary
Fig. 2. Large cyst of spleen.
Fig. 3. Transected gross specimen of splenic cyst.
splenic cyst resulting from a hematoma, although the etiology
is not completely clear.
Her postoperative course was uneventful and she has been
completely relieved of her symptoms. No longer having a
fear of eating, she has gained in weight and strength, and
has been completely rehabilitated.
Discussion and Conclusions
There was no evidence of preoperative secondary
hypersplenism in this case. Only rarely has hyper-
splenism associated with a splenic cyst been reported
in the literature, and this combination, when present,
has usually been considered coincidental. In addition,
there was no postoperative thrombocytosis which is
frequently seen following splenectomy. Thus, re-
moval of this spleen caused no physiological altera-
tions. This probably is explained by the fact that
very little functioning splenic tissue remained because
of the encroachment by the cyst.
Many splenic cysts may be asymptomatic and only
discovered coincidentally at the time of surgical re-
moval or at autopsy. When splenic cysts attain a
certain size, they usually become symptomatic and
present a variety of symptoms.3 The diagnosis may
be readily suggested by the clinical picture and easily
confirmed by the routine roentgenographic methods.
However, an occasional symptomatic splenic cyst may
be quite difficult to diagnose, as exemplified by the
present case report. When routine measures fail to
reveal the diagnosis in obscure intra-abdominal condi-
tions, it is suggested that aortography be considered.
Of the 563 splenic cysts reported in the literature
to date, none has been diagnosed by angiography.
The catheter method of aortography is preferable to
the translumbar approach, since the level of injection
may be altered, thereby permitting selective visualiza-
tion of the aortic branches. Serial exposures using a
rapid cassette changer should be employed.
References
1. Fowler, R. H.: Nonparasitic Benign Cystic Tumors of the
Spleen. Int. Abstr. Surg., 96:209-227 (March) 1953.
2. Qureshi, M. A.; Hafner, C. D., and Dorchak, J. R. : Nonpar-
asitic Cysts of the Spleen; Report of 14 Cases. Arch. Surg., 89:570-
574 (Sept.) 1964.
3. Qureshi, M. A., and Hafner, C. D.: Clinical Manifestations
of Splenic Cysts. Study of 75 Cases. Amer. Surg., 31:605-608
(Sept.) 1965.
CEREBRAL INFARCTION. — One hundred and thirty-four patients with a
clinical diagnosis of cerebral infarction were studied; 71 had a diastolic
blood pressure below 110 mm. Hg and 63 a diastolic pressure of 110 mm. Hg
or above. The former group presented a picture of a large cortical and sub-
cortical lesion and showed a high incidence of stenotic and occlusive lesions at
angiography; the degree of recovery was poor. The latter group presented a
picture of a small deeply situated lesion. There was a low incidence of arteri-
ographic lesions and the patients were left with little disability. The importance
of distinguishing between these two groups is stressed. — John Prineas, M. D.,
and John Marshall, M. D., London, England: British Medical Journal, 1:14-17,
January 1, 1966.
576
The Ohio State Medical Journal
Bilateral Congenital Lumbar Hernia
BENJAMIN W. BUTLER, M. D., and ALAN D. SHAFER, M. D.
The Authors
• Dr. Butler, Dayton, is Senior Surgical Resident,
Veterans Administration Center, Dayton, Ohio.
• Dr. Shafer, Dayton, is Pediatric Surgeon on
the staffs of the following Dayton Hospitals:
Miami Valley, Good Samaritan, Kettering, and
St. Elizabeth.
triangle is bounded above by the twelfth rib and the
A LUMBAR hernia is a parietal wall defect
rarely seen by the practicing surgeon. It is
the third rarest of hernias with only the
perineal and sciatic hernia being more rare. Histori-
cally the first authentic case was described at autopsy
by Garangeot. Petit in 1783 anatomically described
a strangulated hernia through the space which now
bears his name. In 1866 Grynfeltt described a sec-
ond point of exit for lumbar hernia. A lumbar
hernia may present either through the superior triangle
of Grynfeltt or through the inferior triangle of Petit.
Lumbar hernias are classified as being either con-
genital or acquired. Acquired lumbar hernias include
defects in the lumbar region secondary to trauma, in-
flammation or herniation through a congenital weak-
ness. A congenital lumbar hernia manifests itself
at or shortly after birth and is not uncommonly
associated with other muscular defects due to its eti-
ology on the basis of mesodermal arrest.
Our case is one of congenital bilateral hernia with
an associated eventration of the right diaphragm. In
reviewing the anatomy of the lumbar region, several
points are noted which illustrate reasons for the rarity
of the congenital lumbar hernia.
Anatomy
In the lumbar area two triangles are described.
These are the superior triangle of Grynfeltt and the
inferior triangle of Petit (Fig. 1). The superior
Fig. 1. Surgical Anatomy
Submitted August 12, 1965.
serratus muscle, anteriorly by the posterior border of
the internal oblique muscle, and posteriorly by the
anterior border of the sacrospinalis muscle. The
floor is formed by the transversus abdominis muscle
and fascia. This triangle is much more common;
however, herniation through it is rarer according to
Harkins.8
Petit’s triangle, by contrast, is not always present,
and according to Lesshaft10 it is present in less than
25 per cent of infant cadavers. The floor of the
triangle is formed jointly by the internal oblique, the
lumbar fascia, and the transversus abdominis. It is
bounded anteriorly by the posterior border of the
external oblique, inferiorly by the crest of the ilium,
and posteriorly by the anterior border of the latis-
simus dorsi.
Three muscles that form an integral part of this
triangle all have some origin from the crest of the
ilium: the external oblique, the internal oblique,
and the latissimus dorsi. If the external oblique and
the latissimus dorsi are in close proximity and overlap
somewhat as they usually do, then there is no triangle
of Petit. The internal oblique thus lies under the above
two muscles, and the three muscles combine to con-
tract jointly to an increase in intra-abdominal pressure.
However, if the internal oblique arises too far later-
ally or is thinned out and frayed, then the intra-
abdominal pressure tends to push through or around
the internal oblique and protrude between the exter-
nal oblique and the latissimus dorsi. This, according
to Adamson, is considered the mechanical factor in
the production of herniation through Petit’s triangle.1
In congenital lumbar herniation, additional factors
are considered. The defect of the abdominal wall,
is considered by most embryologists to be a develop-
mental accident or arrest which occurs about the third
week of embryonal life. At the 6 mm. stage or at
the third week of embryologic development the
for June, 1966
577
myotomes are completely formed. At the 10 mm.
stage or at the fifth week the superficial portions of
the myotomes fuse to form the myotomic column,
the ventral edge of which later forms the trunk
musculature. Tangential splitting from the myotomic
column results in the oblique muscles. Arrest or ac-
cident at this point between the third and fifth week
yields the abdominal wall defect. Arey states that
a whole muscle or part of a muscle may be lacking
because of agenesis.2 The possibility of frayed or
thinned out muscles is thus more easily understood.
Incidence
Less than 40 cases of congenital lumbar hernia
have been reported. Only three of these have been
bilateral (Coley 1921, Flickinger and Masson 1946,
Adamson 1958).
Case Report
This 5 lb. 14 oz. Negro female infant was born spon-
taneously at St. Elizabeth Hospital, Dayton, Ohio, on Nov-
ember 13, 1964. The mother was prima gravida. There
were no remarkable findings in the pregnancy history. Gesta-
tional period was 40 weeks.
Physical examination at delivery was unremarkable. How-
ever, ten minutes after delivery a large compressible soft
tissue mass was noted in the left flank (Fig. 2). Closer
Fig. 2. Left Flank of Infant at Birth.
examination revealed a defect of the fascial wall of the left
flank which involved not only Petit’s triangle, but also Gryn-
feltt’s triangle, the defect extending from the 12th rib down
to the iliac crest. There was a smaller defect felt in the right
flank just above the iliac crest in the region of Petit’s triangle,
but it was only a slight bulge seen mainly when the patient
was crying.
Flat film of the abdomen and barium enema on the first
day revealed a loop of sigmoid colon included in the left
flank mass. Intravenous pyelogram on the third day was
normal. X-rays revealed the right diaphragm elevated to
rib 6 anteriorly and to rib 7 posteriorly.
The diagnosis of congenital lumbar hernia was made, and
at 7 days of age the patient was taken to surgery. An
oblique skin incision was made over the left flank mass. The
hernia sac was delineated by sharp dissection. The hernia
protruded through the flank wall with marked attenuation
of the transversus abdominis muscle and the internal oblique
muscle, with sparse slips of these muscles present stretched
over the sac. Borders of the external oblique and latissimus
were identified and observed to be better developed. The
sac (which consisted of peritoneum and overlying thin fascial
layers) was depressed and, without excising the sac, repair
was carried out by imbricating external oblique to latissimus
dorsi with 3-0 silk sutures. This left triangular weaknesses
in the superior-most portion of Grynfeltt’s triangle and the
inferior-most portion of Petit’s triangle. These areas were
reinforced with sutures. Subcutaneous fascial layer was ap-
proximated with 4-0 silk and the skin with 5-0 silk sutures.
The wound healed nicely per primum.
Follow-Up: No surgery was contemplated for the defect
of the right Petit’s triangle nor for the eventration of the
right diaphragm since both were asymptomatic.
At eight weeks of age the infant was admitted to the
hospital with right-sided atelectasis and pneumonitis. The
child responded well to antibiotics and moisture per croup-
ette. Because of the atelectasis it was felt that the eventra-
tion on the right side should be repaired electively in the
immediate future as well as the right lumbar defect. The
parents wished to defer the surgery, however. On subse-
quent visits the child has been found to be developing well.
The Petit’s triangle defect on the right has become smaller.
The child is now eight months old and shows no evidence
of herniation from the right Petit’s triangle and has had no
further episodes of respiratory difficulty. Therefore no fur-
ther surgery is contemplated at the present time. The left
flank remains stable.
Discussion
This rare type of hernia represents a mesodermal
defect of the myotome or an arrest of normal devel-
opment resulting in attenuation and absence of a por-
tion of the deeper flank muscles. The same meso-
dermal arrest of development may occur with the
diaphragmatic muscle development, which may result
in a hernia through the foramen of Bochdalek or an
eventration as was seen in this case. This differs in
origin from the acquired lumbar hernias seen in the
adult age group.
Treatment
An intrinsic surgical repair of the defect or im-
brication should be carried out utilizing the patient’s
own tissues if at all possible. Rarely, if ever, is
exogenous material such as Marlex mesh necessary
for the repair either of congenital lumbar hernia or
diaphragmatic hernias. Primary repair is more easily
accomplished in infants because of the marked elastic-
ity of the tissues and because of continued muscle
and fascial development. Other methods of repair
found in the literature which have worked satisfac-
torily are a free graft of fascia lata or a repair utilizing
a flap developed from the tensor fascia lata.
Summary
1. Congenital lumbar hernia is extremely rare,
with less than 40 cases recorded, and this the fourth
578
The Ohio State Medical Journal
reported bilateral congenital lumbar herniation.
2. Differences between the congenital lumbar
hernia and acquired lumbar hernia with anatomic
landmarks are discussed, stressing the fact that con-
genital lumbar hernia is an arrest of normal muscular
development.
3. Treatment is an intrinsic surgical repair with-
out delay, aimed at reducing the bulge and imbricat-
ing surrounding musculofascial layers as necessary
over the defect to bring about a solid flank wall.
References
1. Adamson, R. J.: A Case of Bilateral Herniae Through Petit’s
Triangle with Two Associated Abnormalities. Brit. J. Surg.,
46:88-89 (July) 1958.
2. Arey, L. B.: Developmental Anatomy, A Textbook and Lab-
oratory Manual of Embryology, ed. 4, Philadelphia: Saunders, 1940.
3. Coley, W. B.: The Value of Conservative Treatment in Sar-
coma of the Long Bones. Ann. Surg., 74:655-661, 1921.
4. Dowd, C. N. : Congenital Lumbar Hernia, at the Triangle
of Petit. Ann. Surg., 4 5:245-248, 1907.
5. Flickinger, F. M., and Masson, J. C.: Bilateral Petit’s
Hernia and an Anterior Sacral Meninogocele Occurring in the Same
Patient. Amer. J. Surg., 71:752-759 (June) 1946.
6. Grynfeltt, J. : Quelques Mots sur la hernia lombaire. Mont-
pellier Med., 16:323, 1866.
7. Hafner, C. D.; Wylie, J. H., Jr., and Brush, B. E.: Petit's
Lumbar Hernia: Repair with Marlex Mesh. Arch. Surg., 86:108-
116 (Feb.) 1963.
8. Harkins, H. N. : Editorial Comment on Lumbar Hernia, in
Harkins, H. N., and Nyhus, L. M. Hernia, Philadelphia: Lip-
pincott, 1964, p. 379.
9. Lee, C. M., Jr., and Mattheis, H.: Congenital Lumbar Hernia.
Arch. Dis. Child., 32:42 (Feb.) 1957.
10. Lesshaft, P.: Lumbalgegend in Anatomisch-Chirurgischer Him-
sicht. Arch. f. Anat., Physiol, u. wissensch. Med., 1870, pp. 264-
299.
11. Rishmiller, J. H.: Hernia Through the Triangle of Petit.
Surg. Gynec. Obstet., 24:589-591 (May) 1917.
12. Swartz, W. T.: Lumbar Hernias. /. Kentucky Med. Asso.,
52:673-678 (Sept.) 1917.
13. Swartz, W. T. : "Lumbar Hernia,” in Harkins, H. N., and
Nyhus, L. M. : Hernia, Philadelphia: Lippincott, 1964, pp. 361-379.
14. Watson, L. F.: Hernia, ed. 3, St. Louis, Mosby, 1948.
THOUGHTS ON TEACHING MEDICINE. — The students I enjoy teach-
ing most are those who after two or three years of university education
are confronted for the first time by a real patient. They are fascinated, if given
the chance, by the infinite variety of human personality and experience which is
presented to them.
The first staggering fact about medical education is that after two and a half
years of being taught on the assumption that everyone is the same, the student
has to find out for himself that everyone is different, which is really what his
experience has taught him since infancy. And the second staggering fact about
medical education is that after being taught for two and a half years not to
trust any evidence except that based on the measurements of physical science,
the student has to find out for himself that all important decisions are in real-
ity made, almost at unconscious level, by that most perfect and complex of
computers the human brain, about which he has as yet learnt almost nothing, and
will probably go on learning nothing to the end of his course — this computer
which can take in and analyze an incredible number of data in an extremely
short time. And the data are mostly not of the hard crude type with which that
simple fellow the scientist has to deal, but are of a much more subtle, human,
and interesting character, each tinted in its own colors of personality and emotion.
All this the student has to discover for himself while his teachers strangely
pretend to believe that the secrets of medicine are revealed only to those whose
biochemical background is beyond reproach. — Sir Robert Platt, BT., M. D., M. Sc.,
F. R. C. P., F. C. G. P., British Aledical Journal, 2:551-552, September 4, 1965.
Prescription medicines cannot be bought over the counter and can
reach the public only through experts, members of the medical profession.
There is no parallel to this situation with any other commodity, in which the
industry supplies, the doctor prescribes, and the patient consumes, with the doctor
figuratively watching over the patient’s shoulder to evaluate the effect and the
safety of the product. . . . The entire billion prescriptions filled in 1966 will
cost the American people about one-sixth the estimated cost of landing the first
American on the moon. — J. Mark Hiebert, M. D., Pharmacy Colloquium, Uni-
versity of Kansas Centennial, Lawrence, Kansas, April 13, 1966.
for June , 1966
579
A Clinicopathological Conference
From The Ohio State University Hospital, Columbus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
J. B. McMILLAN, M. B., Ch. B., President
PRESENTATION OF CASE
A WHITE woman, aged 68 years, entered Uni-
versity Hospital in 1964 with complaints of
- nausea, vomiting, and abdominal swelling.
The patient stated that she had her last bowel move-
ment approximately four weeks prior to admission.
In the interim she had taken only liquids and had
noted progressively increasing abdominal distention
with nausea and vomiting for the week before ad-
mission. She also complained of pain in her right
shoulder. She denied bloody or tarry stools or inter-
mittent diarrhea.
Although the patient was a very poor historian,
it could be determined that she had been taking no
medications and that she had had tuberculosis in
1918. Between 1937 and 1950 she made repeated
outpatient visits with complaints of alternating right
upper quadrant pain, nausea, or diarrhea. A barium
enema in 1942 was reported to show "no evidence of
organic pathology of the colon.” A cholecystogram
was normal, but an upper gastrointestinal series was
interpreted as showing "duodenal ulcer with gastric
atonia” and the Sippy regime was started. When
the latter two examinations were repeated in 1949,
they were reported as normal. In 1949, the patient
entered University Hospital with symptoms of tremor,
frequent stools, 13 lb. weight loss, and irregular
tachycardia. The basal metabolic rate was plus 29
per cent and the radioactive iodine uptake was 56
per cent. After treatment with 4 me. of I131 the
patient was discharged. At the Clinic six months
later, the patient had symptoms and laboratory data
consistent with hypothyroidism and treatment was
started on thyroid. She refused to take her medica-
tion and subsequently became lost to follow-up.
Physical Examination
The patient was thin and appeared both chroni-
cally and acutely ill. Her temperature was 98.6°F.,
pulse rate 88/min., respiratory rate 24/min., and
blood pressure 152/90 mm. Hg. The skin was dry and
scaly and the eyes were sunken. The mouth was dry,
Submitted March 22, 1966.
Presented by
• William G. Pace III, M. D., Columbus, and
• Jacob W. Old, M. D., Columbus;
Edited by Dr. Old.
and the neck veins were flat. The lungs were clear.
The cardiac rhythm was regular and there were no
murmurs. The abdomen was markedly distended
and tympanitic. No liver dullness could be elicited
nor was there a fluid wave. The abdomen was gen-
erally tender but not rigid. No rebound tenderness
was noted. The bowel sounds were hypoactive with
occasional rushes. The rectal examination revealed
brown stool but no mass lesion could be palpated.
There was no dependent edema; the peripheral pulses
were present but weak.
Laboratory Data
The hemoglobin was 12.3 Gm., the hematocrit 38.5
per cent; the white blood cell count 7,528 per cu.
mm. with 70 per cent total neutrophils. Platelets
appeared adequate. The urine had a specific gravity
of 1.026 and 10 to 15 white blood cells per high
power field; sugar and albumin were negative. The
blood urea nitrogen was 88 mg., the creatinine 1.3
mg. per 100 ml. The serum sodium was 139 mEq.,
the potassium 3.1 mEq., the chlorides 94 mEq., and
the C02 combining power 29 mEq. per liter.
X-ray examination of the abdomen showed a grossly
distended large bowel with free intraperitoneal air
and two fecal masses in the left lower quadrant. The
colon filled only to the midsigmoid region on barium
enema.
The electrocardiogram showed low voltage but was
otherwise within normal limits.
Hospital Course
The sigmoidoscope was admitted only to the level
of 15 cm. and no tube could be passed through it.
The patient was prepared for surgery with intra-
venous fluids, antibiotics, and whole blood. Never-
580
The Ohio State Medical Journal
theless she remained hypotensive and tachycardia per-
sisted. The urinary output was less than 100 ml.
At laparotomy, 12 hours after admission, the peri-
toneum was found grossly contaminated and a tem-
porizing procedure was performed. During surgery
the patient required 4 units of blood, 400 mg. Solu-
Cortef,® and a Neo-Synephrine® rinse. Soon after
arrival in the recovery room the systolic blood pres-
sure was above 100 mm. Hg, and the heart rate was
normal.
Initially the urine output averaged 40 to 50 ml.
per hour, the specific gravity 1.015-1.020. During
the next 14 hours her blood pressure slowly fell to
50 systolic and the pulse rate rose to 100-120. The
urinary output fell to zero yet the central venous pres-
sure ranged from 8 to 12 cm. of water. Venipunc-
ture sites failed to clot and bleeding was noted in the
oral cavity. The patient was thought to be hypothy-
roid and to have an underlying blood dyscrasia as well
as hypofibrinogenemia. Laboratory studies showed a
hematocrit of 48 per cent, hemoglobin 15.4 Gm.,
white blood cells 6,480 with 61 per cent neutrophils
and 34 per cent juvenile myelocytes; platelets 840,-
000; fibrinogen 0.141 Gm. per 100 ml.; prothrombin
time above 21 minutes (less than 10 per cent). The
blood urea nitrogen was 26 mg. and creatinine 1.3
mg. The amylase was 52 units. Despite controlled
respiration, vitamin K, fibrinogen, Amicar,® fresh
whole blood, steroids, antibiotic therapy, vigorous
fluid replacement, mannitol and intravenous calcium,
the patient died at 10:23 p. m. on the second hospital
day.
CLINICAL DISCUSSION
Dr. Pace: We have here today the case of a
68 year old woman who had been without bowel
movements for four weeks. We do not know ex-
actly how long she was seriously ill prior to her ad-
mission here, but we note that she had acute symp-
toms with pain in her right shoulder and nausea and
vomiting about one week prior to her admission.
The past history has a couple of interesting points
in it. On her upper G. I. in 1942 she had a duodenal
ulcer and was started on a Sippy diet. Then about
seven years later she was hospitalized when she had
clinical hyperthyroidism with a BMR of plus 29. She
was given 4 millicuries of I131, which I assume was
an adequate dose since it seems to have resulted in
clinical hypothyroidism after an interval of six months.
She was lost after that visit and came back 16 years
later. Her vital signs were surprisingly normal but
her skin was dry and scaly. I am surprised that she
was as thin as described if she was markedly hypothy-
roid. Her adbomen was tender but not rigid and
was without rebound tenderness, which, taken with
her symptoms and x-ray findings, would certainly be
most consistent with perforation of a viscus without
highly irritating substance in it. Such a perforation
is almost certainly not gastric since, even though she
is old and hypothyroid, we would expect to find some
rigidity or rebound tenderness if her old ulcer had
been activated. Thus I assume she perforated her
colon and put relatively nonirritating stool into her
peritoneal cavity, and the free air was enough to give
her shoulder pain. The bowel sounds were hypcac-
tive as I would assume they should be.
On rectal examination there was no palpable mass
and brown stool was noted. If she really had had no
bowel movement for four weeks I would think the
stool should be pretty7 dry and we ought to have some
note of it. Since she was a poor historian maybe this
wasn’t a four-week history. If she had been without
bowel movement for four weeks the stool would have
been like bricks in her rectum. I am trying to estab-
lish how acute this process was, because I suspect she
must not have been constipated for four weeks.
Dr. Williams: The stool was guaiac-negative.
Dr. Pace: All right then, this was a relatively
acute process, so let’s question the original history of
four weeks without a bowel movement.
The urine specific gravity was 1.026, which is
pretty good, and her creatinine was normal, so the
elevated BUN indicates an acute process — probably
acute dehydration. The rest of the electrolytes ex-
cept for lowered potassium aren’t too far out of line;
they are consistent with the moderate amount of
vomiting that she had before she came in.
May we now have a review of the radiological
findings ?
Radiologist’s Discussion
Dr. Dunbar: First is the chest film and the lung
fields are clear with no evidence of cardiac failure.
There is a little bit of pleural fluid and a little atelec-
tasis at the right base, but the striking thing is the
huge pneumoperitoneum beneath the diaphragms.
The liver and the spleen are visible because of the
surrounding air, and a nice bowel wall sign can be
seen due to the air within the bowel and the pneu-
moperitoneum outside. The abdomen shows, in addi-
tion to the huge pneumoperitoneum, a greatly dilated
colon with a large amount of fecal material in the
right side. Barium enema was then done and an
essentially complete obstruction in the midsigmoid or
low sigmoid is identified. Now this comes down to
a rather sharp point which is sometimes described as
a bird’s "beak.” This means to us that this is prob-
ably a sigmoid volvulus. It is not completely typical
because we would like to see the actual folds being
twisted into the point of volvulus in spiral fashion.
I certainly don’t see a tumor mass here. My opinion
would be that this is probably a sigmoid volvulus with
perforation.
Dr. Pace: Isn’t this a bigger colon than you
would expect to find in a volvulus?
Dr. Dunbar: That’s the problem. I don’t see
the twisted sigmoid. This is described as a coffee-
bean shadow; that is, one loop coming up, another
for June, 1966
581
loop coming down with a twisted point, with the
bowel wall in between making the slit in the coffee
bean. Since I don’t actually see the volvulus, I would
say that a chronic obstructing carcinoma would also
have to be considered.
Dr. Pace: Is this colon larger in caliber than
you would expect in acute obstmction?
Dr. Dunbar: Yes. It is quite large and I
think it has been there for some period of time.
Dr. Pace: How often do you see a colon this
large with a hypothyroid patient who is just chroni-
cally constipated? This would put her in a category
of being almost like institutionalized patients.
Dr. Dunbar: We do certainly see colons like
this in mental hospitals and homes for the aged. They
are possibly most prevalent in schizophrenics. I have
never seen one of these large colons in such patients
perforate without a point of obstruction.
Dr. Pace: If they perforate, they will perforate
in the cecum.
Dr. Dunbar: Sure.
Dr. Pace: We are thus faced with a woman
with too much free peritoneal air to have resulted
from a perforation of a gastric lesion. She seems
obviously to have a colon obstmction and the only
question would be whether the perforation is in the
cecum — and I would agree that it is a pretty big
cecum — or whether it is in a volvulus which has
decompressed itself by perforation and allowed these
fecal balls to escape into the peritoneal cavity.
I suppose this CPC presents two problems: one
is why she died, and the other is what she had to
bring her to surgery. One explanation would be
megacolon associated with hypothyroidism with a
tendency to volvulus; this I am going to have to put
first on the list. Carcinoma is certainly a possibility
and I don’t know any way of ruling it out other than
by the unusual x-ray picture.
So, having made our surgical diagnosis of intestinal
perforation, we plan to correct this with a definitive
surgical procedure and try to get our patient into
shape, but apparently we didn’t get her quite enough
into shape, because she required 4 units of blood,
400 mg. of Solu-Cortef, Neo-Synephrine, and a few
other heroic measures during the procedure, which
was a "temporizing” procedure — I don’t quite know
what that means. After arrival in the recovery room,
she fell into shock. Initially postoperatively she put
out 40 to 50 cc. of urine per hour with a pretty good
specific gravity, but over the next 14 hours she went
on a progressively downhill course starting with her
drop in blood pressure, some rise in the pulse rate,
and urinary output falling to zero. This, I am sure,
is septic shock due to Gram-negative septicemia with
subsequent fibrinolysis. I think this may explain the
low prothrombin time.
The patient had a fibrinogen level of 0.141 with
a normal of 0.235 to 0.339 and a prothrombin time
582
which was less than 10 per cent. A decrease in
prothrombin time associated with fibrinolysis without
decrease in fibrinogen is a downhill spiral in most
individuals. Sooner or later the fibrinogen falls be-
cause fibrinogen is being converted to fibrin as fast
as possible with the fibrinolysis taking away all the
fibrin. Fibrinogen will be exhausted before the plas-
min or fibrinolysin is exhausted. The patient was given
Amicar which specifically inhibits the plasminogen
to plasmin conversion, and inhibits to some extent the
effect of fibrinolysin directly. Unfortunately this
whole course of events took only 14 hours, which is
probably not sufficient time to have inhibited her
fibrinolysin before the fibrinolysin inhibited her. In
spite of mannitol and intravenous calcium the patient
died in septic shock about 14 hours postoperatively.
So we have a woman who was elderly and who
came in with four weeks of constipation — probably
had more nearly 14 years of constipation perhaps
associated with her hypothyroidism which was the
iatrogenic result of our vigorous attempts to cure her
hyperthyroidism — and her acute course probably
started just a day or so prior to admission when she
obviously perforated her colon and had shoulder pain.
She perforated her colon, massively soiled her peri-
toneal cavity, had overwhelming peritonitis, barely
tolerated her surgical procedure, which I guess was
an exteriorization of the area involved, and then died
in the recovery room 14 hours later from overwhelm-
ing septicemia.
CLINICAL DIAGNOSIS
1. Hypothyroidism.
2. Hypothyroid megacolon with fecal impaction.
3. Perforation of colon probably due to
obstruction.
4. Peritonitis.
5. Septicemia with fibrinolysis.
PATHOLOGIC DIAGNOSIS
1. Fibrosis of thyroid with anatomic changes
consistent with hypothyroidism.
2. Hypothyroid megacolon with massive fecal
impaction.
3. Multiple idiopathic perforations of sigmoid,
ascending and transverse colon.
4. Septicemia.
5. Bleeding diathesis consistent with septicemic
fibrinolysis.
DISCUSSION OF PATHOLOGY
Dr. Old: I can’t tell you whether the patient
had a volvulus or not. The only way we can tell
anything about this is from the operative notes. Was
there actually a volvulus or not?
Dr. Williams: No volvulus was found, Dr.
Old. Dr. Westerheide in his operative note men-
tions two perforations — one of the transverse colon
and another one approximately 1.5 cm. in size in
The Ohio State Medical Journal
the sigmoid colon with a huge fecal ball presenting
through this necrotic area.
Dr. Old: The first gross picture shows the tem-
porizing procedure, which was an exteriorization of
two loops of bowel — one in the epigastrium and one
in the lower right quadrant. You will notice that the
bowel has some degree of viability but there are focal
areas of bluish-gray change which represent necrotic
areas. The colon was distended with firm feces from
the sigmoid area across the transverse colon and into
the ascending colon. Our second gross photograph
shows a large tear. Our next slide shows the cecal
area dilated with fecal material. You will notice
that the bowel is beginning to get apoplectic and I
believe that surgeons do not like to see bowel this
color.
Dr. Williams: And you are right.
Dr. Old: So, this woman was getting a kind of
ischemic infarction, but we have no good mechanical
reason why she should have perforated. She not
only had a perforation in the sigmoid area but she
had one in the transverse colonic area which was
exteriorized. Both of these were described as about
6 cm. long, and several other perforations a centi-
meter or so in size were described in the descending
colon. So we assume that something intrinsic hap-
pened to this woman’s bowel to allow this. A search
was made of the arteries and veins and no essential
abnormality was found. So we don’t have vascular
thrombi to contend with, and all I can do is to pre-
sume that this woman simply got so full of fecal
matter and the bowel wall became so distended that
adequate blood supply wouldn’t flow through. Even-
tually those areas with the least blood supply simply
perforated.
The next photograph shows the abdominal con-
tents. There is some fibrin deposition on the surface
of the small bowel but no great amount of fibrinous
adhesions. There was some ascites within the ab-
dominal cavity. Our last photograph shows the
unusual degree of hemorrhage which was present in
some of the soft tissues. In other words, this pa-
tient had a rather diffuse bleeding problem as well.
Now if you will turn on the lights we will go over
what this case might possibly be.
The pathological protocol describes the body as
well-developed and well-nourished rather than thin
as stated in the clinical protocol. Everybody has a
different criterion for where fat and thin commence.
The skin was described as dry, scaly and coarse, the
face slightly puffy. This of course goes along with
some degree of hypothyroidism, and I think this is
probably the basic mechanism of this patient’s illness
and death. She had no functional thyroid what-
soever left at autopsy, and according to the clinical
record she didn’t take her thyroid properly after her
radioiodine treatment, but we don’t know what medi-
cations she had been on during these 14 years. One
would presume that she was taking thyroid hormone
intermittently or at least in enough dosage to keep her
out of marked hypothyroidism if she got along for
14 years with a thyroid as fibrotic as hers.
Hypothyroidism has many manifestations. On the
cardiovascular side, there is low stroke volume and
relative bradycardia, and this woman, who had some
degree of peritonitis and showed signs of it on admis-
sion, didn’t have a very high pulse rate. Cardiac
failure may occur, but I don’t know whether this was
the case in this particular instance. Cardiac changes
with myxedema are rather nonspecific — the so-called
flabby heart, which was present. At autopsy the
heart has no rigidity and no essential mass to it, but
this may also occur with many debilitating illnesses.
Another feature in this case was very marked coro-
nary arteriosclerosis, which is also seen with hypo-
thyroidism. These patients are said to be somewhat
like diabetics in that hypothyroidism predisposes
them to excessive arteriosclerosis and the coronary
arteries are often severely involved. Some clinicians
recommend the slow treatment of hypothyroidism to
avoid precipitating angina pectoris, which may occur
if the patient becomes euthyroid too fast.
The hypothyroid patient manifests a number of
symptoms related to the gastrointestinal tract: im-
paired secretions, occasional examples of malabsorp-
tion due to myxedema, and of course atonia is the
main consideration with constipation which may even
go on to megacolon. This patient’s history may
have been more accurate than it sounded in that the
fecal contents were too voluminous to have accum-
ulated in a short period of time and I presume that
she may not have had a bowel movement for at least
a couple of weeks anyway.
As for bleeding disorders, there is little in the
literature related to hypothyroidism, so the mechan-
isms that Dr. Pace mentioned are probably as good
as any, although peritonitis was not marked. There
have been bleeding problems described with hypothy-
roidism, but it’s not too clear what they are. It has
been suggested that hypothyroidism may lead to a
deficiency of so-called stable factors of the clotting
mechanism. Possibly the vitamin K deficiency was
due to a poor diet.
The adrenal glands have sometimes been a factor,
and steroids apparently may sometimes be required in
control of myxedema patients.
Finally, these patients with myxedema can appar-
ently undergo comatose changes and mental aberra-
tions just on the basis of hypothyroidism itself.
Apparently the thyroid hormone is necessary for
metabolism within the brain and the brain cells
gradually decrease their function like all other cells
with the deficiency. This leads to lowered cerebral
metabolism and then to lowered reflexes, and finally
to lowered breathing with an accumulation of C02
in the process, and these patients are described as
brittle to any type of shock. In other words, if she
for June, 1966
583
were basically a hypothyroid patient at the time of
surgery, she would be very susceptible and very dif-
ficult to control as a postsurgical or even a surgical
patient, which I think is borne out by the history.
The microscopic sections were not very helpful in
this case. The thyroid was pure scar and is the main
positive finding to account for hypothyroidism. The
bowel was remarkable mainly for venous congestion
and edema, which support my postulate of impaired
circulation.
I cannot be absolutely certain of the cause of death,
but I would say that in all probability it was related to
the remote thyroidectomy by 4 millicuries of iodine.
She probably let herself get myxedematous and got into
various chronic problems including the colon, and I be-
lieve one can get enough of a fecal impaction to cause
rupture just on the basis of the impaction itself.
This one was really extensive, running from the
sigmoid colon all the way around almost to the
cecum, and the perforations were down in the older
parts of the impaction. We will occasionally observe
at autopsy a type of ulceration known as stercoraceous
ulcer in fecal impactions, which apparently is due
simply to pressure of the fecal mass against the
mucosal wall to the point where it cuts off circulation.
Capillary circulation can be cut off so that ulcerations
may occur, and I would suggest that this is prob-
ably the mechanism by which these lesions finally
perforated.
Dr. Pace: I just wondered whether Dr. Mac-
pherson had any comment about hypothyroidism and
the bleeding and the fibrinolysis that she subsequently
presented with.
Dr. Macpherson : I don’t know of any relation-
ship between those two. If we discuss the possible
mechanisms of the fibrinolysis, rapid onset of Gram-
negative shock, or endotoxic shock, in a woman who
is physically unhealthy would be an important con-
sideration in addition to surgery and the anesthesia,
which can in themselves do it.
Dr. Marable: Do you agree with the shotgun
load of therapy that was given here of Amicar, fresh
blood, fibrinogen, steroids, and antibiotics?
Dr. Macpherson : Well, I don’t know how
many of them were necessary, but I can’t say that any
of them specifically would not be indicated.
M
ORE THAN ONE BILLION PRESCRIPTIONS will be filled in the
pharmacies of America this year, of which almost 95 per cent will be
produced in their entirety by pharmaceutical manufacturers, according to Dr.
J. Mark Hiebert, board chairman of Sterling Drug Inc.
"This huge number of prescriptions,” he said, "symbolizes the respon-
sibility of the manufacturer in his task of producing efficacious medicines
of high quality and safety, and this is uppermost in the manufacturer’s
mind.” The fundamental responsibility of drug manufacturers consists
the manufacture of medicines of "quality, efficacy and safety.” Dr.
in
as:
Hiebert listed other major obligations
• Create through research more and more life-saving and health-preserving
medicines.
• Bring to the attention of physicians all new developments that may
favorably affect the health of their patients.
• Alert physicians to undesirable and unanticipated side effects, con-
traindications, new indications when permitted to do so by law, dosages.
• Notify the medical profession immediately if product error occurs,
if safety is at stake, withdraw the product at once.
• Adapt our policies and practices to higher standards made possible by
science and technology, and to regulation by government.
and,
ATTENTION PROGRAM CHAIRMEN: We are most anxious to receive
for consideration manuscripts, abstracts, or news items based upon lectures,
symposia, etc., presented to Ohio physicians or those presented by Ohio physicians
to other groups. — The Editor.
584
The Ohio State Medical Journal
Maternal Health in Ohio
Maternal Mortality Report
For Ohio-1963*
By the OSMA COMMITTEE ON MATERNAL HEALTH
THE Committee on Maternal Health presents its
Ninth Annual Report in compliance with a
House of Delegates directive adopted April 23,
1953 which created the Committee, and follow-up
action taken by the OSMA Council, January 16,
1954.1
Five Sections comprise this report, the first consist-
ing of a resume of activities of your Committee since
its last report to The Council on September 19, 1965. 2
The second portion describes various projects de-
veloped and pursued by the Committee in fulfilling
its prescribed functions.
Section Three presents a statistical summary of The
Ohio Maternal Mortality Study for 1963* covering
88 counties in the state, while the following portion
analyzes the data. As the reader will note, the ma-
terial includes figures for patients who died outside
of hospitals as well as for those who died during
hospitalization. In the final part, recommendations
are advanced by the Committee, based upon its ex-
periences in the study and allied facets.
Activities
The Committee on Maternal Health consists of the
same 20 members mentioned in the last annual re-
port; the chairman and one member have been on
the Committee since its incipience. Previously men-
tioned, through its members the Committee not only
represents the 11 Councilor Districts of Ohio, but
also reflects an excellent cross section of general prac-
tice, obstetrics, gynecology, cardiology, pathology, and
anesthesiology.
Quarterly the Committee has met. Perhaps the most
effective meeting of the group is the annual two- day
conference held at Granville in the famous Inn. Be-
sides conducting many items of important business,
during this meeting January 22 and 23, 1966, the
Committee studied, reviewed and classified 72 mater-
nal death cases. In the customary manner, "Guiding
Principles for Obstetric Care’’3 was used as a mini-
mum standard to assess avoidability in each case.
*A continuous state-wide Maternal Mortality Study is being con-
ducted in Ohio by the Committee on Maternal Health of the Ohio
State Medical Association, in cooperation with the Ohio Department
of Health, and assisted by representatives of the various County
Medical Societies of the State. Since work of the Committee is edu-
cational as well as statistical, summaries of some of the cases studied
by the Committee, based on anonymous data submitted, are pub-
lished in The Ohio State Medical journal from time to time. Each
presentation is brief but informative. It contains opinions of the
Committee, based on the data submitted for review.
In this column titled "Maternal Health in Ohio”
the Committee continues to publish an article each
quarter year. Besides the annual report to The Coun-
cil, its subjects include various primary causes of ma-
ternal death gleaned from cases in The Ohio Study.
Frequently brief case reports are published to provide
further educational media, through concise pertinent
comments.
During a presentation of the Committee’s report
to The Council at a meeting in 1965, several mem-
bers displayed great interest in The Ohio Study. One
presented queries concerning "Child Outcome” in the
death of various mothers. Another asked about the
significance of "Prenatal Care” in connection with
maternal mortality. After a lengthy survey of mate-
rial in The Ohio Study, in answer to these questions
an article was published on the subject, appearing in
this column in March, 1966.4
The Committee supports well established county
maternal death studies operated in Cleveland, Colum-
bus, Cincinnati, Dayton and Toledo. In addition, the
Committee was delighted to assist in the organization
of a newly augmented maternal mortality study, to
operate continuously on a county-wide basis as a co-
operative effort — the Akron Obstetrical and Gyne-
cological Society and the Summit County Medical
Society. This study was duly authorized January 1,
1966; physicians of the community are to be compli-
mented upon this accomplishment.
Projects
The data processing system coding information
from questionnaire forms onto IBM cards continues.
To date, data from 1084 maternal cases have been
transcribed to the cards for the first nine years of
The Ohio Study, 1955 to 1963, inclusive. As the
files of completed cases grow, more cases (old and
new) are added, to provide a wealth of material for
information and education.
As this article goes to press, a subcommittee is pre-
paring an exhibit for the Committee, to be displayed
at the annual OSMA meeting in Cleveland, May 24-
28, 1966. The title: "Maternal Deaths Due to Anes-
thesia.” Efforts were coordinated with The Ohio So-
ciety of Anesthesiologists, Inc.
In a collateral fashion, the Committee is assisting
The Ohio Society of Anesthesiologists, as the latter
plans and pursues a new program devised to ascertain
for June, 1966
585
the practices and needs for personnel and facilities
connected with OB anesthesia in Ohio hospitals;
thereafter the program will be directed toward meas-
ures recommended to meet these needs.
At the request of The Council, the Committee
studied certain proposed changes to be made on the
official certificates of live birth, death and stillbirth
(fetal death). Specific recommendations were made
by the Committee; however subsequently it was
learned that the U. S. Department of Health, Educa-
tion, and Welfare (HEW) had delayed revision of
these forms for one year.
During the annual meeting at Granville, a new
project was developed following prolonged discussion
and final deliberation. This was tagged the "Medi-
cally Avoidable Maternal Death’’ program of educa-
tion, aimed to further educate physicians in their early
responsibility to advise and guide the (cardiac, dia-
betic) patient concerning future pregnancies, etc. Fu-
ture reports will be forthcoming.
Under direction of The Council, the Committee on
Maternal Health thoroughly investigated planning
and implementation of a national project entitled
"National Foundation Prenatal Care Project”
(NFPNCP) sponsored by "March of Dimes.” Avail-
able material was studied and discussed. Recommen-
dations were made by the Committee to The Council
and approved (see The Ohio State Medical Journal,
61:1004-1005, November, 1965). The NFPNCP car-
ried a fetching slogan, "Be good to your baby before
it is born. Seek Prenatal Care. For further informa-
tion contact your local Chapter, National Foundation,
March of Dimes.” Subsequently a conference was
held with a district representative of the National
Foundation; officials of OSMA, and a member of the
Committee were present. It was pointed out by the
latter that the medical profession founded prenatal
care in the United States. In conclusion it was sug-
gested that the Foundation, in consultation with the
AMA, revise the NFPNCP to establish it on a sci-
entific basis that the medical profession would be
able to support.
Utilization of Maternity Beds
The Committee on Maternal Health and the Presi-
dent of OSMA were introduced to another new
project, on an advisory basis. On March 16, 1966 by
invitation, with the Ohio Director of Health, they
attended an initial conference with the Governor’s
Ohio Hospitalization Benefits Committee. Purpose of
the conference was "To examine the possible alterna-
tive use of existing maternity units in (Ohio) general
hospitals for 'appropriate’ gynecological cases in order
to have more effective utilization of existing facili-
ties.” It was pointed out that there has been a progres-
sive annual decline in Ohio live births since 1957
(Fig- 1).
As this article is being processed for publication,
additional conferences are being scheduled. The proj-
ect "GYN Patients on OB Floors, Draft No. 7”
Fig. 1. Number of Ohio Live Births per year, 10 years,
1955-1964.
developed after tireless study by the Committee, is
being surveyed by the Director of Health and the
Governor’s committee. By the time this article appears
in print it is anticipated that the "knotty problem”
will be well on its way to a favorable solution.
Statistics for the year 1963 from The Ohio Study
are published below. They are presented in a uniform
manner to facilitate comparison with similar reports
issued in the past and with those to appear in the
future. Terminology and nomenclature used through-
out the study were adopted in 1954, after careful
deliberation. They follow closely those prescribed
in the International Classification, for purposes of
uniformity.
Ohio Maternal Mortality Study
Statistics for 1963
Total Live Births in Ohio, 1963 212,583
(Total Cases in files, 9 years, 1955-1963-. ..1084)
Total Cases Studied (1963) ; 96
Cases not studied due to lack of information 4
Undetermined 2
Maternal Deaths (Classified) 64
Non-white 18
White 46
Age:
Teens 8
20’s 21
30’s 31
40’s 4
Parity:
Primigravidae 17
Multiparae 42
Unknown 5
Place of Death:
Hospital 57
Home 6
Other 1
Type of Delivery:
Not Recorded 0
Operative 33
Nonoperative (spontaneous) 18
Not delivered 13
Route of Delivery:
Not recorded 0
Vaginal 38
Cesarean 12
* (postmortem) 1
Laparotomy (ectopic preg. ) 1
*Not delivered 13
Case Classification: (when death occurred)
Not known 1
Group I (fr. concept, to 20th wk.) 4
Group II (fr. 20th wk. to 28th wk. ) 2
Group III (fr. 28th wk. through term) 7
Group IV (postabortal, postpartum) 50
Autopsies 50
(includes 15 coroners’ cases)
Prenatal Care: (apparent from data sheets)
None 8
Unknown or not reported 8
Adequate 37
Inadequate 5
Excluded (ecotopic preg. and abortion) 6
Classification of Preventability :
Nonpreventable 21
Preventable (avoidable factor) 43
Patient responsibility (Pi) 15
586
The Ohio State Medical Journal
Personnel responsibility (P2) 19
Both Pi and P2 8
Ps 1
Classification of Primary Causes of Death:
Hemorrhage 25
Abortion, without sepsis 2
Abruptio 0
Afibrinogenemia 5
Abruptio 1
Am. fl. embolus 2
Dead fetus 2
Ruptured uterus 0
Atony, uterine, postpartum 1
Ectopic pregnancy (without sepsis) 5
Laceration, extrauterine 1
Placenta Praevia 1
Retained Placenta 0
Ruptured uterus (no afibrin.) 8
Other 2
Infection 14
Abortion, alleged “criminal” 5
Abortion, septic, spontaneous 4
Up. Resp. Inf 1
Peritonitis 0
Septicemia (puerperal sepsis) 0
Septicemia (other) 3
Other 1
Toxemia 4
Acute yellow atrophy 2
Hypertension, chronic (inch Hypertension
with cerebrovascular hem. ) 0
Eclampsia 2
Preeclampsia 0
Puerperal Toxemia, not specified 0
Other 21
Amniotic fl. emb. (no hemorrhage) 4
Anesthesia 5
(general) 2
(regional) 3
Cardiac disease 4
Cerebrovascular hemorrhage (no. tox.) 1
Intestinal Obstruction 1
Pulmonary embolus 4
Renal disease, chronic, unspecified 0
Other 2
In Ohio, there were 212,583 live births reported
during 1963. From this maternal mortality study, the
Committee classified 64 maternal deaths for the year.
The maternal mortality rate was 0.30 per 1000 live
births, or 3.01 per 10,000 live births for 1963.
Discussion
Once more, in comparison, these statistics for 1963
are even more significant since there were 4,882 fewer
live births reported in Ohio during 1963 than in
1962 (see Fig. 1). The progressive, gradual, annual
decline in live births since 1957 has been noted
above. In addition, approximately 3,000 still births per
year reported in Ohio for the same period have
neither varied nor diminished materially.
Following the usual custom, the Committee re-
viewed every maternal case carefully, studying all
available facts and data on an anonymous basis. Using
"Guiding Principles for Obstetric Care”3 as a stand-
ard for "Ideal Care,” each case was classified; patients
receiving less than ideal care were voted preventable
maternal deaths. Final decisions reached by the Com-
mittee were justifiably correct. With the usual obser-
vations, members realized that a number of cases
escaped inclusion in the 1963 study, due to various
reasons of omission of information on the official
certificate of death.
Out of the 96 cases studied for 1963, 64 (66.6
per cent) were voted maternal deaths, while 26 were
voted nonmaternal deaths (no connection with preg-
nancy or the puerperium). Two cases had the cause
of death undetermined after complete investigation
by autopsy.
The majority of deaths fell in age groups 30 to 39
years. Multiparae again led the parity group; 57 pa-
tients died in hospitals while six died at home. One
patient was "D.O.A.” at the emergency room.
Among the 64 maternal deaths, 51 patients deliv-
ered; 33 were delivered by operative procedure while
only 18 delivered spontaneously. The remaining 13
died undelivered; of these only one had had a post-
mortem cesarean operation performed. Thirty-eight
patients, (74.4 per cent) of those delivered, were
delivered by the vaginal route; there were 12 ante-
mortem cesarean sections and one patient had a lap-
arotomy for ectopic pregnancy.
Again, the overwhelming number of patients (50
of the 63 patients) died in the postpartum or post-
abortal state. In one case the state was not known.
Fifty autopsies were performed on the 64 patients
(78.1 per cent) including 15 coroners’ autopsies.
Based upon available data, the Committee voted 43
cases (67.3 per cent) preventable maternal deaths.3
A study of prenatal care statistics proved interest-
ing. Of 50 patients in the eligible group (excluding
unknown, ectopic pregnancy and abortion), 37 (or
74 per cent) received adequate prenatal care; three
received care from a clinic while 34 received care
from a physician. Five patients received inadequate
prenatal care and eight received none at all.
A review of the primary causes of maternal death
in the 64 cases (Fig. 2) reveals many interesting
features:
Again hemorrhage leads the list as a single primary
cause of death with 25 cases (39 per cent), including
No. of portents Ohio Maternal Mortality Study for 1963
Fig. 2. Classification of pritnary causes of death , 64
maternal deaths for 1963-
eight cases of ruptured uterus! And once more this
figure reflects the scarlet trend published in the 1962
report.2
Well over half the 14 cases dying of infection died
following abortion. Only four patients died from
toxemia, two of these developed eclampsia. Under
"other causes,” anesthesia was responsible for five of
the 21 deaths. Cardiac disease and pulmonary em-
bolus relinquish leadership with only four cases for
each; an equal number of deaths (four) occurred
for June, 1966
587
from amniotic fluid pulmonary embolus, proved at
autopsy.
The two "other causes’’ in this last group bear a
brief description: Case No. 913 developed abruptio
placenta, hemorrhage, gastric hemorrhage, then vom-
ited and aspirated causing death. Case No. 939,
through a coroner’s autopsy, died of "accidental
anoxia, no other cause found.”
The distribution of causes of death during 1963
is strikingly similar to those listed for 1962 (Fig. 3).
Recommendations
1. Again the Committee recommends that The
Ohio Maternal Mortality Study with its research and
educational facets, be continued to reduce further
the maternal mortality and morbidity in Ohio. Trends
in maternal deaths can be controlled only through
constant evaluation of factors producing this mortal-
ity, followed by a program of education which is
focused towards the causative factors.
2. Once again it is recommended that county med-
ical society presidents appoint the chairmen of (local)
Committees on Maternal Health for terms longer
than one year. Through some adjustment in local
customs, this committee chairman then would not
terminate his one-year tenure just as he became famil-
iar with the operation of his local study. A term of
three years is recommended.
3. It is reiterated that county Committees on Ma-
ternal Health should establish closer liaison with local
vital statistics bureaus and respective offices of the
coroner. It is recommended that greater effort be
exerted to discover maternal cases where the patient
dies at home or elsewhere. These cases, of which a
fair number now escape inclusion in the study, should
be included.
4. In the past, members of The Council have sup-
ported The Ohio Maternal Mortality Study with
constant devotion. It is recommended that members
remind program chairmen of county medical societies
that speakers from the Committee are available for
local schedules, to present topics or discussions con-
cerning "Maternal Health in Ohio.” Correspondence
may be addressed to the Committee on Maternal
Health, OSMA Headquarters, 17 South High Street,
Suite 500, Columbus, Ohio 43215.
The Chairman takes this opportunity to express sin-
cere appreciation to members of the Committee for
continued loyal support and for faithfully discharging
their duties. Furthermore, the Committee gratefully
ALL
OTHER
Fig. 3.
Ohio Maternal Mortality Study for 1962
Distribution of Primary Causes of Death, 66 Maternal Deaths in Ohio.
588
The Ohio State Medical Journal
acknowledges the assistance provided by attending
physicians, representatives of various county medical
societies, The Ohio Department of Health and nu-
merous other agencies and individuals. Without their
untiring cooperation, this Maternal Mortality Study
could not have been compiled.
Respectfully submitted,
Anthony Ruppersberg, Jr., M.D., Chairman,
Committee on Maternal Health
Approved by The Council of the Ohio State Medi-
cal Association, April 24, 1966.
References
1. Maternal Mortality Study, Statewide Basis. Ohio State M.
51:886-888 (September) 1955.'
2. Committee on Maternal Health: Maternal Mortality Report for
Ohio — 1962. Ohio State M. }., 61:1103-1105 (December) 1965.
3. Guiding Principles for Obstetric Care. Ohio State M. J.,
53:1328-1329, 1957 (Revised 1963).
4. Ruppersberg. Anthony, Jr.: Adequate Prenatal Care — Be
Good to Mother Before Baby is Born.” Ohio State M. ]., Gl'.lAl-
248 (March) 1966.
INSTRUCTIONS TO CONTRIBUTORS OF SCIENTIFIC PAPERS
1. Exclusive Publication. Articles are accepted for publication with the understanding that they
are contributed solely to this Journal. Permission for subsequent publication elsewhere must be obtained in
writing from the Editor and from the Author.
2. Correspondence. Address all correspondence relating to publication of scientific papers to:
The Editor, The Ohio State Medical Journal, 17 South High Street, Suite 500, Columbus. Ohio 43215.
3. Manuscripts. (a). Manuscripts should be submitted in the original on standard 8I/2" x 11"
white typing paper.
(b) . The entire text including case reports and lists of references should be typed double or
triple space with margins of at least one inch on all sides.
(c) . Tables, charts, and figures (illustrations) should be submitted separately from the text.
They should be identified by number and by a concise, descriptive title. In the text, reference to them
should be made by number, e. g. (Fig. 1). We shall place the figure as close as possible to this reference
in the printed text.
(d) . A copy of the manuscript should be retained by the Author.
4. Tables and Charts. Tables and charts that can be set in type must be included, and there will
be no charge for their reproduction. (See 3-c.)
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(c) . Legends for the figures should be written on separate paper.
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within 30 days after publication. Plates will be sent to the Author after the article has been published.
(e) . Obtaining permission for the taking and publishing of photographs, whether or not they are
recognizable, is the responsibility of the Author.
6. Summaries. The summary should be a concise restatement of the information given in the
body of the article.
7. References, (a). Lists of references should be at a minimum to conserve space and ex-
pense and be limited to those essential to the subject and to which actual reference is made in the text.
The Editor reserves the right to reduce the number when necessary.
(b) . References should be listed in the order of their appearance in the text.
(c) . Authenticity and accuracy of references are the responsibilities of the Author.
(d) . Each journal reference should include, in this order: Author’s last name and initials,
title of article, name of journal (abbreviated in accordance with standard usage), volume number, inclusive
page numbers, month (day of month, if weekly), and year, e. g.
"2. Doe, J. , and Roe, R. X.: How to Go About It. Ohio State M. J., 13:24-30 (Feb.) 1920.”
Each textbook reference should include, in this order: Author’s surname and initials, title of
the book (capitalize all main words), edition, place of publication, name of the publisher, year of publica-
tion, volume, if more than one has been published, and page, e. g.
"5. Osier, W. : Modern Medicine, ed. 3, Philadelphia, Lea & Febiger, 1927, vol. 5, p. 66.”
8. Identification of Patients. Names, initials, hospital numbers, or any other identifiable labels,
should not be used. It is preferable to identify patients for the purpose of publication by the use of
numbers in series for the study being reported.
9. Reprints. An order blank for reprints with a table covering cost will be sent with the
galley proof to the senior author.
10. Editorial Assistance. The Journal staff is anxious to assist the Author in preparing his
manuscript. For his own assistance, however, the Author is encouraged to consult standard texts on medi-
cal writing, such as " Medical Writing — the Technique and the Art.” by Morris Fishbein, M. D., Blak-
iston Division, McGraw-Hill Book Company, Inc.. 330 West 42nd Street. New York. New York 10036.
and Style Book and Editorial Manual, 3rd Edition. $1.50, prepared by the Scientific Publications Division,
American Medical Association, 535 North Dearborn Street. Chicago, Illinois 60610.
/or June, 1966
589
(propantheline bromide)
Intragastric photography has provided a
new and precise method of measuring the
effectiveness of anticholinergic drugs. The
transition from gastric motor activity to re-
laxation seen with effective doses of such
drugs takes only a few seconds and is easily
demonstrated.
The importance of vagal stimulation of
gastric hyperacidity and hypermotility
makes such measurements particularly im-
portant in evaluating the parasympatholytic
effect of drugs used in patients with peptic
ulcer, gastritis, biliary dyskinesia and other
gastrointestinal disorders.
Pro-Banthine has been shown1 to produce
complete gastric motor inactivity with doses
of 6 to 8 mg. intravenously. Comparison
tests were made with the belladonna frac-
tion, atropine. Measured usual dosage unit
versus usual dosage unit, Pro-Banthine was
more than four times as effective as the
belladonna alkaloid.
Indications: Peptic ulcer, functional- hypermotility,
irritable colon, pylorospasm and biliary dyskinesia.
Oral Dosage: Adequate dosage should be given for
optimal results. For most adult patients this will be
four to six 15-mg. tablets daily in divided doses. In
severe conditions as many as two tablets four to six
times daily may be required. Pro-Banthine (brand of
propantheline bromide) is supplied as tablets of 15
mg., as prolonged-acting tablets of 30 mg. and, for
parenteral use, as serum-type ampuls of 30 mg.
Side Effects and Contraindications: Urinary hesitancy,
xerostomia, mydriasis and, theoretically, a curare-
like action may occur. Pro-Banthine is contraindi-
cated in patients with glaucoma, severe cardiac
disease and prostatic hypertrophy.
I. Barowsky, H.; Greene, L., and Paulo, D.: Cinegastro-
scopic Observations on the Effect of Anticholinergic and
Related Drugs on Gastric and Pyloric Motor Activity, Amer.
J. Dig. Dis. 10:506-513 (June) 1965.
590
The Ohio State Medical Journal
Is Effective
Complete gastric relaxation with Pro-BanthJne. As this intragastric photo-
graph demonstrates, gastric relaxation is attained with 6 mg. of
Pro-BanthTne intravenously; the antrum is relaxed and the pyloric orifice
remains open. Full intravenous doses of atropine (4 mg.) produce no
measurable effect.
SEARLE
Research in the Service of Medicine
for June, 1966
591
Proceedings of The Council . . .
Minutes of the Meeting of April 23-24; With Reports of
Numerous Matters Discussed and Official Actions Taken
A REGULAR MEETING of The Council of the
Ohio State Medical Association was held
- April 23 and 24, 1966, in the new headquar-
ters office, 17 South High Street, Columbus. All
members of The Council were present except Dr.
Robert E. Howard, Cincinnati, Councilor of the First
District, and Dr. George Newton Spears, Ironton,
Councilor of the Ninth District. Others attending
the meeting were: Dr. John H. Budd, Cleveland,
chairman, Ohio Delegation to the American Medical
Association; Mr. Wayne Stichter, Toledo, OSMA
legal counsel; Mr. David B. Weihaupt, Chicago,
AMA field representative; Dr. Anthony Ruppersberg,
Columbus, chairman, OSMA Committee on Maternal
Health; Dr. Edmond K. Yantes, Wilmington, presi-
dent, Mr. Charles H. Coghlan, Columbus, executive
vice-president, Ohio Medical Indemnity, Inc.; Dr.
William Hamelberg, Columbus, president of the
Ohio Society of Anesthesiologists; Messrs. Page,
Edgar, Gillen, Traphagan and Moore, members of
the OSMA staff.
Resolution in Memoriam
The following resolution concerning the death of
Dr. Fred W. Dixon, Cleveland, was submitted by
Dr. Robechek, and by official action was adopted by
The Council :
WHEREAS, Fred W. Dixon, M. D., of Cleveland,
a Past President of this Association and a former
member of this Council, died April 11, 1966, and
WHEREAS, this physician and surgeon established
in his lifetime a distinguished record of service
to his patients and to his profession, and
WHEREAS, his dedication, humility and relationships
with his patients and his fellow physicians gained
for him the admiration and respect of all who were
privileged to know him, now therefore
BE IT RESOLVED, that The Council of the Ohio
State Medical Association hereby pays tribute in
memoriam to this distinguished physician, and
BE IT FURTHER RESOLVED, that deepest sym-
pathy is extended to his widow, and
BE IT FURTHER RESOLVED, that this resolution
be made an official part of the records of this
Association, that a copy of it be forwarded to
Mrs. Dixon, and that it be suitably printed in the
official publication of this Association.
Unanimously adopted by standing tribute
April 23, 1966
Henry A. Crawford, M. D., President
Hart F. Page, Executive Secretary
Minutes Approved
Minutes of the meting of The Council held March
20, 1966, were approved by official action.
Membership Statistics
The following membership statistics were an-
nounced by Mr. Page: OSMA membership as of
April 22, 1966, 9,524, compared to a total member-
ship of 9,471 on April 22, 1965, and 10,042 on
December 31, 1965. He reported that of 9,524
members, 8,507 were affiliated with the AMA.
Reports of Councilors
The Councilors reported on activities in their re-
spective districts.
1966 Annual Meeting
Mr. Traphagan presented a progress report on de-
velopments concerning the Annual Meeting of the
Association in Cleveland, May 24-28.
A total of 44 resolutions to be presented under the
60-day rule at the first session of the House of Dele-
gates were distributed to The Council for information.
New Section on Plastic Surgery
In answer to a request from Clifford L. Kiehn,
M. D., Cleveland, The Council approved the forma-
tion of a Section on Plastic Surgery for the Ohio
State Medical Association. The Executive Secretary
was instructed to advise Dr. Kiehn of the procedure
for establishing such a section.
Letter Regarding 1963 Resolution
A letter from George H. Hoke, M. D., Lorain,
Secretary of the OSMA Section on Neurological Sur-
gery and the Ohio Neurosurgical Society, transmitting
a copy of a resolution passed at the 1965 meeting
of the Section on Neurological Surgery, was submitted
to The Council. Such letter concerned Resolution
No. 22 adopted by the 1965 House of Delegates.
The Executive Secretary was directed to inform Dr.
Hoke that the procedure of acting on resolutions at
a section meeting is out of order in accordance with
Chapter 3, Section 5 of the Bylaws of the Ohio State
Medical Association. This provision limits section
activities to scientific subjects. It was further pointed
out by The Council that resolutions may be properly
presented by submitting them through an officially
elected delegate to the Ohio State Medical Associa-
tion in accordance with Chapter 4, Section 8 of the
Bylaws of the Association.
June AMA Meeting
The Council voted to instruct the Ohio delegates to
the American Medical Association to support the
592
The Ohio State Medical Journal
proposed $25 increase in annual AM A membership
dues, to become effective January 1, 1967 if approved.
Mr. Page reported to The Council on developments
in plans for the President’s Reception in honor of
Dr. Charles L. Hudson, Cleveland.
On motion duly made, seconded and carried, The
Council instructed the Ohio delegates to the Ameri-
can Medical Association to nominate Dr. John H.
Budd for the office of vice-speaker of the American
Medical Association and to conduct a campaign in
support of Dr. Budd prior to and during the AMA
meeting in Chicago, June 26-30. The Council au-
thorized the expenses necessary to carry on the cam-
paign and authorized the staff to proceed with its
implementation.
Mr. Stichter presented a report for the information
of The Council which indicated that there is nothing
in the Illinois statutes or in the Articles of Incor-
poration of the American Medical Association requir-
ing that a citizen from the State of Illinois be a
member of the American Medical Association Board
of Trustees.
Texas Resolution
A communication from the Texas State Medical
Association, which included resolutions adopted by
that Association’s House of Delegates, April 15, 1966,
on the subject of the individual responsibility of the
physician, direct billing, and eliminating third party
interference in the doctor-patient relationship, was
distributed to members of The Council for information.
Ohio Medical Indemnity, Inc.
By official action, Council ratified a mail vote con-
ducted April 8 on the nomination of five members
of the Board of Directors of Ohio Medical Indem-
nity, Inc.
Dr. Tschantz reported for the OMI Liaison Com-
mittee on the annual meeting of the OMI Board
of Directors held April 20, 1966.
Dr. Yantes and Mr. Coghlan reported to The
Council on development of procedures for indemnify-
ing patients of hospital-based physicians.
Mr. Coghlan reviewed meetings OMI has held
with the Ohio State Radiological Society and dis-
cussed details under way in preparation for issuing
an Ohio Medical Indemnity policy to indemnify
patients for radiological fees.
Mr. Coghlan also discussed Blue Cross - Blue
Shield advertisements which had raised objections
from physicians in several areas. He indicated that
the Blue Cross Plans have been notified that Ohio
Medical Indemnity requests that OMI and the Blue
Shield name not appear in any advertising on the
subject of "Medicare.”
Council voted to ask officials of Ohio Medical In-
demnity, Inc. to confer with responsible members
of the Ohio Society of Anesthesiologists, with the
expressed hope that individual and direct billing can
be extended to anesthesiology claims submitted to
Blue Shield. A report on this matter was requested
for the next meeting of The Council.
Name of Committee Changed
The Council approved the change in the name of
the special Committee on Care of the Aging to the
Committee on Government Medical Programs.
Workmen’s Compensation
Developments in the usual and customary fee pro-
gram under Ohio Workmen’s Compensation were
presented by Dr. Diefenbach and Mr. Edgar. After
a lengthy discussion, The Council directed that a
combined exploratory meeting on the subject be con-
ducted, beginning with a luncheon at noon, May 18,
1966, with members of the Industrial Commission
and representatives of the Ohio Manufacturers’ As-
sociation, self-insurers, chairman of the OSMA Com-
mittee on Workmen’s Compensation and others. In
addition, The Council authorized the President of the
Ohio State Medical Association to confer with the
review committee of the Cincinnati Academy of Medi-
cine regarding problems in Workmen’s Compensation
fee bills.
Maternal Health
Dr. Ruppersberg presented the minutes of a meet-
ing of the committee held April 17. The minutes
included a commendation to Dr. Gilbert M. Schiff,
Cincinnati, for his efforts in promoting a progressive
study in Rubella antibody detection. Information
concerning the chairman’s appearance, by invitation,
before the Ohio Hospitalization Benefits Committee,
February 23 and March 17, 1966, to discuss with the
committee problems involving integrating clean gyne-
cological patients on maternity floors of general hos-
pitals, was included in the report. The minutes were
approved as presented.
1963 Maternal Mortality Report for Ohio
The 1963 Maternal Mortality Report for Ohio was
presented by Dr. Ruppersberg and received the ap-
proval of The Council. (The text of the report is
on pages 585-589 of the June issue of The Ohio State
Ale di cal Journal.)
ODH Laboratory Advisory Committee
On invitation from the Director of the Ohio De-
partment of Health, the President was authorized to
designate six physicians who utilize laboratory serv-
ices, Wo of whom will be selected by the director for
appointment to the Laboratory Advisory Committee
for the department.
The President was instmcted to write to Director
Arnold for clarification with regard to why the Ohio
State Medical Association was asked to submit the
names of physician users of laboratory sendees and
why nothing was said about suggestions of names for
pathologist members for the committee.
Ohio State Medical Board
Dr. Merchant reviewed the historical development
and the legislative background of the Ohio State
for June, 1966
593
Medical Board. He told The Council of current
problems faced by the Board in dealing with "pro-
fessional incompetence’’ and "mental incompetence”
on the part of licensees. He emphasized also the
need for certain immunity provisions to permit the
Board to take action without jeopardy to itself and
the necessity to provide protection for investigators
hired by the Board. He told The Council about the
need for multiple choice examinations and electronic
data processing in the grading of examinations. He
contrasted this system with the present essay-type ex-
amination system in Ohio.
He indicated that salaries of the executive secretary
of the Board and employees must be raised and addi-
tional personnel obtained.
By official action, The Council directed that the
OSMA Judicial and Professional Relations Commit-
tee meet with the Ohio State Medical Board for the
purpose of developing legislation necessary for the
rewriting of the Ohio Medical Practice Act.
Ohio Association of Blood Banks
A request for approval of the Ohio Association
of Blood Banks was submitted along with a proposed
constitution for such organization. It was the ex-
pression of The Council that it found nothing objec-
tionable about the formation of such organization.
United Medical Laboratories, Inc.
A complaint regarding communications issued by
a physician in connection with the United Medical
Laboratories, Inc., was brought before The Council.
It was The Council’s opinion that this matter is
under the jurisdiction of the Columbus Academy of
Medicine, and the Executive Secretary was instructed
to refer the matter to the Academy.
Vocational Rehabilitation
A communication from the Bureau of Vocational
Rehabilitation, stating that Federal authorities require
the bureau to have a published fee schedule, was dis-
cussed by The Council. It was the expression of
The Council that it would be necessary to review a
copy of such regulation before the matter could be
satisfactorily considered. The Executive Secretary
was instructed to request this information.
VA Hometown Program
Presented for the information of The Council was
a letter from R. K. Laubhan, M. D., Chief, Outpa-
tient Service, Veterans Administration Hospital,
Cleveland, and an attached relative value fee sched-
ule which will be used for the hometown program
of the VA beginning July 1, 1966. The Council
approved a letter written to Dr. Laubhan on April 1 1
by the Executive Secretary, indicating that the present
policy of the Ohio State Medical Association does not
permit the execution of a letter of agreement with
the VA on behalf of OSMA members.
Health Survey
A communication from Arthur J. McDowell, chief,
Division of Health Examination Statistics, Depart-
ment of Health, Education, and Welfare, announcing
that a Public Health Service health survey will be
conducted in the Ashtabula-Geauga area to examine
a sample of the teen-aged population during a four-
week period this summer, was presented to The Coun-
cil. This is the third cycle of the survey. Earlier
a second cycle of children’s health examinations was
completed and during the first cycle ending in 1962
a three-year survey of adults was completed. The
department indicated that the survey is designed to
collect data primarily on the health aspects of growth
and development.
Request for Contribution to School Project
A request from the Ohio Academy of Science for
suggestions and funds for implementation was con-
sidered by The Council. It was indicated that the
communication was submitted too late for considera-
tion this year and it was suggested that the Academy
be advised that it is necessary for such requests to be
received by the Ohio State Medical Association prior
to the annual budget meeting in December.
Proposed Statute for Disposition of Tissues
and Organs after Death
The Council reviewed a request from the Cleveland
Academy of Medicine that the Ohio State Medical
Association consider legislation directed toward the
Ohio General Assembly on the subject of the disposi-
tion of tissues and organs after death. The Council
approved the idea in principle, but specified that
any proposed legislative drafts be submitted to The
Council for review prior to the granting of approval
by the OSMA.
Letter from Mr. J. Edwin Farmer
A letter dated March 22, 1966 from Mr. J. Edwin
Farmer, Columbus, was presented to The Council.
Such communication involved Mr. Farmer’s proposed
trade association building. In reply The Council di-
rected Mr. Farmer’s attention to a letter written
to him by Mr. Page on May 17, 1965, with specific
attention to the final paragraph thereof.
Kellogg Grant to Hospital Association
Information was presented to The Council con-
cerning a grant to the Ohio Hospital Association
from the W. K. Kellogg Foundation, Battle Creek,
Michigan, in the amount of $61,697 for a three-year
program to assist "with the development and im-
provement of long term and extended care facilities
and services.”
American Nursing Home Association
The Executive Secretary was instructed to send a
letter to the American Nursing Home Association,
asking what programs are planned or are under way
under its jurisdiction with regard to research and
development in the improvement of long-term and
extended care facilities.
( Continued on Page 599)
594
The Ohio State Medical Journal
(Proceedings of the The Council — Contd.)
Medicare — Civil Rights Pledge
Council directed that a letter be addressed to the
Director of Public Welfare, advising him of the
OSMA policy on the civil rights pledge and asking
him for clarification, since it is the understanding
of the Association that no such pledge is required.
The Council asked that a communication be for-
warded to the AMA asking what is being accom-
plished by that association to remove the requirement
for the pledge.
Medicare — Newspaper Advertisement
An advertisement regarding Medicare, published
by the Marion County Academy of Medicine, was
presented to The Council for information.
Nationwide Insurance Company and Medicare
Drs. Crawford and Meredith and members of the
staff reported on a conference with Nationwide Insur-
ance officials with regard to the role of Nationwide
Insurance Company as the intermediary in Ohio on
Part B of Medicare. A lengthy discussion followed
the report.
Legal Matter
Mr. Stichter reported to The Council on the dis-
position of a case brought by a member of the Asso-
ciation against a member of the Ohio State Bar Asso-
ciation.
Dirksen Amendment
A communication from Dr. E. B. Mainzer, Mans-
field, regarding the Dirksen amendment was accepted
by The Council for information.
Reports on Meetings
Mr. Gillen presented information with regard to
the student lecture programs at the University of Cin-
cinnati College of Medicine and Ohio State Univer-
sity College of Medicine and noted that such a pro-
gram is scheduled for the Western Reserve Univer-
sity School of Medicine, May 11.
The Second National Voluntary Health Confer-
ence, Chicago, February 16-17, 1966 was attended
by Mr. Gillen who reported on activities and delibera-
tions at the conference.
Dr. Tschantz reported on the AMA Air Pollution
Medical Research Conference, Los Angeles, March
2-4, 1966.
The Executive Secretary was instructed to send to
the members of The Council copies of the text of
a paper delivered by Francis M. Pottenger, Jr.,
M. D., on "What Can A County Medical Association
Do About Air Pollution?” at the AMA Air Pollution
Medical Research Conference in Los Angeles.
Dr. Meredith and Mr. Stichter discussed the AMA
Legal Conference held in Chicago, April 16, 1966.
It was pointed out that promotion material on the
prevailing fee concept being encouraged by the Na-
tional Association of Blue Shield Plans was distrib-
uted at the meeting. The Council approved a letter
to the AMA, signed by Drs. Crawford and Meredith,
objecting to this action and asked that copies of the
communication be directed to appropriate officials of
Ohio Medical Indemnity, Inc.
Mahoning County Amendment
Final approval of an amendment to the Mahoning
County Constitution and Bylaws, which was adopted
by that society" April 19, 1966, was granted by The
Council.
OSMA Major Medical Insurance
A letter from Daniels-Head & Associates, Inc.,
Portsmouth, dated April 20, 1966, stating that for
those insureds 65 and over under the OSMA major
medical expense plan, rates would be reduced because
of the advent of Medicare on July 1, 1966, was re-
viewed by The Council.
The Executive Secretary was instructed to write a
letter to Daniels-Head & Associates, Inc., asking if
physicians over 65 have a choice to continue their
present coverage or whether they must accept the
coverage written around Medicare in view of the fact
that many companies are not modifying their contracts
and are making the existing coverage available for
those who do not wish to participate in the Medicare
program.
Conference on Medicare Regulations
The Council discussed plans for a conference of
county society officers shortly after the issuance of
Medicare regulations. It was felt that, if the regula-
tions go beyond the law, an emergency" Council meet-
ing must be called and the Association’s protest be
made known.
The President was directed to write a letter to the
Department of Health, Education, and Welfare,
pointing out that, as of this date, no regulations
have been issued concerning Part B of Medicare and,
in addition, that there has been no indication as to
when such regulations will be issued. In view of
the approach of the implementation of the Medicare
Act, July 1, 1966, The Council expressed the opinion
that they should be published at once.
Resolution of Appreciation
On motion by Dr. Hardymon and seconded by
many, The Council expressed appreciation to Dr.
Tschantz for his active and effective service on The
Council for the past seven years and for the dedicated
leadership in the role of President and his devotion
in the role of Past President.
There being no further business, The Council
adjourned.
Attest: Hart F. Page
Executive Se ere tar)
for June, 1966
599
Medical Staffing of Emergency Rooms;
Legal and Ethical Considerations
By WAYNE E. STICHTER, Juris Doctor, Toledo
Legal Counsel for the Ohio State Medical Association
T
~THE tremendous increase in the past few years
in the number of cases treated in the emergency
rooms of hospitals, combined with the increas-
ing difficulty in securing personnel, professional and
non-professional, to staff the emergency department,
has served to focus attention upon a number of ques-
tions with respect to the staffing and operations of the
emergency department:
1. Legal questions affecting the hospital and its
authority over the operations of the emergency room.
2. Legal and ethical questions affecting the
medical profession generally and particularly those
physicians who render emergency room care.
3. Practical questions affecting the hospital, the
medical profession, and the public.
In order that we may understand the nature and
extent of these problems and to discuss them intel-
ligently, it is important, so it seems to me, to have
an understanding of the facts that give rise to these
problems — to ascertain the causes for the critical
problems existing today in connection with the ren-
dition of high quality medical care in the emergency
department of a hospital.
Years ago the emergency room of a hospital was
just what the name implies — a room in the hospital
for the treatment of emergency cases, a room for pro-
viding immediate medical services for acute traumatic
problems and life endangering situations. The public
had not yet gotten into the habit of going to the emer-
gency room for the treatment of a minor illness or
injury; rather, the patient sent for or went to his own
physician. Years ago, interns and residents in train-
ing in the hospital were generally adequate in number
and sufficiently competent to handle these emergency
cases — with the help, of course, of the attending
physicians or members of the medical staff who might
be summoned to the emergency room.
Situation Today
What is the situation today? Since World War II
there has been an astronomical upsurge in the number
Text of an address delivered by Mr. Stichter at the American
Medical Association Legal Conference in Chicago on April 16, 1966.
of visits to the emergency room; indeed; surveys in-
dicate that in the past five or six years there has been
an increase — on the average — of 400 to 600 per
cent in the number of cases treated in the emergency
room. Concurrently with this astounding increase
in the number of emergency room cases, there has
been an actual decline in the number of interns and
residents available for the staffing of the emergency
room.
We all know, of course, that in these same years
there has been quite an increase in the number of
traumatic injuries due to automobile accidents and
perhaps other types of accidents (there has been an
actual decline in industrial accidents). However,
this increase in accidental injuries cannot possibly ac-
count for the great increase in the number of emer-
gency room visits. The most plausible explanation
for this large increase in emergency room visits lies in
the fact that the hospital emergency room has grad-
ually been converted into what one doctor has ap-
propriately called "a neighborhood drop-in clinic.”
Recent statistical surveys reveal that of the total num-
ber of cases brought to the emergency room 50 to
80 per cent can be definitely characterized as non-
emergency cases. These non-emergency cases, in-
volving as they do minor illnesses or minor injuries,
could just as well be taken care of in the physician’s
office. If this great volume of non-emergency cases
could be diverted away from the emergency room,
the present strain on the facilities and personnel of
the emergency room would be greatly relieved, and
the job of rendering prompt and adequate care to
tme emergency patients would be greatly facilitated.
Why the Emergency Room?
Why does a patient with a minor illness or injury
go to the hospital emergency room instead of to the
doctor’s office? Various reasons have been ascribed
to this change in the pattern of cases brought to the
emergency room. I shall mention only a few that
have been advanced:
1. There are fewer general practitioners avail-
able for family care.
600
The Ohio State Medical Journal
2. The patient may not have a family doctor.
3. The patient may not know what kind of a
specialist to call to take care of his particular
complaint.
4. Doctors are not always available at their of-
fices whereas the hospital emergency room is always
open.
5. The necessity of an appointment with the
private physician.
6. The automatic transportation of injury cases,
however slight, to the emergency room (someone
calls an ambulance and the ambulance driver auto-
matically transports the patient to the hospital
whether or not directed by the patient or someone
in his behalf to do so).
7. A general belief that the equipment and
facilities in the emergency room are more ade-
quate and modern than those in the physician’s
office.
8. Physicians frequently encourage their own
patients to go to the emergency room for treat-
ment by them of the patient’s minor illness or
injury.
9. The major reason appears to be the public’s
general acceptance and seeming approval of the
idea that hospital facilities — and particularly emer-
gency room facilities — should be available for all
kinds of illnesses and injuries — the idea that the
hospital emergency room should be a sort of com-
munity medical center or "neighborhood drop-in
clinic.”
Problems in Some Areas
Regardless of the validity of any of these reasons
for this tremendous increase in the number of cases
coming into the emergency room, the fact remains
that the overwhelming demand for medical sendees in
the hospital emergency room has created critical prob-
lems in some areas, such as:
1. The need for enlarged emergency room
quarters.
2. The need for adequate modern equipment
and facilities.
3. The need for adequate staffing of competent
personnel, professional and non-professional, to
handle emergency cases.
4. The need to reconvert the "community medi-
cal center” or "neighborhood drop-in clinic” into
a true emergency room for the care and treatment
of true emergency patients. Such reconversion will
involve both the education of the public to the
proper function and use of the emergency room,
and the cooperative effort of hospital and medical
personnel in the reference of non-emergency cases
to the private practitioner, medical clinic or the
out-patient department. This will also involve a
complete separation of the emergency room de-
partment from the out-patient department.
All of these needs must be met. The public
rightfully demands (and is entitled to) the rendition
of high-quality medical care and the maintenance of
emergency rooms which have the facilities needed
for the prompt rendition of medical services by a staff
of licensed physicians. Assuredly, the medical pro-
fession wants to see these rightful demands met.
In meeting these demands, it is important to keep in
mind two things: (1) the separate and distinct func-
tions of the hospital and the medical practitioner,
and (2) the fact that the proper and efficient opera-
tion of emergency room sendee requires close co-
operation between the hospital and the medical
profession in the performance of their separate func-
tions. Each needs the other. The hospital cannot
lawfully practice medicine. The medical profession
cannot effectively practice medicine without the use
of hospital facilities and non-professional person-
nel of the hospital.
Separate Functions and Responsibilities
The furnishing of the physical equipment and
facilities of the emergency room, the furnishing of
necessary non-professional personnel, and the general
administration and operation of the emergency room,
are the proper function and responsibility of the
hospital.
On the other hand, the rendition of professional
services in the emergency room is the exclusive right
and responsibility of the medical profession; such
professional services may legally be rendered only
by duly qualified physicians directly or by hospital
personnel under the direct supervision and control
of the physicians. The hospital has no legal right
to direct, control or supervise the rendition of any
services which are of a professional character, regard-
less of whether such services are rendered by the
hospital’s non-professional employees, or by its sal-
aried physicians, or by physicians under contract with
the hospital; and any attempt by the hospital to
direct, control or supervise such services would con-
stitute, in my judgment, the unlawful practice of
medicine. Furthermore, even though the hospital
should not attempt to direct, control or supervise the
rendition of professional sendees in the emergency
room, the hospital would nevertheless be engaged in
the unlawful practice of medicine if it receives the
whole or any part of the fee charged for such pro-
fessional services, or if the hospital otherwise
derives any profit, financial gain or benefit from
the rendition of such services.
Principles of Medical Ethics
It should also be mentioned here that a physician
who permits fee-splitting with the hospital, or who
renders professional sendees (in the emergency room
or elsewhere in the hospital for that matter) under
an arrangement whereby the hospital derives some
for June, 1966
601
profit, financial gain or benefit, is guilty of a violation
of the Principles of Medical Ethics.
In this connection, I call attention to Sections 6
and 7 of the Principles of Medical Ethics of the
American Medical Association.
Section 6 reads:
"A physician should not dispose of his services
under terms or conditions which tend to interfere
with or impair the free and complete exercise of
his medical judgment and skill or tend to cause
a deterioration of the quality of medical care.”
Section 7 reads:
"In the practice of medicine a physician should
limit the source of his professional income to medi-
cal sendees actually rendered by him, or under his
supervision, to his patients. His fee should be
commensurate with the services rendered and the
patient’s ability to pay. He should neither pay nor
receive a commission for referral of patients.
Drugs, remedies or appliances may be dispensed
or supplied by the physician provided it is in the
best interests of the patient.”
These sections have been interpreted by the Judicial
Council of the AMA as forbidding the following:
1. Any interference by a hospital with the free
and complete exercise of the physician’s medical
judgment or skill through any direction, control or
supervision by a hospital over the physician’s per-
formance of medical services.
2. The receipt and retention by the hospital of
the whole or any part of a fee paid for professional
sendees rendered by a physician employed by the
hospital on a salary basis or other contract basis,
regardless of whether such payment is made to the
physician and a part thereof delivered over to the
hospital or whether the fee is paid to the hospital
and the whole or a part thereof is retained by the
hospital.
Explicit Understanding
How, then — it may be asked — can the demands
of the medical public for adequate emergency room
services be met without involving the hospital in the
unlawful practice of medicine or involving the emer-
gency room staff of physicians in a violation of the
Principles of Medical Ethics? I submit that this can
be accomplished by a clear, explicit understanding
between the hospital and the emergency room physi-
cians as to (1) the legal limitations on the functions
and activities of the hospital, and (2) the ethical
limitations that are imposed on all practicing physicians
by the Principles of Medical Ethics, coupled with a
willing obedience to these legal and ethical principles
by the hospital and the emergency room physicians,
respectively.
In this connection, it must be borne in mind that
the unlawful practice of medicine by a hospital is
usually accomplished through or by means of the
unethical practice of medicine by the physician.
It thus becomes readily apparent that if ever)- physi-
cian will carefully refrain from entering into any
arrangement with a hospital (1) which involves fee-
splitting, or (2) which involves the obtaining by the
hospital of some profit or other financial gain or
benefit from the professional services of the physician,
or (3) which subjects the physician to any direction,
control or supervision by the hospital over his profes-
sional judgment — the practice of medicine by hospi-
tals will be greatly reduced and, perhaps, eventually
eliminated.
Contractual Arrangements
There are several forms of contractual arrange-
ments for the staffing and operation of the emergency
room which, if properly implemented and conscienti-
ously adhered to, will not involve the hospital in the
practice of medicine or expose the physician to a
charge of violating the Principles of Medical Ethics.
These may be summarized as follows:
Arrangement #1. This would provide for the
rendition of services by use of bona fide interns
and residents in AMA-Approved Emergency Room
Training Programs, under the active guidance of
the medical staffs. Under this plan, no charge
would be made by the hospital for the professional
services so rendered and no part of any fee that
might be collected from the patient would be
shared by the hospital.
Arrangement #2. Services would be rendered
on a fee-for-service basis by several practicing physi-
cians who would be approved by the medical staff
with a minimum monthly compensation guaranteed
by the hospital As in Arrangement #1, no charge
would be made, or fee collected or shared, by the
hospital for any such professional services.
Arrangement #3. Services would be rendered
by members of the medical staff either on a volun-
tary or mandatory assignment, and on a fee-for-
service or gratuitous basis with billing, if any, direct
by the physician for such professional services.
Again, no charge would be made by the hospital
for such services and there would be no splitting
of fees as between the physician and hospital.
Arrangement #4. This provides for services to
be rendered by several practicing physicians (em-
ployed by a medical partnership or a medical cor-
poration) who would be approved by the medical
staff. The billing and remuneration for such pro-
fessional services would be the prerogative and re-
sponsibility of the medical partnership or corpora-
tion and the employed physicians. In no event
would any charge be made, or fee collected or
shared, by the hospital for any such professional
services.
There is another form of contractual arrangement
which might pass muster but which I think less desir-
602
The Ohio State Medical Journal
able than the four forms of arrangements I have just
mentioned. We shall call this "Arrangement #5.”
Under this Arrangement, sendees would be performed
by one or more licensed physicians approved by the
medical stalf and employed by the hospital on a salary
basis. Such sendees would be rendered without any
charge being made by the hospital, or any fee collected
or shared by the hospital, for such professional serv-
ices. Further, there would not be included in the
hospital’s bill for hospital sendees any charge what-
ever for the professional services of the salaried physi-
cian. I consider this Arrangement #5 much less desir-
able because I think it is too much to expect that the
hospital would pay a fair and reasonable salary with-
out expecting and obtaining some financial benefit — -
by way of fee-splitting or otherwise — from the pro-
fessional sendees of the salaried physician.
Consideration of Needs
Each of these five arrangements or methods seems
unobjectionable from the standpoint of legality and
medical ethics. The selection of any particular
method of staffing the emergency room will depend,
I think, on the particular needs of the community'
and the particular conditions under which a group
of physicians is willing to undertake the responsibility
of staffing. Obviously, that method should be se-
lected which promises to do the best job in the
community (a) in rendering high quality medical
care to emergency patients, and (b) in preserving
and promoting the best possible relation between the
profession and the hospital, between physician and
physician, and between the medical profession and
the public. Other things being equal, that method
should be selected which affords the least opportunity
— the least temptation — to the hospital and physi-
cian to indulge in practices which are unlawful from
the standpoint of the hospital or unethical from the
standpoint of the physician.
While each one of these several contractual ar-
rangements, if conscientiously adhered to by the hos-
pital and the emergency room physician, should prove
effective in preventing the encroachment of hospitals
upon the practice of medicine, there are other im-
portant factors that must be given serious considera-
tion in the development of a successful hospital
emergency room plan. In the first place, it is of the
utmost importance, I think, that the hospital emer-
gency room program have the full approval and
support of the private practitioners in the community.
Medical Society7 Responsibility
We all know that it is the responsibility7 of the
medical profession to see to it that adequate, high
quality medical care is rendered at all times, in all
places, to all patients. Consequently, the local medi-
cal society has, or should have, a decided interest as
well as a professional duty' with respect to the details
of any plan for the staffing and operation of a
hospital emergency room. The local society owes a
duty to the public as well as to the local profession
to ascertain whether the emergency room program
will be implemented in such fashion as to insure the
rendition of high quality7 emergency care. At the
same time, it has the right, and it also owes the
duty to the practicing physicians in the community,
to insist that the activities of the emergency7 room
staff be confined, as a general rule, to the treatment
of true emergency cases to the end that there may be
preserved complete confidence, respect, and harmony
as between the members of the emergency room staff
and private practitioners.
Evaluating an Emergency Room Plan
It is my belief that any contract, arrangement or
plan for the staffing and operation of a hospital
emergency room should be carefully analyzed and
evaluated by the local society before the plan is final-
ized and put into effect. Any such plan might well
be tested and evaluated on the basis of the answers
to the following questions:
1. Is the plan such as to give assurance of the
rendition of high quality medical care in true emer-
gency cases on a round-the-clock basis?
2. Will the responsibility, control and direction
of professional services in the emergency room be
kept exclusively in the hands of the medical
profession ?
3. Will the group of physicians staffing the
emergency' room have the respect and confidence
of the local society' and of the profession generally,
both with respect to the competence of the group
and with respect to their ethics and integrity ?
4. Does the plan provide that the physicians
staffing the emergency' room will limit their serv-
ices and activities to true emergency cases and will
render emergency services to a patient only if the
patient’s own physician is unknown or is not im-
mediately available?
5. Will the treatment by the emergency room
group of an emergency case be limited to such
initial treatment as the emergency case requires?
6. Will the emergency room staff, as a matter
of course, refer each emergency patient to his own
physician for necessary' follow-up care ?
7. Will each non-emergency patient be refer-
red to his own physician without treatment by the
emergency' room group except perhaps for necessary
first aid? If the patient has no family physician,
will the patient be afforded freedom of choice of
physician — freedom to choose either a member
of the emergency room group or some other physi-
cian? Will the emergency room group be cir-
cumspect regarding this matter so as to maintain the
confidence, respect and esteem of their confreres in
private practice?
for June, 1966
603
Official OSMA Policy Statement
On Staffing Emergency Rooms
Acting on recommendations of the OSMA
Hospital Relations Committee, The Council at
its March 20 meeting adopted the statement
printed below as the official policy of the Asso-
ciation :
The following are recommended as acceptable
methods for the medical staffing of emergency
rooms :
1. Sendees by use of bona fide interns and
residents in AMA-approved training programs,
under the active guidance of the Medical Staff:
2. Sendees on a fee-for-service basis by one
or more licensed physicians approved by the
Executive Committee of the Medical Staff of
the hospital, with a minimum compensation
guaranteed in a manner satisfactory to the Medi-
cal Staff.
3. Services by members of the Medical Staff,
either voluntary or mandatory, on a fee-for-
sendee or gratuitous basis, with the method of
billing for professional sendees being direct
billing by the physician for his sendees.
4. Services by licensed physicians employed
by a medical partnership or corporation, ap-
proved by the Executive Committee of the
Medical Staff, and composed of all or part of
the members of the Medical Staff, billing and
remuneration for such professional services to
be on any mutually satisfactory arrangement
between the medical partnership or corporation
and the employed physicians.
8. Will the plan have the approval and coopera-
tion of the local medical society and the medical
profession generally?
It is obvious, I think, that the ideal emergency
room plan will provide affirmative answers to each
of these questions.
Interest of the Public
In the final analysis, the best interests of the pub-
lic will be served, the best interests of the hospital
will be served, and the best interests of the medical
profession will be served if the emergency room plan
clearly delineates, in writing, the respective functions,
rights, responsibilities and obligations of the hospital
and the physician. Regardless of the particular
method selected for the staffing and operation of the
hospital emergency room, the contractual arrangement
between the hospital and each emergency room physi-
cian should be such as
(a) will allow the physician to retain his pro-
fessional integrity and independence;
(b) will leave unimpaired the physician’s right
to the free and complete exercise of his medical
judgment;
(c) will recognize the physician’s right to fix,
collect and retain the entire amount of his fee for
professional services rendered to patients in the
emergency room — without any fee -splitting of
any sort or the deriving by the hospital of any
profit, financial gain or benefit, directly or indi-
rectly, from the professional services rendered by
the physician; and
(d) will preserve and promote the best of rela-
tions between the medical profession and the hospi-
tal, between the emergency room staff physicians
and their confreres, and between the medical pro-
fession and the public.
Resolution Expresses Appreciation
For Service on Medical Board
Upon his recent retirement from the State Medical
Board of Ohio, Dr. John N. McCann, of Youngs-
town, was accorded the following resolution in ap-
preciation of his service. The resolution was for-
warded to The Journal by Dr. Donald F. Bowers,
Columbus, member of the Board and interim secretary.
RESOLUTION
WHEREAS, John N. McCann, M. D., has faith-
fully and well performed his duties as a member of
the State Medical Board for the past 21 years and
WHEREAS, The State Medical Board of Ohio is
aware of the long and faithful service, devotion,
dedication and interest to the Board and to the State
of Ohio as well as to the medical profession and
patients, and
WHEREAS, The State Medical Board of Ohio
desires to express its gratitude to John N. McCann,
M. D., for his sendees,
NOW BE IT RESOLVED BY THE STATE
BOARD OF OHIO, That the Board on behalf of
itself and the State of Ohio extends its thanks and
best wishes to John N. McCann, M. D., for his 21
years of faithful service to the Board and to the
State of Ohio.
Columbus, Ohio, this
5th day of April, 1966.
(Signed by the eight members of the Board)
Dr. Lloyd R. Evans, Columbus, was named by the
Governor to succeed Dr. McCann on the Medical
Board. (See May issue of The Journal, page 521.)
Ray Bruner, Toledo Blade science writer, was given
special commendation in the newspaper category by
the judging committee of the American Medical As-
sociation’s 1965 Journalism Awards Contest.
60-1
The Ohio State Medical Journal
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. . . one of these 86 is close
to you . . . can help you save
credit losses and profits
AKRON CREDIT BUREAU, INC.
53 West State Street, AKRON
CREDIT BUREAU OF ALLIANCE
611 City Savings Bldg., ALLIANCE
CREDIT BUREAU OF ASHLAND, INC.
159 West Main St., ASHLAND
CREDIT BUREAU OF ASHTABULA
132 West 46th St., ASHTABULA
CREDIT BUREAU OF ATHENS
2 South Congress St., ATHENS
BARBERTON AREA CREDIT RATING BUREAU
539-V2 W. Tuscarawas Ave., BARBERTON
CREDIT BUREAU OF CLERMONT COUNTY
285 Main St., BATAVIA
CREDIT BUREAU OF LOGAN COUNTY
111 S. Madriver, BELLEFONTAINE
CREDIT BUREAU OF BELLEVUE
202 W. Main St„ BELLEVUE
CREDIT BUREAU OF BOWLING GREEN, WOOD
AND HENRY COUNTIES
802 E. Wooster St., BOWLING GREEN
CREDIT BUREAU OF WILLIAMS COUNTY
204 W. Bryan St., BRYAN
BUCYRUS CREDIT BUREAU
Eagle Building, BUCYRUS
CREDIT BUREAU OF NOBLE COUNTY
722 West St., CALDWELL
CAMBRIDGE CREDIT BUREAU
220 N. Eighth St., CAMBRIDGE
CREDIT BUREAU OF CANTON
128 Third St., N.E., CANTON
CREDIT BUREAU OF CHILLICOTHE
15 W. Second St., CHILLICOTHE
CREDIT BUREAU OF CINCINNATI, INC.
309 Vine St„ CINCINNATI
CREDIT BUREAU OF CIRCLEVILLE
219 S. Court St., CIRCLEVILLE
CREDIT BUREAU OF CLEVELAND, INC.
1965 E. 6th St., CLEVELAND
CREDIT BUREAU OF COLUMBUS, INC.
170 E. Town St., COLUMBUS
CREDIT BUREAU OF CONNEAUT
247-1/2 Main St., CONNEAUT
CREDIT BUREAU OF COSHOCTON
439-1/2 Main St., COSHOCTON
CREDIT BUREAU OF DAYTON, INC.
115 E. Third St., DAYTON
CREDIT BUREAU OF DEFIANCE, WILLIAMS,
FULTON & PAULDING COUNTIES
509 Second St., DEFIANCE
CREDIT BUREAU OF DELAWARE
Delaware County Bank Bldg., DELAWARE
CREDIT BUREAU OF PREBLE COUNTY
208 N. Barron St., EATON
ELYRIA CREDIT BUREAU, INC.
360 Second St., ELYRIA
CREDIT BUREAU OF HANCOCK COUNTY
118 E. Sandusky St., FINDLAY
CREDIT BUREAU OF FOSTORIA
215 First Nat’l. Bank Bldg., FOSTORIA
CREDIT BUREAU OF FREMONT, INC.
316-1/2 W. State St., FREMONT
CREDIT BUREAU OF GALION
Quay Building, GALION
CREDIT BUREAU OF GALLIA & MEIGS COUNTIES
530-1/2 Second Ave., GALLIPOLIS
CREDIT BUREAU OF NORTHEASTERN OHIO
104 W. Main St., GENEVA
CREDIT BUREAU OF BROWN COUNTY
First Nat’l Bank Bldg., GEORGETOWN
CREDIT BUREAU OF DARKE COUNTY
Fourth & Broadway, GREENVILLE
REPORTING SERVICE INC.
250 High St., HAMILTON
CREDIT BUREAU OF HIGHLAND COUNTY
IO6-I/2 N. High St., HILLSBORO
IRONTON CREDIT BUREAU, INC.
206 Masonic Temple, IRONTON
CREDIT BUREAU OF JACKSON
202-V2 Broadway, JACKSON
CREDIT BUREAU OF NORTHEASTERN OHIO
944 Stow St., KENT
CREDIT BUREAU OF KENTON, INC.
221-1/2 W. Franklin, KENTON
CREDIT BUREAU OF LANCASTER
210 Fairfield Bldg., LANCASTER
LEBANON CREDIT BUREAU
151-y2 S. Broadway, LEBANON
CREDIT BUREAU OF LIMA
205 W. Market St., LIMA
CREDIT BUREAU OF LONDON & MARYSVILLE
16 W. High St., LONDON
CREDIT BUREAU OF LORAIN, INC.
314 Ninth St., LORAIN
MANSFIELD CREDIT RATING BUREAU
28 Park Ave. West, MANSFIELD
THE CREDIT BUREAU
303 St. Clair Bldg., MARIETTA
MARION CREDIT RATING CO. INC.
142 E. Center St., MARION
CREDIT BUREAU OF MASSILLON, INC.
810 Peoples Merchants Bldg., MASSILLON
MEDINA COUNTY CREDIT BUREAU, INC.
215 W. Liberty St., MEDINA
CREDIT BUREAU OF NORTHEASTERN OHIO
14944 S. Main St., MIDDLEFIELD
THE MIDDLETOWN CREDIT BUREAU CO.
508 First Nat’l Bank Bldg., MIDDLETOWN
CREDIT BUREAU OF KNOX COUNTY
102 E. Gambier St., MOUNT VERNON
CREDIT BUREAU OF NEWARK
Schaus Bldg., NEWARK
CREDIT BUREAU OF PERRY COUNTY
218 N. Main St., NEW LEXINGTON
CREDIT BUREAU OF NEW PHILADELPHIA
AND DOVER
162 N. Broadway, NEW PHILADELPHIA
CREDIT BUREAU OF NILES
409 Niles Bank Bldg., NILES
CREDIT BUREAU OF NORWALK, INC.
18 W. Main St., NORWALK
CREDIT BUREAU OF OBERLIN, INC.
5 South Main St., OBERLIN
PUTNAM CREDIT BUREAU
1035 E. Second St., OTTAWA
CREDIT BUREAU OF PAINESVILLE
41 E. Erie St., PAINESVILLE
CREDIT BUREAU OF MIAMI COUNTY
118 West Ash St., PIQUA
CREDIT BUREAU OF PORT CLINTON
426 W. Sixth St., PORT CLINTON
THE MERCHANTS CREDIT BUREAU, INC.
413 Masonic Temple, PORTSMOUTH
CREDIT BUREAU OF SALEM, INC.
368 E. Third St., SALEM
CREDIT BUREAU OF ERIE COUNTY, INC.
808 Feick Bldg., SANDUSKY
MERCHANTS CONSUMER CREDIT BUREAU
223 N. Main Ave., SIDNEY
CREDIT BUREAU OF SPRINGFIELD
20 W. Columbia St., SPRINGFIELD
CREDIT BUREAU OF STEUBENVILLE & WEIRTON
First Nat’l Bank Bldg., STEUBENVILLE
CREDIT BUREAU OF TIFFIN & SENECA COUNTY
140 Riverside Drive, TIFFIN
CREDIT BUREAU OF TOLEDO, INC.
205 N. St. Clair St., TOLEDO
CREDIT BUREAU OF MIAMI COUNTY
604 W. Main St., TROY
CREDIT BUREAU OF URBANA & CHAMPAIGN CO.
121-1/2 N. Main St., URBANA
CREDIT BUREAU OF VAN WERT COUNTY
111 W. Court St., VAN WERT
CREDIT BUREAU OF WAPAKONETA &
AUGLAIZE COUNTY, INC.
206 N. Johnston Ave., WAPAKONETA
CREDIT BUREAU OF WARREN
409 Second Nat’l. Bank Bldg., WARREN
CREDIT BUREAU OF FAYETTE COUNTY
132-1/2 E. Court St., WASHINGTON C.H.
CREDIT BUREAU OF WHEELING
210-222 Laconia Bldg., WHEELING, W. VA.
CREDIT BUREAU OF WILLARD
119 Myrtle Ave., WILLARD
CREDIT BUREAU OF WILLOUGHBY, INC.
4056 Erie St., WILLOUGHBY
CREDIT BUREAU OF WILMINGTON
Masonic Bldg., WILMINGTON
CREDIT BUREAU OF WOOSTER, INC.
151 S. Market St.. WOOSTER
GREENE COUNTY CREDIT BUREAU,
CREDIT BUREAU OF XENIA
34 E. Main St., XENIA
CREDIT BUREAU OF YOUNGSTOWN, INC.
125 W. Commerce St., YOUNGSTOWN
CREDIT BUREAU OF ZANESVILLE
135 S. Sixth St., ZANESVILLE
ASSOCIATED CREDIT
BUREAUS OF OHIO
for June, 1966
AM A Annual Convention
• • •
Ohio's Dr. Hudson To Be Installed as the 121st President;
All-Inclusive Program Scheduled in Chicago, June 26 - 30
OHIOANS will have a special interest in the
115th Annual Convention of the American
Medical Association in Chicago, June 26-30.
On that occasion an Ohioan will be installed as Presi-
dent — the highest honor the medical profession can
bestow on one of its members.
The inauguration of Dr. Charles L. Hudson, of
Cleveland, as the 121st President of the AMA will
be held on Tuesday afternoon, June 28, beginning
at 4:00 p. m. in the Grand Ballroom of the Palmer
House. The ceremonies are
open to all registrants.
Dr. Hudson was named
President-Elect at the 1965
Annual Convention in New
York City. He previously
served on the AMA Board
of Trustees, was for a num-
ber of years delegate from
the OSMA to the AMA, is a
Past President of OSMA, a
Past President of the Cleve-
_ T , land Academy, and served
Ur. Hudson . , r
the medical profession in
many other capacities. A practicing physician of
long standing in Cleveland, Dr. Hudson specializes
in internal medicine.
The world’s largest medical meeting, the Annual
Convention of the American Medical Association,
is expected to draw an attendance of 45,000, includ-
ing some 15,000 physicians.
The program is outlined in a special section of
the May 9 Journal of the AMA. A diverse scientific
program covering virtually every medical specialty
will be presented. The AMA’s policy-making House
of Delegates will meet in the Palmer House hotel,
and more than 350 scientific exhibits will be housed
in McCormick Place convention center.
McCormick Place also will be the site of many
scientific sessions and an extensive medical motion
picture and television program. The telecasts will
originate from the University of Illinois College of
Medicine, University Hospitals, Chicago.
Topics of the six general scientific sessions include
emphysema, population expansion, burns, mysterious
fevers, community hospitals and coronary care units,
and headaches.
Another highlight will be the Sixth Multiple Dis-
cipline Research Forum. Topics will include hema-
tology, immunology and tumor; gastrointestinal
problems; metabolism and renal diseases; neurology
and pulmonary diseases, and cardiovascular subjects.
The AMA House of Delegates will convene at
3 p. m. Sunday, June 26, in Arie Crown Theater at
McCormick Place. Speaker of the House is Milford
O. Rouse, M. D., of Dallas, Texas.
The scientific program will open at 9 A. M. Mon-
day, June 27, in McCormick Place. Scientific and in-
dustrial exhibits will open at 10 A. M. Sunday, June
26, in McCormick Place, and will be open Monday
through Thursday from 8:30 A. M. to 5 p. m.
General registration will be in the lower lobby of
McCormick Place. It will open 10 A. m. Sunday,
and will be open from 8:30 A. M. to 5 P. M. on
following days.
Among preconvention activities is the Conference
of State Medical Society Presidents and Secretaries
scheduled to begin at 9:30 A. M. on Sunday, June 26,
in the Palmer House.
A listing of other special events is included in the
May 9 issue of JAMA, beginning on page 515. The
Woman’s Auxiliary program is printed in the same
issue, beginning on page 518.
Here Are More Features
The American College of Chest Physicians will
again join the AMA Section on Diseases of the Chest
in an all day program.
The American College of Cardiology and the
American Heart Association will join the AMA Sec-
tion on Internal Medicine in a half-day session.
The American Congress of Physical Medicine and
Rehabilitation and the Mid-America Society of Physi-
cal Medicine and Rehabilitation will meet jointly with
the Section on Physical Medicine.
The American Society of Clinical Pathologists will
join the AMA Section on Pathology and Physiology
in a half-day session on Computers in Medicine.
606
The Ohio State Medical Journal
OSMA Announces Candidacy of Cleveland Physician
For the Office of AMA House Vice-Speaker
THE Ohio State Medical Association has an-
nounced through official medical organization
channels that it will place in nomination for the
office of Vice-Speaker of the American Medical As-
sociation House of Delegates, Dr. John H. Budd, of
Cleveland. The nomination will be made at the 1966
Annual Convention of the
AMA in Chicago, June 26-
30.
In announcing Dr. Budd’s
candidacy, Dr. Theodore L.
Light, Dayton, and Dr.
George W. Petznick, Cleve-
land, cochairman of the cam-
paign committee, write in
part as follows:
"We are quite certain
that, if you have been in
attendance at the regular and
special sessions of the House
of Delegates in the past four crucial years, you are
aware of Dr. Budd’s leadership in that body and his
earnest efforts to establish and maintain policies that
will preserve the private, free enterprise system of
medical practice.
"He often has spoken on the floor of the House of
Delegates and in reference committee hearings as to
the importance of adherence to the established policies
of the House.
"Dr. Budd is a family physician engaged in the
private practice of medicine in Cleveland, Ohio. He
has served as Chairman of the Ohio Delegation to the
AMA since 1962 and has been a Delegate since I960.
"He is the author of the Nine Standards for Health
Programs, adopted by the AMA House of Delegates
in February, 1965. These standards are an example
of Dr. Budd’s earnest defense of principle. ’’
The Council, by official action, directed the OSMA
delegation to the AMA to place Dr. Budd’s name in
nomination.
On the national level, Dr. Budd has been a delegate
to the AMA since I960, and chairman of the Ohio
delegation since 1962. He is a member of the AMA
Planning and Development Committee, and a member
of the AMA Speakers’ Bureau.
He has been a member of the OSMA Committee
on Public Relations and Economics since 1958; was
chairman of the OSMA Ad Hoc Ohio Medical Indem-
nity Study Committee, and has long served as chair-
man of one of the OSMA House of Delegates Com-
mittees on Resolutions.
He is a Past President of the Academy of Medi-
cine of Cleveland and a former member of its Board
of Directors. Also he has been a delegate of the
Cleveland Academy to OSMA since 1948. His
leadership in other local and area activities and his
participation on various Academy committees are
too numerous to relate in detail.
Dr. Budd is a private practitioner in Cleveland
and a member of the American Academy of General
Practice. During World War II he received several
battle awards for sendee in Europe, Africa and the
Middle East.
He is one of four physicians given special honors
by the Cleveland Academy of Medicine at the Acad-
emy’s Annual Meeting May 13.
Tour of AMA Headquarters
A Convention Highlight
Special feature of the American Medical Associa-
tion’s 115th Annual Convention will be a guided
tour of AMA headquarters at 535 North Dearborn
Street and the new Institute for Biomedical Research.
All physicians, their wives and other convention
guests are invited to tour the building. Tours will
be conducted every hour from 9 a. m. to 4 P. M.,
Monday, June 27 through Friday, July 1.
A special corps of guides will escort the visitors
and answer any questions regarding AMA publica-
tions, sendees and activities.
Among features at the 115th Annual Convention,
the International Academy of Pathology will join the
Section on Pathology and Physiology in a full day’s
program on Tropical Medicine.
^ ^ %
The AMA Committee on Blood and the Section on
General Practice will present a half-day session.
Hi ^
The Society for Investigative Dermatology, Inc. will
hold its meetings in conjunction with the Section on
Dermatology, and the Association for Research in
Ophthalmology, Inc. in conjunction with the Section
on Ophthalmology.
for June, 1966
607
REPORT ON EXAMINATION OF CASH RECEIPTS AND DISBURSEMENTS,
YEAR ENDED DECEMBER 31, 1965, OF OHIO STATE MEDICAL
ASSOCIATION AND THE OHIO STATE MEDICAL JOURNAL
ACCOUNTANTS’ REPORT
The Committee on Auditing and Appropriations
Ohio State Medical Association
Columbus, Ohio
We have examined the statement of assets of the Ohio State Medical Association at
December 31, 1965, and the related statement of cash receipts and disbursements of the
Executive Secretary and the Treasurer and the statement of operations of The Journal for
the year then ended. Our examination was made in accordance with generally accepted
auditing standards and accordingly included such tests of the accounting records and such
other auditing procedures as we considered necessary in the circumstances.
The statements of the Journal included herein have been prepared on the accrual basis
of accounting. The statements of the Executive Secretary and the Treasurer included
herein have been prepared on the cash receipts and disbursements basis, and, as a result,
include as income 1966 membership dues of $86,522.50. Under generally accepted account-
ing principles, such dues would be deferred at December 31, 1965 and included in income
during 1966. Accordingly, the statements as a whole do not in our opinion, present finan-
cial position and results of operations as they would appear had generally accepted accrual
basis accounting principles been applied in their preparation.
In our opinion, the accompanying statement of assets at December 31, 1965, and the
related statement of cash receipts and disbursements and the statement of operations for
the year then ended present fairly the information set forth therein and have been prepared
on a basis consistent with that of the preceding year.
Lybrand, Ross Bros. & Montgomery
Columbus, Ohio,
March 16, 1966
OHIO STATE MEDICAL ASSOCIATION
Statement of Assets, December
31, 1965
Total
Executive
Secretary’s
Account
Treasurer’s
Account
The
Journal
Cash in bank and petty cash
$ 84,212.62
$ 61,342.63
$ 20,788.42
$ 2,081.57
Cash in savings account
75,869.54
75,869.54
United States Government obligations, at cost
75,000.00
75,000.00
Accounts receivable —
advertisers, less allowance for doubtful accounts of
$727.00
9,234.76
9,234.76
Deposit on postage ....
160.00
160.00
Office equipment, at cost less accumulated deprecia-
tion of $30,098.99
18,050.17
18,050.17
$262,527.09
$ 61,342.63
$171,657.96
$ 29,526.50
608
The Ohio State Medical Journal
OHIO STATE MEDICAL ASSOCIATION
Statement of Cash Receipts and Disbursements, Year ended December 31, 1965
Total
Executive
Secretary’s
Account
Treasurer’s
Account
Cash in bank, beginning of year
$118,537.60
$ 87,429.03
$ 31,108.57
Cash receipts:
1966 Membership dues
86,522.50
86,522.50
1965 Membership dues
244,292.50
244,292.50
Interest on savings deposits ___
3,526.22
3,526.22
Interest on United States Government obligations
3,095.78
3,095.78
Exhibit space, 1965 annual meeting
17,805.00
17,805.00
Exhibit space, 1966 annual meeting
7,910.00
7,910.00
Fees for collection of A. M. A. dues
3,396.15
3,396.15
$366,548.15
$334,341.22
$ 32,206.93
Interaccount transfers (principally 1965 dues)
(360,427.62)
360,427.62
Cash disbursements:
Ohio State Medical Journal
47,920.00
47,920.00
Salaries; and expenses (Staff, Officers, Council)
152,762.73
152,762.73
Professional conferences and scientific meetings
65,850.37
65,850.37
Committee expenses ___
14,639.14
14,639.14
Department of Public Relations
27,756.89
27,756.89
Emplovees’ benefits
21,693.85
21,693.85
Contributions ____
7,987.05
7,987.05
General __
64,344.67
64,344.67
402,954.70
402,954.70
Cash in bank, end of vear
$ 82,131.05
$ 61,342.63
$ 20,788.42
Cash in savings accounts, beginning of year
$ 72,868.72
$ 72,868.72
Interest received
3,000.82
3,000.82
Cash in savings accounts, end of year
$ 75,869.54
$ 75,869.54
THE OHIO STATE MEDICAL JOURNAL
Statement of Operations, Year ended December 31, 1965
Income:
Advertising, Net $ 50,618.42
OSMA appropriation 47,920.00
Subscriptions 1,295.00 $ 99,833.42
Expense:
Salaries $ 29,267.50
Journal printing 59,810.53
Other (includes depreciation of $1,911.47) 11,509.17 100,587.20
Net loss
$ 753.78
for June, 1966
609
Control of Infections . . .
Conference on Prevention and Control of Infections in
Health Care Facilities Scheduled in Columbus, June 22-24
^rINE ORGANIZATIONS with interest in the
subject are cosponsoring A Conference on
^ ^ Prevention and Control of Infections in
Health Care Facilities at the Sheraton-Columbus
Motor Hotel in downtown Columbus, Wednesday,
Thursday, and Friday, June 22, 23, and 24.
The conference is designed for administrators of
health care facilities — hospitals, institutions, nursing
homes, physicians, nursing directors and instructors in
health care facilities, health commissioners and health
department personnel responsible for health care pro-
grams, and faculty members for medical and nursing
schools.
Cosponsors are the Ohio Department of Health,
Ohio Department of Mental Hygiene and Correction,
Ohio Hospital Association, Ohio Nursing Home As-
sociation, Ohio State Medical Association, Ohio State
Nurses Association, Ohio Osteopathic Association of
Physicians and Surgeons, the Ohio State University
College of Medicine, and the U. S. Department of
Health, Education and Welfare.
Registration opens at 9:00 A. Mv on June 22 and
the conference mns through noon on June 24. There
is no charge for the course, but a registration fee of
$5.00 will cover incidental expenses.
Following are features of the program:
Welcome — Calvin B. Spencer, M. D., acting chief,
Division of Communicable Disease, Ohio Department
of Health.
Introduction to the Conference — Bernard A.
Brown, D. V. M., Health Professions Training Sec-
tion, Communicable Disease Center, Atlanta, Ga.
What Is the Extent of the Hospital Infections
Problem with Its Varying Etiology ? — Martin D.
Keller, M. D., associate professor of preventive medi-
cine and assistant professor of medicine, Ohio State
University.
Implications and Liabilities of Infections Con-
trol— Nathan Hershey, LL. B., associate director of
Health Law Center, University of Pittsburgh.
An Effective Infections Control Committee; Its
Organization, Functions, Channels, and Problems
— Clifton K. Himmelsbach, M. D., chairman, Com-
mittee on Infections Within Hospitals, American
MAIL APPLICATION TO:
Calvin B. Spencer, M. D.
Acting Chief, Division of Communicable Diseases
Ohio Department of Health
P. O. Box 118
Columbus, Ohio 43216
Please consider me for enrollment in the training course, "Prevention and Control of Infections in Health
Care Facilities” — June 22, 23, 24, 1966, at the Sheraton-Columbus Motor Hotel, Columbus, Ohio.
NAME
TITLE
ORGANIZATION
ADDRESS
Pd Enclosed is my check for the registration fee of $5.00 made payable to, Dr. Calvin B. Spencer, Chairman.
610
The Ohio State Medical Journal
Hospital Association, and associate dean for research,
Georgetown University Medical and Dental Schools.
What Is Your Infection Rate? Designing Sur-
veillance Systems — Theodore C. Eickhoff, M. D.,
deputy chief of the Investigation Section, Epidemi-
ology Branch, Communicable Disease Center, At-
lanta, Georgia.
Patients and Personnel with Overt and Inap-
parent Infections; Patient Information and Isola-
tion Procedures; Management of Information —
Dr. Himmelsbach.
Coordination and Continuity in the Infections
Committee Through a Permanent Member:
Physician Hospital Epidemiologist in 38 New
York City Hospitals — Harry S. Lichtman, Borough
chief, Bureau of Preventable Disease, New York City
Department of Health;
Nurse Hospital Epidemiologist in Reporting
and Coordination — Shirley J. Streeter, R. N., assist-
ant director of nursing, Research and Education Hos-
pital, University of Illinois.
Administrative Actions and Costs in the Control
of Infections — Roy J. Weinzettel, administrator,
Memorial Hospital of Chatham County, Savannah,
Georgia.
Essential Laboratory Services — Colin R. Mac-
pherson, professor and vice - chairman, Department
of Pathology, Ohio State University.
Monitoring Inanimate Environment — George F.
Mallison, chief, Biophysics Section, Communicable
Disease Center, Atlanta, Ga.
Design and Modification for Environmental
Control — Wilbur R. Taylor, assistant chief, Archi-
tectural, Engineering and Equipment Branch, Hospi-
tal and Medical Facilities Division, PHS, Washing-
ton, D. C.
Motivation for Personnel Action — William H.
Hale, Ph. D., associate director, Georgia Center for
Continuing Education, University of Georgia.
Note the attached registration application form.
Additional information also may be obtained from
Dr. Spencer at the address indicated on the applica-
tion form.
Malpractice Insurance Rates . . .
Approximately Ten Per Cent Increase in Most Classifications
Authorized for National Bureau Companies, Effective June 1
WHAT AMOUNTS to an average ten per
cent increase in professional liability insur-
ance rates charged to Ohio physicians and
surgeons by companies belonging to the National Bu-
reau of Casualty Underwriters has been authorized
by the Ohio Department of Insurance, effective June 1.
Following are old and new scales of rates for
basic $5,000 - $1 5,000 coverage, as released by Wil-
liam R. Morris, director of the Ohio Department of
Insurance:
Class No. 1 Physicians:
Old rate, $38.00; new rate, $42.00.
This classification applies to general practitioners
and specialists who do not perform obstetrical pro-
cedures or surgery (other than incision of boils
and superficial abscesses, or suturing of skin and
superficial fascia), and who do not ordinarily assist
in surgical procedures. Specialists referred to in
this classification are: allergists, cardiologists (not
including catheterization), dermatologists, gastro-
enterologists, industrial medicine, internists, neu-
rologists, pathologists, pediatricians, preventive
medicine, psychiatrists, public health, physiatrists
and roentgenologists - radiologists.
Class No. 2 Physicians:
Old rate, $48.00; new rate, $53.00.
This classification applies to general practitioners
and specialists who perform minor surgery (includ-
ing obstetrical procedures not constituting major
surgery) or assist in major surgery on their own
patients. Tonsillectomies, adenoidectomies, and
cesarean sections are considered major surgery.
The specialists referred to are the same as those
listed in Class No. 1.
Class No. 3 Surgeons:
Old rate, $91.00; new rate, $101.00.
This classification applies to general practitioners
who perform major surgery or assist in major
surgery on other than their own patients and cer-
tain specialists. The specialists referred to are:
cardiologists (including catheterization, but not
including cardiac surgery) ophthalmologists, and
proctologists.
Class No. 4 Surgeons:
Old rate, $137.00; new rate, $151.00.
This classification applies to the following spe-
cialists: anesthesiologists, cardiac surgeons, neuro-
surgeons, obstetricians - gynecologists, orthopedists,
otolaryngologists, plastic surgeons, general sur-
for June, 1966
611
geons, thoracic surgeons, urologists and vascular
surgeons.
Physicians and Surgeons in
active U. S. military service:
Class No. 1 Physicians:
Old rate, $15.00; new rate, $15.00
Class No. 2 Physicians:
Old rate, $19.00, new rate $19.00
Class No. 3 Surgeons:
Old rate, $36.00; new rate, $36.00
Class No. 4 Surgeons:
Old rate, $54.00; new rate, $54.00
X-ray therapy:
Old rate, $15.00; new rate, $15.00
Shock therapy:
Old rate, $15.00; new rate, $15.00
Additional charges which apply to all the fore-
going classifications except physicians in active
military service:
^Employed physicians as defined in Class No. 1 :
Old rate, $9.50; new rate, $10.50
*Employed physicians as defined in Class No. 2:
Old rate, $12.00; new rate, $13-50
^Employed surgeons as defined in Class No. 3:
Old rate, $23.00; new rate, $25.50
*Employed surgeons as defined in Class No. 4:
Old rate, $34.50; new rate, $38.00
*Employed technicians (radium, laboratory, or
pathological) :
Old rate, $5.00; new rate, $5.00
^Employed technicians (X-ray therapy) :
Old rate, $13.00; new rate, $13.00
Partnership liability: 20% of the per person
rate for each individual comprising the partnership
* Shock therapy, by employed physicians or
surgeons :
Old rate, $12.00; new rate, $13.50
Shock therapy, by insured physicians or surgeons :
Old rate, $48.00; new rate, $53.00
*X-ray therapy, by employed physicians or sur-
geons :
Old rate, $12.00; new rate, $13.50
X-ray therapy, by insured physicians as defined
in Class No. 1 or Class No. 2:
Old rate, $48.00; new rate, $53.00
X-ray therapy, by insured physicians or surgeons
as defined in Class No. 3 or Class No. 4:
Old rate, $48.00; new rate, $53.00
* Note : This rate applies not only to employees
of individual insureds but also to employees of part-
nerships. It applies per employee regardless of the
number of partners. It applies also to such person-
nel in pathological or x-ray laboratories operated or
supervised by the insured in hospitals, whether or
not employees of the insured.
Ohio Physicians Are Appointed
To AMA Committee Posts
George J. Hamwi, M. D., Columbus, has been
elected chairman of the Council on Foods and Nutri-
tion of the American Medical Association.
Previously, Dr. Percy E. Hopkins, chairman of the
AMA’s Board of Trustees, announced Dr. Hamwi’s
reappointment to the Council.
The AMA Council consists of 11 authorities in the
field of nutrition appointed by the Board of Trustees.
These members represent medicine and allied sciences
such as biochemistry, physiology and food technology.
The Council’s current interests include continuing
medical education in nutrition, improvement of nutri-
tion teaching in medical schools, and promotion of
rational diet therapy through council statements and
reports.
Dr. Hamwi is a Past President of the Ohio State
Medical Association. He is professor of medicine
at Ohio State University and director of the Division
of Endocrinology and Metabolism in the Department
of Medicine.
* *
Dwight M. Palmer, M. D., Columbus, has been
reappointed a member of the Committee on Rating
of Mental and Physical Impairment of the AMA.
The AMA Committee develops practical guides to
assist physicians in evaluating permanent impairment
of body systems and organs.
* * *
Thomas E. Shaffer, M. D., Columbus, has been re-
appointed a member of the Committee on Medical
Aspects of Sports of the AMA.
The AMA Committee advises athletic personnel on
the various phases of the health supervision of sports,
and disseminates information to interested physicians
on the application of medical skills in the athletic
setting.
* * *
James V. Warren, M. D., Columbus, has been re-
appointed a member of the Committee on Rating of
Mental and Physical Impairment of the AMA.
The AMA Committee develops practical guides to
assist physicians in evaluating permanent impairment
of body systems and organs.
Children’s Hospital, Columbus
Served 84 Ohio Counties
In the neighborhood of a hundred thousand chil-
dren visited Children’s Hospital of Columbus during
1965, according to the hospital’s annual report issued
recently.
They came from 84 counties in Ohio and from 18
other states. Here are the 1965 statistics at a glance:
Admissions, 14,125; average daily census, 240; aver-
age length of stay, 6.2 days; emergency room visits,
34,072; outpatient visits, 50,840; patient days, 87,-
760; unpaid care, $359,000.
612
The Ohio State Medical Journal
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for June, 1966
613
Obituaries
Ad Astra
Richard Stevens Bechk, M. D., Cleveland; Faculty
of Medicine of the University of Budapest, 1930;
aged 68; died April 13; member of the Ohio State
Medical Association and the American Medical Asso-
ciation. A native of Cleveland, Dr. Bechk practiced
for some 34 years in that city. Among affiliations, he
was a member of the Rotary Club. Survivors include
his widow, two daughters, two brothers and a sister.
Berton M. Hogle, M. D., Troy; University of Cin-
cinnati College of Medicine, 1928; aged 66; died
April 12; member of the Ohio State Medical Asso-
ciation and the American Fracture Association; Fel-
low of the American College of Surgeons. A physi-
cian and surgeon in the Troy area for many years, Dr.
Hogle was active in a number of medical organization
groups. He was treasurer of the Ohio State Surgical
Association and a past president and former secretary-
treasurer of the Ohio Chapter, American College of
Surgeons. A veteran of World War I, during which
he served in the Marine Corps, he was a member of
the American Legion; also a member of the Elks
Lodge and the Methodist Church. Surviving are his
widow, a daughter, two sons, one of whom is Dr.
Glen Hogle, of Santa Ana, Calif.; also a sister.
Roy F. Jolley, M. D., Richwood; Ohio State Uni-
versity College of Medicine, 1914; aged 73; died
April 16; member of the Ohio State Medical Asso-
ciation and the American Medical Association. A
native of the Richwood area, Dr. Jolley returned there
to practice in 1953. He previously was in Akron
where his specialty field was surgery. He was a
veteran of World War I, a member of the Ameri-
can Legion, the Methodist Church, the Lions Club,
and several Masonic bodies. Survivors include his
widow, two sons, and two sisters.
Boyd G. King, M. D., Cleveland; University of
Nebraska College of Medicine, 1933; aged 57; died
April 10; member of the Ohio State Medical Asso-
ciation and the American Medical Association; Fel-
low of the American College of Surgeons; diplomate
of the American Board of Internal Medicine. A
practicing physician in Cleveland for more than 30
years, Dr. King was on the faculty of Western Re-
serve University School of Medicine. During World
War II, he was a lieutenant colonel with the Fourth
General Hospital unit. Survivors include his widow,
two sons, his mother and a brother.
Gerald J. Krupp, M. D., Lorain; St. Louis Univer-
sity School of Medicine, 1931; aged 6 1 ; died April
20; member of the Ohio State Medical Association
and the American Academy of General Practice. An
earlier resident of Lorain, Dr. Krupp returned there
to practice after taking his medical training. In
addition to his professional affiliations, he was a
member of the local Businessmen’s Association, the
Lions Club, Elks Lodge, the Catholic Church, Knights
of Columbus, and Holy Name Society. Neil E.
Krupp, M. D., of the Mayo Clinic, and Ralph J.
Krupp, D. D. S., of Lorain, are among four surviving
sons. Other survivors are his widow, and three
daughters.
Carl William Lose, M. D., Flushing; University
of Cincinnati College of Medicine, 1912; aged 79;
died April 5; member of the Ohio State Medical
Association, and the American Medical Association.
Dr. Lose practiced for 52 years in the Belmont County
community. Among affiliations, he was a member of
the Methodist Church and several Masonic bodies.
Surviving are his widow, four brothers and a sister.
James Albert Magoun, M. D., Toledo; University
of Pennsylvania School of Medicine, 1916; aged 77;
died April 26; member of the Ohio State Medical
Association, the American Medical Association,
American Urological Association; Fellow of the
American College of Surgeons; diplomate of the
American Board of Urology. A physician and sur-
geon in Toledo for more than 42 years, Dr. Magoun
was one of the cofounders of the Toledo Clinic. He
was a veteran of World War I, during which he
served in the Navy Medical Corps. Among sur-
vivors are his widow, a son, and a daughter.
Norvil A. Martin, M. D., Santa Barbara, Calif.;
Washington University School of Medicine, 1930;
aged 61; died April 25; member of the Ohio State
Medical Association, the American Medical Associa-
tion, and the American Academy of Ophthalmology
and Otolaryngology; diplomate of the American
Board of Otolaryngology. A former practitioner in
Gallipolis for many years, Dr. Martin was one of the
founders of the Gallipolis Clinic. He retired in
1962 and moved to California. Affiliations included
memberships in the Presbyterian Church and several
Masonic bodies; also the Rotary Club. A veteran of
World War II, he is survived by his widow and two
daughters.
Harry Miller Robuck, M. D., Gomer; University
of Louisville School of Medicine, 1921; aged 74;
died April 13; member of the Ohio State Medical
Association and the American Medical Association.
A practitioner of long standing in the Allen County
community, Dr. Robuck was active in Republican af-
fairs and was former chairman of the county central
614
The Ohio State Medical Journal
Dairy Councils of Cleveland, Columbus &
Stark County District
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second by pointing the way to realistic weight
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Day after day.
Naturally, balanced diets and
nourishing, palatable dairy foods go
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Project Weight Watch has been initiated
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To help you translate your concern to your
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PROJECT
WEIGHT
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for June, 1966
615
committee. He was a member of the Baptist Church
and several Masonic bodies. A niece survives.
Edward Carl Rosenow, M.D., Minneapolis, Minn.;
Rush Medical College, 1902; aged 90; died March 7;
member of the Ohio State Medical Association, the
American Medical Association, American Society for
Experimental Pathology, and the American Society
of Clinical Pathologists. Formerly associated with
Longview State Hospital in Cincinnati, Dr. Rosenow
contributed a number of papers in his specialty
field of bacteriology to The Journal. Before com-
ing to Ohio, he was located in Rochester, Minn., with
appointments at the Mayo Clinic and the University
of Minnesota. Dr. Rosenow was making his home
in Minneapolis after retiring some ten years ago.
John Frederick Sanker, M. D., Cincinnati; Uni-
versity of Cincinnati College of Medicine, 1941;
aged 51; died April 5; member of the Ohio State
Medical Association and the American Medical As-
sociation. A pediatrician in Cincinnati for some 20
years, Dr. Sanker, was on the faculty of the Univer-
sity of Cincinnati and was a past president of the
Pediatrics Society and of the Medi-Club. During
World War II he served as surgeon with the Coast
Guard. Surviving are his widow, a son, three daugh-
ters, his parents, a brother and a sister.
Ernst Speyer, M. D., Miami, Florida; Medical Fac-
ulty of the Johann-Wolfgang Goethe University, 1924;
aged 66; died March 20; member of the Ohio State
Medical Association, the American Medical Associa-
tion, and the American Psychoanalytic Association.
Educated in Germany, Dr. Speyer practiced there
and in Palestine before he came to this country. His
practice in Sandusky extended over a period of 20
years prior to his retirement. Survivors include his
widow, two daughters, and a son.
John Carl Stratton, M. D., Middletown; Cleve-
land-Pulte Medical College, 1908; aged 86; died
May 2; member of the Ohio State Medical Associa-
tion and the American Medical Association. A prac-
titioner in Middletown since 1909, Dr. Stratton was
active in numerous community and organization af-
fairs. He was a member and former president of
the local board of education for many years and was
former city health commissioner. He was an elder in
the Presbyterian Church, was a member of the Knights
of Pythias and the Rotary Club. Dr. Frank M. Strat-
ton, of Delaware, is a brother. Other survivors are
his widow, a daughter and a son.
Ralph K. Updegraff, Jr., M. D., Belief ontaine;
Western Reserve University School of Medicine,
1933; aged 56; died April 1; member of the Ohio
State Medical Association, the American Medical
Association, and the American Society of Internal
Medicine; diplomate of the American Board of In-
ternal Medicine. Born in Cleveland, Dr. Updegraff’s
late father was a physician in that city. Dr. Upde-
graff, Jr., served in the Marine Corps during World
War II, and began his practice in Bellefontaine in
1946. Among affiliations, he was a member of the
American Legion, the Episcopal Church, and the
Elks Lodge. Survivors include his daughter, a son,
his mother and a sister.
John A. Welter, M. D., Roanoke, Va.; State Uni-
versity of Iowa College of Medicine, 1935; aged
55; died on or about April 1 6; former member of the
Ohio State Medical Association. Dr. Welter prac-
ticed in Youngstown before he went into military
service during World War II. Survivors include his
widow, a daughter, two brothers, and a sister.
John F. Wilkinson, M. D., Bellaire; Ohio State
University College of Medicine, 1923; aged 68; died
April 5; member of the Ohio State Medical Asso-
ciation and the American Medical Association. A
native of Bellaire, Dr. Wilkinson devoted all of his
professional career to practice in the Belmont County
area. He was a member of several Masonic bodies,
the American Legion, and the Presbyterian Church.
A sister survives.
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The Ohio State Medical Journal
at Merck Sharp & Dohme...
understanding... precedes development
The development of chlorothiazide and probene-
cid were events of major importance, but perhaps
even more important for the future was the Renal
Research Program by which they were developed.
When Merck Sharp & Dohme organized this pro-
gram in 1943, it was expressing in action some of
its basic beliefs about research:
• Many problems connected with renal structure
and function were still undefined or unsolved. The
Renal Research Program would begin its basic
research in some of these problem areas.
• From knowledgethus acquired might comeclues
to the development of new therapeutic agents of
significant value to the physician.
For example, the Renal Research Program put
fifteen years into this search before chlorothiazide
became available. But because these years had
first led to a greater understanding of basic
problems, the desired criteria for chlorothiazide
existed before the drug was developed.
Along with other research teams at Merck Sharp
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to add new understanding of basic problems —
understanding which will lead to important new
therapeutic agents.
©MERCK SHARP & DOHME Division of Merck & Co.. Inc.. West Point. Pa.
where today’s theory is tomorrow’s therapy
for June, 1966
617
Activities of Countv Societies . . .
j
First District
HAMILTON
"Aspects of Autoimmunity” were discussed by Dr.
William Dameshek, director of the Blood Research
Laboratory at Tufts-New England Medical Center,
at the April 19 meeting of the Academy of Medicine
of Cincinnati.
Second District
GREENE
Two physicians presented features of the program
during the April meeting of the Greene County
Medical Society in Xenia. Dr. William H. Havener,
professor of ophthalmology at Ohio State University
School of Medicine, discussed eye injuries; and Dr.
Arthur Klein, Dayton, spoke on the subject of rheu-
matism fever.
Third District
ALLEN
Dr. Robert W. Hopkins, associate professor of
surgery, Western Reserve University School of Medi-
cine, was speaker for the April meeting of the Acad-
emy of Medicine of Lima and Allen County, where
he discussed treatment of shock.
HARDIN
Dr. Ivan Podobnikar, of Columbus, was guest
speaker at the joint meeting of the Hardin County
Medical Society and Auxiliary in San Antonio Hos-
pital, Kenton. His topic, "An Ounce of Prevention,”
was an urge for early treatment of mental illness. He
also showed the film, "Strangers in the Shadow.”
Fourth District
DEFIANCE
Featured speaker for the April meeting of the
Defiance County Medical Society was Dr. Richard
Kraft, assistant professor of surgery at the University
of Michigan School of Medicine. His topic was
"Peripheral Vascular Disease.”
LUCAS
The Specialty Section meeting of members of the
Academy of Medicine of Toledo and Lucas County
was held on May 19. Speaker was Dr. Curtis Lund,
professor of obstetrics and gynecology at the Univer-
sity of Rochester (N. Y.) who discussed "Ion Metab-
olism and Anemia in Pregnancy.”
The Postgraduate Lecture Series was given on
May 12 and 13 at the Academy Building with Dr.
Robert D. Johnson, University of Michigan, as guest
speaker. Theme of the series was "Some Recent
Advances in Medicine.”
Fifth District
CUYAHOGA
The Academy of Medicine of Cleveland held its
annual meeting with the Auxiliary on May 13, with
dinner at the Mid-Day Club. Dr. William F. Bou-
kalik, president, presided. The Woman’s Auxiliary,
with Mrs. Elden C. Weckesser, president, presented
a skit entitled "Auxiliary Shows Her Medals, or
Twenty-Five Sterling Years.”
Dr. Charles L. Hudson, Cleveland, President-Elect
of the AMA, was honored on this occasion by his
home Academy.
The Cleveland Academy has announced its annual
golf outing to be held at Shaker Heights Country
Club on Monday, July 18.
Seventh District
BELMONT
The Belmont County Medical Society met with the
Auxiliary at the Belmont Hills Country Club for
dinner and a program. Guest speaker was Dr. Ed-
mund Beshara, Canton, whose subject was "The
Community Mental Health Program.”
Eighth District
FAIRFIELD
The Fairfield County Medical Society has allocated
$ 9,000 in treasury funds for the future expansion of
Lancaster-Fairfield County Hospital. The funds rep-
resent excess donations by area citizens during the
Sabin immunization program against polio conducted
in the area about two years ago.
WASHINGTON
Dr. Jack Tetirick, of Columbus, discussed his ex-
periences on a tour of service on the hospital ship
Hope at the April meeting of the Washington County
Medical Society in Marietta. Member of the Parkers-
burg Academy of Medicine were guests for the oc-
casion, with the wives attending the meeting.
Eleventh District
ERIE
Members of the Huron and Ottawa County Medi-
cal Societies met with the Erie County Medical So-
ciety during April in Sandusky. Dr. William J.
Feicks, described the program of the mental health
unit at St. Joseph’s Hospital in Lorain, and discussed
mental health units in general. Such at unit at Good
Samaritan Hospital in Sandusky is being developed.
LORAIN
Guest speaker at the regular meeting of Lorain
County Medical Society on May 10 in Oberlin Inn,
618
The Ohio State Medical Journal
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3Levy, G., and Hayes, B. A., New
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1053 (1960)
for June, 1966
619
was Ray C. Kepner, district manager of Lorain Office
of the Social Security Administration. His topic,
"Medicare and the Doctor,’’ outlined the role of the
physician and the Social Security Administration in
the implementation of the new law, and the members
were complimented on the instrumental effect the
profession has had, and may expect to have in the
future, in working towards improvement within the
framework of Medicare.
Following a Question and Answer Period, J. A.
Cicerrella, president, thanked Mr. Kepner for his
informative program.
Dr. Lawrence C. Meredith, President-Elect of Ohio
State Medical Association, extended an invitation to
all members on behalf of Eleventh District Councilor
William R. Schultz and himself, to visit the hospital-
ity room and President-Elect’s suite at the OSMA
Annual Meeting in Cleveland, and reiterated Dr.
Cicerrella’ s request that all who are able should rep-
resent the County Society at this meeting.
Voted unanimously into Associate Membership
with the Society were Liselotte Marr, Alfonso Corzo-
Moody, and Simon J. Isaac. Abdel Rahman Abla
was voted an Active member, on transfer from Cleve-
land Academy of Medicine.
A Memorial Address to the late Dr. Gerald J.
Krupp, of Lorain, was prepared and read by Dr. R.
M. Arnold, and all present stood in silent tribute to
their highly esteemed colleague.
Dr. A. Clair Siddall of Oberlin, chairman of the
Cancer Committee, gave a brief report to the mem-
bership on the statistics of the current Uterine Cancer
Detection Program among women on welfare, and
those in the medically indigent group. In thanking
all who have been participating in the program, he
stressed the cooperation of the opt-patient clinic
staff at St. Joseph Hospital in Lorain, and Elyria
Memorial Hospital.
It was brought to the members’ attention that Dr.
James B. Patterson, of Lorain, was the first area physi-
cian to volunteer for duty with Project Viet Nam and
has already left for service. It was also noted that
Dr. Delbert D. Mason of Oberlin entered Military
Service as of April 1.
Dr. Cicerrella reminded those present of the joint
meeting with the wives in September, when the So-
ciety will be host to Lorain County Medical Founda-
tion’s Board of Supervisors and members’ wives, and
the young students who will have been selected to re-
ceive grants for the school year 1966-1967.
RICHLAND
A discusisoin on the Medicare program was held
when the Richland County Medical Society met on
April 21 in Mansfield.
Guest speakers were Lee Forrest, assistant deputy
administrator in the Chicago office of the Social
Security Administration, and Hugh Hughes, Colum-
bus, of the Nationwide Insurance Company, inter-
mediary for the Medicare program in parts of Ohio
and in West Virginia.
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The Ohio State Medical Journal
Woman’s Auxiliary Highlights
• • •
By MRS. S. L. MELTZER, Publicity Committee
Chairman, 2442 Dorman Dr., Portsmouth 45662
HP
. J L.
^HE PLACE is Chicago this year, and the Big
event is the forty-third Annual Convention of
the Woman’s Auxiliary to the American Medi-
cal Association at the Drake Hotel, June 2 6 to 30,
inclusive. Mrs. Richard A. Sutter, national president,
sends a cordial invitation to all members, their guests,
the wives of AM A delegates, alternates and inter-
national guests to participate in all social functions
and to attend the general meetings.
Open forum discussions for state officers and con-
stitutional amendments on Auxiliary structure will be
features of this forty-third meeting. Registration
opens at 11 a. m., Sunday, June 26, followed by a
6-8 P. M. reception honoring the Auxiliary president
and president-elect (Mrs. Asher Yaguda).
The convention formally opens at 9 a. m. Monday,
June 27. Featured speaker at that day’s Guest Day
luncheon will be Mr. Richard Cornuelle, executive
vice-president, National Association of Manufacturers,
and author of Reclaiming the American Dream. For
Monday evening, there’s a "Nite on the Town.” The
tour consists of dinner at the Ivanhoe Restaurant,
banjo revue at the Red Garter, cocktails and browsing
through Old Town and the Ice Revue at the Conrad
Hilton Hotel.
Dr. James Z. Appel, AMA President, will speak
at the Tuesday luncheon and Mrs. Sutter will present
the Auxiliary’s contribution to AMA-ERF. Dr.
Raymond M. McKeown, foundation president, will
present awards to state and county auxiliaries making
the largest contributions in their membership cate-
gories. The new convention program scheduled for
Tuesday afternoon — "Open Forum — is a two-way
discussion between state presidents and presidents-
elect, and national officers and chairmen. On Wednes-
day, June 29, Mrs. Yaguda will be installed as
president.
There will also be an exciting five-day and two-
evening program offered physicians’ pre-teens (ages
6-12) and teens during the convention. The activ-
ities, handled by Gulliver’s Trails, Inc., are under the
auspices of the Woman’s Auxiliary. What your re-
porter has presented here on the National Conven-
tion is, of course, nothing more than a bird’s eye
glimpse. All of it sounds truly exciting, interesting
and informative. Set your sails for Chicago!
Around Ohio
The Butler County auxiliary heard a talk on
'Medical Legal Responsibility under Medicare” at a
recent meeting. Gaston Herd, administrator of Forst
Hamilton Hospital, was the speaker. Invited to the
luncheon meeting were members of the Butler County
Bar Auxiliary. The Clinton County group honored
its doctors recently with Doctors’ Day Dinner given
annually at the home of Dr. and Mrs. Arthur F. Lip-
pert. Mrs. Lippert used a valentine motif. The
tables were centered with flowers and hearts in milk
glass vases, and the large table featured a valentine
coach and red candles in hurricane lamps.
After a visit to George Mark’s "Salt Box” in
April, the Columbiana auxiliary had a luncheon
meeting in the Hearth Room at Holiday Inn. Mrs.
Wade Bacon, president, led a discussion on the Co-
lumbiana County Mental Health’s proposed tax levy.
Members voted unanimously to endorse the passage
of this levy. The group also approved financial aid,
through its health career fund, to an applicant from
Salem to further her nursing career. The loan fund,
repayable after graduation, is open to students in
any of the paramedical careers.
The final meeting of the year was held in May and
was the annual Rose Luncheon at East Liverpool
Country Club when the new officers were installed.
They were: Mrs. R. J. Bonstalli, president; Mrs. K.
S. Ulicny, president-elect; Mrs. Stephen Sinclair, vice-
president; Mrs. A. P. Falenstein, treasurer; and Mrs.
Fred Banfield, secretary. Mrs. Janis Lauva served as
chairman for the Rose Luncheon and installation.
Franklin County’s traditional Guest Day featured
a salad smorgasbord at the Covenant Presbyterian
Church. Robert Titko, director of Planned Parent-
hood, spoke on "World Population Explosion.”
Diminutive Flemish arrangemnts of violets decorated
the tables at the annual Spring bridge luncheon given
by the Lucas County Auxiliary in April. Proceeds
from the afternoon in the amount of $300 were given
to AMA-ERF. Mrs. John R. Van der Veer was
chairman of the day’s festivities assisted by Mrs.
Harvey Muehlenbeck, cochairman; Mrs. Edward Clax-
ton, Mrs. Paul J. Ditmyer, Jr., Mrs. Everett Kasher
and Mrs. Harold Wachenheim. Mrs. Richard Schafer
is the new Lucas County president. The group’s
for June, 1966
621
foMig
infection
B and C vitamins are therapy : STRESSCAPS B and C vitamins in thera-
peutic amounts . . . help the body mobilize defenses during convalescence ... aid
response to primary therapy. The patient with a severe infection, and many
others undergoing physiologic stress, may benefit from STRESSCAPS capsules.
Each capsule contains:
Vitamin B) (as Thiamine Mononitrate) 10 mg
Vitamin Bj (Riboflavin) 10 mg
Vitamin B4 (Pyridoxine HCi) 2 mg
Vitamin B12 Crystalline 4 mcgm
Vitamin C (Ascorbic Acid) 300 mg
Niacinamide 100 mg
Calcium Pantothenate 20 mg
Recommended intake: Adults, 1 capsule
daily, for the treatment of vitamin deficien-
cies. Supplied in decorative “reminder"
jars of 30 and 100; bottles of 500.
LEDERLE LABORATORIES, A Division of American Cyanamid Company, Pearl River, New York
626-6-3612
Senior Citizens’ Tea was held on May 6 at the
Academy. The Community Service Committee acted
as hostesses, with Mrs. Jose Guerra as chairman. The
International Health Committee reports a very suc-
cessful year. About 30 large cartons of drugs were
delivered to Detroit by Mrs. Marvin Green, Mrs.
Max Schnitker and Mrs. Irvin McConnell.
A Woman Honored
The Stark County Auxiliary is bursting with pride
over an honor recently given one of its outstanding
members — Mrs. Mark G. Herbst. Mrs. Herbst
was named Woman of the Year recently by the Junior
League of Canton — a tribute paid annually for hours
devoted to volunteer service. In presenting the
award, Mrs. Robert E. Levitt, president of the League
commented "Mrs. Herbst has a deep feeling of re-
sponsibility to her community and to her fellow man.
She does not merely lend her name to community
boards, but gives tireless hours of dedicated work.”
Virginia Herbst is a very active Auxiliary member
and a past president of the Stark County group.
Just last year, she received an award from the Urban
League for "her outstanding work to the underpri-
vileged and senior citizens.” Selection of Woman of
the Year is made by a panel of judges from nomina-
tions submitted by civic, welfare, health and educa-
tional groups in the community. Every time a doc-
tor’s wife is so honored, it points up the significance
and importance of our place in the community —
and our individual responsibility to our individual
communities. You serve as a shining example,
Virginia Herbst. Our congratulations . . .
The annual Public Scholarship Dance sponsored
a few months ago by the Stark group made possible
further proceeds to assist young people who need
financial assistance for training in paramedical fields.
This year, scholarship money is being lent to student
nurses — two at Aultman Hospital, five at Mercy
Hospital and one at St. Thomas Hospital in Akron.
For the fourth consecutive year, this same energetic
group of women are packaging drugs to be sent to
World Medical Relief. The current project has been
carried out at the home of Dr. and Mrs. Jack Hen-
dershot.
May Day Breakfast
Scioto County auxiliary held its traditional May
Day Breakfast and installation of new officers on
May 11, as it has for many years, at the home of
Mrs. Herbert M. Keil. Mrs. Alden Oakes, retiring
president, conducted the business session and called
upon her chairmen to give their annual reports. The
installation ceremony was given by Mrs. Francis Kulc-
sar, ninth district director. New Scioto County of-
ficers include: Mrs. Harlan Williams, president; Mrs.
Clyde Hurst, president-elect; Mrs. George Martin,
vice-president; Mrs. B. U. Howland, treasurer; Mrs.
Robert E. Martin, secretary; Mrs. Carl Braunlin, his-
torian; Mrs. Alden Oakes and Mrs. Jerome Rini
elected members to the Board.
Trumbull County sent out an effective News Letter
to its membership in April. Edited by Geneva Kohn,
it highlighted events for April and May. This News
Letter idea is such a good way of "keeping in
touch” and I’m sure the Trumbull gals won’t mind
it a bit if the rest of you copy that idea! The April
meeting of the group was a brunch at the home
of Mrs. Donald Miller and highlighted election of
officers, a talk on Civil Defense and "cards and
chatter.” The auxiliary was invited by the Corydon-
Palmer Dental Auxiliary to be guests at a luncheon
given by them for foreign exchange students. The
program featured "Let’s Build World Peace.” The
annual Gardenia Ball was held on April 29 at the
Trumbull Country Club.
A new Auxiliary year has begun. Let’s give it
everything we’ve got — like enthusiasm, co-operation,
interest, and an honest effort to do a job that nobody
else can do for us.
GROUP LIFE INSURANCE
Initiated and Sponsored by
Your OHIO STATE MEDICAL ASSOCIATION
For Information, Call Or Write
TURNER & SHEPARD, inc.
insurance
20 SOUTH THIRD STREET COLUMBUS, OHIO 43215 PHONE 228-6115 CODE 614
for June, 1966
623
JOURNAL ADVERTISERS
Advertisers in The Journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The Journal,
and help make it a quality publication. In return we
place their messages on the desks of Ohio’s physicians.
Please familiarize yourself with their services and pro-
ducts, and let them know that you see their advertising
in The Journal.
In This Issue:
Abbott Laboratories 551-552-553-554
Allergy Laboratories of Ohio, Inc 528
Ames Company, Inc Inside Back Cover
Appalachian Hall 543
Associated Credit Bureaus of Ohio 605
Ayerst Laboratories 535-536-537
Blessings, Inc 616
The Brown Pharmaceutical Co 543
Burroughs Wellcome & Co. (USA) Inc 620
The Coca-Cola Company 530
Dairy Councils of Cleveland, Columbus
and Stark County District 615
Daniels-Head & Associates, Inc 558
Data Corporation 613
Dorsey Laboratories, a division of
The Wander Company 595-596-597-598
Elder, Paul B. Company 538
Hynson, Westcott & Dunning, Inc 525
The Kendall Company 561
Lederle Laboratories, A Division of American
Cyanamid Company .... 546-547, 556-557,
560, 622, 626
Lilly, Eli, and Company 562
Loma Linda Foods, Medical
Products Division 529
The Medical Protective Company 530
Merck Sharp & Dohme, Division of
Merck & Co., Inc 617
Parke, Davis & Company Inside Front Cover
Philips Roxane Laboratories .... 541-542, 548-549
Roche Laboratories, Division of
Hoffmann-La Roche Inc Back Cover
Searle, G. D., & Company 590-591
Smith Kline & French Laboratories 555
Squibb, E. R., & Sons 544
Turner & Shepard, Inc 623
Tutag, S. J., & Co 534
The Vale Chemical Company, Inc 531
Wallace Laboratories 539, 559
Warren-Teed Pharmaceuticals Inc 532-533
The Wendt-Bristol Company 625
West- ward, Inc 619
Windsor Hospital 545
Winthrop Laboratories 526
Table of Contents
( Continued From Page 527 )
Page
531 Ohio Medical Society Executives Move to
Strengthen Ties
534 Health Service Student Loans and Scholarships
Announced
538 New Members of the Association
538 November Conference on Sports Scheduled in
Las Vegas
540 New IRS Tax Guide Issued for Income Tax
Withholdings
540 Stouffer Loundation Posts Award in Vascular
Research Field
545 Toledo State College of Medicine’s First
President Appointed
545 Opinion on Medical Treatment for Ohio Youth
Commission Wards
550 Health Referral Service in Ohio for Selective
Service Rejectees
550 Grant Will Promote Nursing Program at
Western Reserve
550 School of Allied Medical Services To Be
Established at OSU
556 Western Reserve Medical School Gets
Substantial Gift
558 Dean of Medical School Named at Western
Reserve
558 What To Write For
589 Instructions to Contributors of Scientific Papers
604 Resolution Expresses Appreciation for Service
on Medical Board
610 Conference on Control and Prevention of
Infection in Health Care Facilities
612 Ohio Physicians Appointed to AMA Committee
Posts
6l4 Obituaries
618 Activities of County Medical Societies
621 Woman’s Auxiliary Highlights
624 The Journal’s Advertisers in This Issue
625 Classified Advertisements
Dr. Winslaw J. Bashe, Jr., Cincinnati, has been
awarded a fellowship by the Pan-American branch
of the World Health Organization for a three-month
study tour of medical-health facilities in Europe.
624
The Ohio State Medical Journal
CAe I
OHIO STATE MEDICAL
journal
OSMA OFFICERS
President
Lawrence C. Meredith, M. D.
205 Elyria Block, Elyria 44035
President-Elect
Robert E. Howard, M.D.
2600 Union Central Bldg.,
Cincinnati 45202
Past President
Henry A. Crawford, M. D.
1058 Hanna Bldg., Cleveland 44115
T reasurer
Philip B. Hardymon, M. D.
350 E. Broad St., Columbus 432 15
EDITORIAL STAFF
Editor
Perry R. Ayres, M. D.
Managing Editor and
Business Manager
Hart F. Pace
Executive Editor and
Executive Business Manager
R. Gordon Moore
OSMA EXECUTIVE STAFF
Executive Secretary
Hart F. Page
Director of Public Relations and
Assistant Executive Secretary
Charles W. Edgar
Administrative Assistants
W. Michael Traphagan
Herbert E. Gillen
Address All Correspondence:
The Ohio State Medical Journal
17 South High Street, Suite 500
Columbus, Ohio 43215
Published monthly under the direction of the
Council for and by members of The Ohio State
Medical Association, 17 South High Street, Suite
500, Columbus, Ohio 43215, a scientific society,
nonprofit organization, with a definite member-
ship for scientific and educational purposes.
Subscription, $6.00 per year to non-members;
single copy, 50 cents (outside Continental U.S.,
$7.50 and 75 cents).
Entered as second class matter July 5, 1905, at
the Postoffice at Columbus, Ohio, under the Act
of Congress of March 3, 1879; Acceptance for
mailing at special rate of postage provided for in
Section 1103, Act of Oct. 3, 1917. Authority
July 10, 1918.
The Journal does not assume responsibility for
opinions expressed by the essayists. Advertisers
must conform to policies and regulations estab-
lished by The Council of the Ohio State Medical
Association.
; Page
| 665
| 668
■ 672
1 677
| 681
1 684
1 654
1 692-730
| 692
1 695-716
1 716
1 718
| 722
1 723
I 725
1 726
■ 729
1 731
| 736
I 739
Table of Contents
Scientific Section
Sound Perception. Its Theoretical History and Present
Status. James T. McMahon, M. D., Columbus.
The Middle Ear. A Simplified Discussion of Some Com-
mon Disorders. William H. Saunders, M. D., Co-
lumbus.
Psychiatric Aftercare. A Discussion of the Importance
of Predischarge Planning. Theodor Bonstedt, M. D.,
and Hooshang Khalily, M. D., Cincinnati.
Placental Localization. Donald W. Shanabrook, M. D.,
Tiffin.
Idiopathic Retroperitoneal Fibrosis. Report of a Case.
Wai-man Leung, M. D., and Charles L. Cogbill, M. D.,
Dayton.
A Clinicopathological Conference from The Ohio State
University Hospital, Columbus, Ohio.
The Historian’s Notebook: The Health Officers of Cin-
cinnati and the Problems of Their Day — 1900 to
I960. (Part I.) Kenneth I. E. Macleod, M. D., Cin-
cinnati.
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
News and Organization Section
Reports of the 1966 OSMA Annual Meeting
Presenting the Officers of OSMA for the Current Year
Proceedings of the House of Delegates
House of Delegates Roll Call
President’s Address (Dr. Crawford)
Outstanding Scientific Exhibits
Inaugural Address (Dr. Meredith)
Tabulation of Annual Meeting Attendance
Annual Meeting in Review — with Illustrations
Woman’s Auxiliary Report to House of Delegates
The OSMA Section for Directors of Medical Education
Ohio Academy of General Practice Annual Assembly
Woman’s Auxiliary Annual Meeting Report
( Continued on Page 750 )
STONEMAN PRESS, COLUMBUS, OHIO
[PRINTED 1
IN u s a JJ
Whe
thiazid
reserpine
alone
won’t
keep
Ohioans Inducted into Fellowship by
American College of Physicians
A number of Ohio physicians were among those
recently honored at the 47th Annual Session of the
American College of Physicians (ACP). They were
inducted into Fellowship in the medical specialty
society which represents specialists in internal medi-
cine and related fields.
Among the Fellows inducted were:
Drs. Flenry Beekley, Jerome R. Berman, Richard
C. Bozian, John L. Friedman, E. Gordon Margolin,
Louis M. Rosenberg, Stuart A. Safdi, all of Cincin-
nati; Drs. Bernard Chojnacki, Harriet E. Gillette, R.
Thomas Holzbach, O. Peter Schumacher, Eugene
Winkelman, all of Cleveland; Drs. D. Bruce Sodee
and Jim R. Young, both of Cleveland Heights;
Drs. Richard D. Carr, William A. Millhon, Robert
J. Murphy, and Robert L. Perkins, all of Columbus;
Dr. Raymond H. Murray, Dayton; Dr. Edward O.
Hahn, Fairview Park; Dr. Robert A. Hahn and Dr.
Lee Sataline, both of Lakewood; Dr. John L. Bauer,
of Middletown; Dr. R. E. Roy, of Ravenna; Dr.
Brian K. Bradford, Toledo; Dr. Viola Startzman,
Wooster, and Dr. Leonard Caccomo, Youngstown.
Dr. Louis J. Goorey, Worthington, was elected
president of the Ohio Junior Chamber of Commerce
at the recent Jaycees annual meeting in Columbus.
New Members . . .
Following are names of new members of the Ohio
State Medical Association certified to the Headquar-
ters Office during May. List shows name of physician,
county and city in which he is practicing or tempo-
rary addresses for those taking graduate work.
Butler
William T. Repasky,
Middletown
William T. Scott, Middletown
Stephane Zelling, Middletown
Cuyahoga
Berly E. Bridges, Jr., Cleveland
Cathel A. MacLeod, Cleveland
Earl F. Shields, Jr., Cleveland
Kathleen J. Simak, Cleveland
William K. Sterin, Cleveland
Geauga
Neil V. Johnston, Chardon
Hamilton
Thomas J. Ball, Jr., Cincinnati
Robert D. Green, Cincinnati
Donald H. Jansen, Cincinnati
Hamilton (Continued)
E. Bruno Magliocco, Cincinnati
Victor M. Napoli, Cincinnati
Majid A. Qureshi, Cincinnati
Thomas A. Saladin, Cincinnati
William L. Santen, Cincinnati
leva Veveris. Cincinnati
Edward W. Walters, Cincinnati
Lorain
Liselotte A. Marr, Avon
Lucas
Fernando Crotte, Toledo
Baltazar J. Reyes, Toledo
Ottawa
Luis Mantalvo, Port Clinton
Summit
Roger E. Hakim, Barberton
Dr. Samuel Saslaw, professor of medicine and
microbiology at Ohio State University College of
Medicine, received an honorary Doctor of Science
degree during commencement ceremonies at Transy-
lvania College, Lexington, Ky.
CANDIDATES FOR
“THE MOST EFFECTIVE SUNSCREEN”1 OR WINDSCREEN
RVP-Elder, called "the most effective sunscreen,” is also an
ideal windscreen.
Constant occupational exposure to sun and wind often
causes major discomfort in producing irritating sunburned
and windburned skin . . . commonly found in street workers,
construction workers, and telephone linemen, to mention a few.
There’s reassuring protection and skin comfort for those
outdoor workers who use RVP-Elder. Swimmers, golfers and
others engaged in outdoor activities can have the same skin
protection.
A razor-thin layer of only 10 microns adheres tenaciously
to the skin for hours, yet washes off easily with soap and
water. Virtually invisible, RVP-Elder is odorless, non-staining,
and perspiration and water resistant, even while swimming.
No sensitivity has been encountered.
Supplied in 2 oz. and 16 oz.
Write for clinical trial package and absorption spectrum -
References: (1) Schoch, A. G.: Current News in Dermatology,
August, 1963; (2) Jillson, 0. F., and Baughman, R. D.: Arch.
Dermat. 88:409, 1963; (3) Cole, H. N., et al.: J.A.M.A. 130: 1,
1946; (4) MacEachern, W. N., and Jillson, 0. F.: Arch. Dermat. 89:
147, 1964.
ALSO AVAILABLE: NEW RVP Aerosol, RVP-2, RVPaque, RVPellent
PAUL B. ELDER COMPANY • Bryan, Ohio
for July, 1966
633
greater potency
lower mg intake per day
600 mg versus 1,000 mg
higher activity
levels than ordinary tetracyclines
From Sweeney, W. M.; Dornbush, A. C., and Hardy, S. M.;
Amer. J. Med. Sci. 243:296 (Mar.) 1962
For the Busy Physician . . .
A FAST, CLINICALLY PROVEN ALLERGY
TEST and THERAPY SERVICE
TESTS
7 TIMES
FASTER
THAN ANY COMPARABLE
TESTING
This easy three-step allergy test kit contains 42 Aller-
gens, clinically selected. The new testing technique
allows you or your nurse to apply 7 different drops
of potent allergens to the skin at one time. It's econ-
omical, fast . . . allowing you to manage allergy
diagnosis with minimum time and cost.
TREATMENT BY R
The physician's prescription of therapeutic antigens for the individual patient are carefully
compounded in our laboratories by following the clinical diagnostic indications of skin test
and history reports submitted.
The prescription treatment sets are sent to you in four vials of graduated dilutions to
support a conservative dosage schedule and to permit a dosage adjustment if indicated by
your patient’s sensitivity.
STOCK TREATMENT SETS AVAILABLE
When clinical diagnosis indicates a clear seasonal pattern
of sensitivity you may desire a combination of the most
prevalent antigens occurring in that season. You may
choose from these stock treatment sets; Ragweed Mix,
Grass Mix, Tree Mix, Mixed Mold Treatment, Dust Treat-
ment, Animal Dander (dog, cat or horse), Stinging Insect
Mix.
NEW SPACE-SAVING PACKAGE
Allergy Laboratories of Ohio, Inc. has devised a new
package to speed your prescription and reduce space
requirements. The four vials are packed in a convenient
window-clear plastic box with patient's name, and pre-
scription numbers, face up. The bulky corrugated mailer
box is thrown away after you've received your prescription.
WRITE OR PHONE TODAY FOR PRICE LIST
AND INFORMATION ABOUT THERAPEUTIC ALLERGENS
ALLERGY
LABORATORIES
OF OHIO, INC.
150 EAST BROAD STREET — COLUMBUS, OHIO 43215
for July, 1966
637
AMA Takes Responsibility
For Project Vietnam
The American Medical Association is taking com-
plete responsibility for Project Vietnam, the program
under which American physicians volunteer to pro-
vide medical care to South Vietnamese civilians.
Under AMA auspices the program will be known as
AMA Volunteers for Vietnam.
The AMA has signed a contract with the State
Department’s Agency for International Development
(USAID), assuming complete responsibility for re-
cruitment and the administration of the program.
USAID has asked the AMA to become more
strongly involved in the program. The AMA had
previously helped recruit physicians but administra-
tion was handled for USAID by the People-to-People
Foundation, Inc.
Under the program, U. S. physicians volunteer to
work in South Vietnamese civilian hospitals on a
short-term basis, usually 60 days.
Dr. Winslow J. Bashe, Jr., associate professor of
preventive medicine at the University of Cincinnati,
has been granted a fellowship by the Pan-American
Health Organization for a three-months tour of
European facilities where he will observe methods
of preventive medicine and epidemiology.
Director Is Named for AMA
Health Care Services
Roy F. Perkins, M.D., of Alhambra, California,
has been named director of the American Medical
Association’s newly established Department of Health
Care Sendees.
The Department of Health Care Services is one
of six departments of the AMA Division of Socio-
Economic Activities. The department will be con-
cerned with community health services, voluntary
health agencies, aging, maternal and child care, group
practice, insurance and prepayment, patterns for the
organization and delivery of medical care, manpower,
and the business side of medical practice.
Dr. Edwin R. Westbrook, Warren, was named
chairman of the Trumbull County Hope Chest in the
Multiple Sclerosis Society drive. He is OSMA Coun-
cilor for the Sixth District.
Dr. Arthur E. Rappoport, Youngstown, discussed
modern improved methods of laboratory procedures
before a meeting of the New York State Association
of Public Health Laboratories. Dr. Rappoport is
consultant to the Advance Systems Development Di-
vision of IBM.
For prompt, emphatic diuresis
(BENZTHIAZIDE)
NEW FROM TUTAG for prompt, comfortable
diuretic action with a balanced excretion
of sodium chloride and a lower potassium
loss under normal dosage and diet regimen
DIURETIC ACTION: Clinically, the oral administration of AQUATAG (benzthi-
azide) results in diuretic activity within two hours with maximal natriuretic,
chloruretic, and diuretic effects occurring during the fourth, fifth and sixth hours.
Maintenance of response continues for approximately 12 to 18 hours. Acidosis
is an unlikely complication since therapeutic doses of AQUATAG (benzthi-
azide) do not appreciably increase bicarbonate excretion. Edematous patients
receiving 50 mg. of AQUATAG (benzthiazide) daily for five days developed a
maximal increase in the rate of sodium excretion on the first day, and main-
tained this high rate until depletion of excessive body stores of sodium. |
In congestive heart-failure patients, AQUATAG (benzthiazide) produced tl)e
same weight loss, during a 48-hour treatment period as did a maximally effec-
tive dose of hydrochlorothiazide.
DOSAGE: Diuresis, initially 50 to 200 mg.; maintenance 25 to 150 mg., daily.
Hypertension 50 to 100 mg. initially, adjusted to 50 mg. t.i.d. or downward to
minimal effective dosage level.
PRECAUTIONS AND SIDE EFFECTS: Electrolyte imbalance with hypoka-
lemia, hypochloremic alkalosis and hyponatremia may occur. Other reactiorfs
may include blood dyscrasias, hyperuricemia and gout, nausea, jaundice,
anorexia, vomiting, diarrhea, dizziness, paresthesia, photosensitivity and head-
ache. Insulin requirements may be altered in diabetes.
WARNINGS: Dosage of coadministered antihypertensive agents should bp
reduced by at least 50%. Use with caution in edema due to renal diseasd;
advanced hepatic disease or suspected presence of electrolyte imbalancd.
Stenosis or ulcer of small intestine have been reported with coated potassium
formulas and should be administered only when indicated. Until further clinical
experience is obtained, the use of the drug in pregnant patients should be
carefully weighed against possible hazards to the fetus.
CONTRAINDICATIONS: AQUATAG (benzthiazide)
is contraindicated in progressive renal disease or
disfunction including increasing oliguria and azo-
temia. Continued administration of this drug is
contraindicated in patients who show no response
to its diuretic or antihypertensive properties.
Before prescribing or administering, read the package
insert or file card available on request.
Available as 25 or 50 mg. scored tablets. MUDAUV
Request clinical samples and literature on your & COMPANY
letterhead. Detroit. Michigan 48234
J.TUTAG
638
The Ohio State Medical Journal
n
I
when readings
indicate hypertension
Time for
Naturetin0
SQUIBB BENDROFLUMETHIAZIDE
to reduce blood pressure
In the management of your hypertensive patients,
Naturetin is good therapy to start with, good ther-
apy to stay with.
In mild hypertension, Naturetin lowers blood
pressure gradually toward normotensive levels.
In long-term therapy, Naturetin may keep blood
pressure low— for months, sometimes years. When
used in combination with other antihypertensive
agents, blood pressure often falls further— and
lower doses of both drugs are usually possible.
Clinical trials have proven Naturetin effective—
without serious side effects.1'2 And, when used to
treat patients with cardiac edema and hyperten-
sion, "in no instance did the concentration of
serum potassium fall below 3.1 mEq. per liter."3
(Normal range for serum potassium: 3. 5-5.0 mEq./
liter).4
When readings indicate hypertension, start with
Naturetin, stay with Naturetin.
Contraindications: Severe renal impairment; previous hypersen-
sitivity.
Warning: Ulcerative small bowel lesions have occurred with
potassium-containing thiazide preparations or with enteric-coated
potassium salts supplementally. Stop medication if abdominal
pain, distension, nausea, vomiting, or C.l. bleeding occur.
Precautions: The dosage of ganglionic blocking agents, veratrum,
or hydralazine when used concomitantly must be reduced by
at least 50% to avoid orthostatic hypotension. Electrolyte dis-
turbances are possible in cirrhotic or digitalized patients.
Side Effects: Bendroflumethiazide may cause increases in serum
uric acid, unmask diabetes, increase glycemia and glycosuria in
diabetic patients and may cause hypochloremic alkalosis, hypo-
kalemia; cramps, pruritus, paresthesias, and rashes may occur.
Supplied: Naturetin (Squibb Bendroflumethiazide) 5 mg. and 2.5
mg. tablets. Also available— Naturetin c K [Squibb Bendroflume-
thiazide (5 or 2.5 mg.) with Potassium Chloride (500 mg.)]. For
full information, see Product Brief.
References: 1. Telfeyan, S. A.: Clin. Med. 70:1668, 1963. 2. Shep-
ard, H. L. : J. Am. Geriatrics Soc. 77:363, 1963. 3. Cummings, D. E.;
Goodman, R. M., and Steigmann, F. : J. Am. Geriatrics Soc. 72:161,
1964. 4. Castleman, B., ed.: New England J. Med. 268: 1462, 1963.
Squibb Quality
—the Priceless Ingredient
Environmental Health Project
Authorized for Cincinnati
With a $6.5 million United States Public Health
Service grant, the University of Cincinnati will be
in the forefront as a leading center for the study of
environmental health. The grant will launch and
cover a seven-year program for a University Center
for study of the Human Environment.
The proposed center will be university-wide, rep-
resenting disciplines in the Graduate School, Medi-
cal Center, College of Engineering, and McMicken
College of Arts and Sciences.
City and Federal health agencies, including the
USPHS Robert A. Taft Sanitary Engineering Center
in Cincinnati, will co-operate in the university center’s
activities.
Dr. Edward P. Radford, professor of environ-
mental health and physiology, is chairman of the
university’s Environmental Health Council. This is
the administrative group responsible for operating the
center.
Immediate purposes of the center include: Draw-
ing together and co-ordinating research and teaching
activities in environmental health already in existence
in the university; planning for expansion in new
areas of environmental health or strengthening exist-
ing campus resources as new programs are developed;
and developing better research and training programs
in association with the USPHS, Robert A Taft Sani-
tary Engineering Center, Division of Occupational
Health, Health Department of the City of Cincin-
nati, and Ohio River Valley Water Sanitation Com-
mission.
Areas at the university already conducting estab-
lished programs relating to environmental health in-
clude the department of environmental health and its
Kettering Laboratory, the Division of Sanitary Engi-
neering in the College of Engineering’s Department
of Civil Engineering, and the Graduate School’s Di-
vision of Community Planning.
Among a wide range of research activities in the
fields of environmental health already under way
on the Cincinnati campus are: Experimental toxi-
cology and radiation biology, effect of environmental
factors on human populations, analysis of the dis-
tribution of potential hazards in the environment,
engineering for control of environmental pollution,
planning for health evaluation and for control of
health hazards in urban environments.
Dr. Thomas E. Shaffer, professor of pediatrics at
Ohio State University College of Medicine, spoke on
the topic "Today’s Teenager,” at a meeting spon-
sored by the OSU Hillel Foundation.
Dr. Herman K. Hellerstein, Cleveland, discussed
"Prevention of Coronary Heart Disease — A Chal-
lenge” at a program in Findlay sponsored by the
Hancock County Heart Association.
Right there
where he’s needed
. . .due to
Improvement of mental alertness and aware-
ness in the management of the senility syndrome
requires a comforting environment, a stimulating
dietary regimen and concomitant drug therapy.
LEPTINOL® is a non-addictive stimulant which
is a useful adjunct in elevating the mood of the
elderly patient who displays apathy, mental con-
fusion or memory lapses.
LEPTINOL® is a combination of pentylenet-
etrazol, niacin, thiamin and ascorbic acid which
acts as a central nervous stimulant and which
exerts its primary effect on the mid-brain and the
medullary center. LEPTINOL® may be pre-
scribed for patients with mild hypertension or
other organic diseases.
Each LEPTINOL® bi-layer tablet contains: PENTYL-
ENETETRAZOL, 100 mg., NIACIN, 50 mg., THIAMINE
HYDROCHLORIDE, 1 mg., ASCORBIC ACID, 20 mg.
DOSE one or two tablets, 3 times daily.
Side Effects: overdosage may produce tremor, convulsions
or respiratory paralysis.
Caution should be taken when treating patients with a low
convulsive threshold. Patients should be warned not to exceed
recommended dose which offers maximum effectiveness.
Write for detailed literature and
starter LEPTINOL® doses.
THE VALE CHEMICAL COMPANY, INC.
Pharmaceuticals
Allentown, Pennsylvania
642
The Ohio State Medical Journal
Harding Hospital
(Formerly Harding Sanitarium)
WORTHINGTON, OHIO
For the Diagnosis and Treatment of Psychiatric Disorders
and with
Limited Facilities for the Aging
GEORGE T. HARDING, M. D. JAMES L. HAGLE, M. B. A.
Medical Director Administrator
Phone: Columbus 885 - 5381
(Area Code: 614)
eruice
of distinction
mart
Professional Protection Exclusive
......
. — — — — — — — —
. j
NORTHERN OHIO OFFICE: J. R. Ticknor, A. C. Spath, Jr., R. A. Zimmerman, Reps
11955 Shaker Boulevard Cleveland 44120 Tel. 216-795-!
CENTRAL OHIO OFFICE: J. E. Hansel and R. E. Stallter, Representatives
Room 201, 1818 West Lane Ave., P. O. Box 5684, Columbus 43221 Tel. 614-486-3939
SOUTHERN OHIO OFFICE: D. M. Routt, III, Representative
Medical Specialties Building, Room 704
3333 Vine Street, P. O. Box 20084 Cincinnati 45220 Tel. 513-751-1
~ — — -
'y | W//A ' ' „y'' , V
for July , 1966
647
Current Comments in the Field
Of the Drug Manufacturers
The following excerpts of comments from various
sources are presented in behalf of the Pharmaceutical
Manufacturers Association and drug manufacturing
firms in general.
* * *
Probably very few physicians have filed patent ap-
plications (1,600 are filled every week). And yet
few other groups have benefited more as a direct re-
sult of the patent system. In 1965, for example, the
pharmaceutical industry spent almost $1 million a
day on research and development — seeking new and
better products for the physician’s armamentarium.
What would happen, possibly in days, if the patent
system fell by the wayside? Would a drug firm
spend hundreds of thousands or millions of dollars
on a product if, having crossed the threshold of suc-
cess, it knew its competitors could gobble up the
profits? — Editorial in GP (32:5), November 1965.
* * *
Many economists are convinced that the American
system of patents and trademarks and brand names
has been a vital factor in the great progress of the
United States and its leadership in establishing a
standard of living superior to that anywhere else in
the world. The factors involved include not only
this system but also the right to advertise, the right to
disseminate information, and the right to legitimate
pride in distributing as widely as possible the bene-
fits of new inventions and discoveries. How much
time must pass before the ultimate effects of the new
(drug) legislation become apparent is difficult to
predict. The effects are only beginning to be felt.
Perhaps the time is near when the legislators will have
to take a second look. — Morris Fishbein, M. D., in
Postgraduate Medicine, (39:205-20 6), February 1966.
* * *
When a prescription contains a generic name, it is
still incumbent on the pharmacist to dispense a drug
he knows to be of the highest quality. Shall we give
our patients the cheapest? Is it through no accident
that cheap has come to mean inferior as well as in-
expensive? When a reputable and well known house
puts its name on a product, it has added something
to it, and what may be its most important element.
If we could be sure that our patients could get the
same medication and save money while doing it, other
arguments might not carry the day. But if there is
a difference, then it is well worth it. — Frank Cole,
M. D., in Nebraska State Medical Journal, (50:507),
October, 1965.
* * *
Mussolini abolished drugs from the Italian patent
system in 1939. Now more than 750 Italian labora-
tories devote their entire production to pharmaceuti-
cals developed by foreign drug companies or by other
Italian firms. These labs generally employ fewer
than 10 persons and rarely more than 50.
Bamadex® Sequels®
Contraindications: In hyperexcitability and in agi-
tated prepsychotic states. Previous allergic or
idiosyncratic reactions.
Precautions: Use with caution in patients hyper-
sensitive to sympathomimetic compounds, who
have coronary or cardiovascular disease, or are
severely hypertensive.
Dextro-amphetamine sulfate: Use by unstable in-
dividuals may result in psychological dependence.
Meprobamate: Careful supervision of dose and
amounts prescribed is advised; especially for pa-
tients with known propensity for taking excessive
quantities of drugs. Excessive and prolonged use
in susceptible persons, e.g. alcoholics, former ad-
dicts, and other severe psychoneurotics, has been
reported to result in dependence. Where excessive
dosage has continued for weeks or months, re-
duce dosage gradually. Sudden withdrawal may
precipitate recurrence of pre-existing symptoms
such as anxiety, anorexia, or insomnia; or with-
drawal reactions such as vomiting, ataxia, trem-
ors, muscle twitching and, rarely, epileptiform
seizures. Should meprobamate cause drowsiness
or visual disturbances, reduce dose — operation of
motor vehicles, machinery or other activity re-
quiring alertness should be avoided. Effects of
excessive alcohol consumption may be increased
by meprobamate. Appropriate caution is recom-
mended with patients prone to excessive drinking.
In patients prone to both petit and grand mal
epilepsy meprobamate may precipitate grand mal
attacks. Prescribe cautiously and in small quanti-
ties to patients with suicidal tendencies.
Side Effects: Overstimulation of the central nerv-
ous system, jitteriness and insomnia or drowsiness.
Dextro-amphetamine sulfate: Insomnia, excita-
bility, and increased motor activity are common
and ordinarily mild side effects. Confusion, anx-
iety, aggressiveness, increased libido, and halluci-
nations have also been observed, especially in
mentally ill patients. Rebound fatigue and de-
pression may follow central stimulation. Other
effects may include dry mouth, anorexia, nausea,
vomiting, diarrhea, and increased cardiovascular
reactivity.
Meprobamate: Drowsiness may occur and can be
associated with ataxia, the symptom can usually
be controlled by decreasing the dose, or by con-
comitant administration of central stimulants.
Allergic or idiosyncratic reactions: maculopapu-
lar rash, acute nonthrombocytopenic purpura
with petechiae, ecchymoses, peripheral edema
and fever, transient leukopenia. A case of fatal
bullous dermatitis, following administration of
meprobamate and prednisolone, has been re-
ported. Hypersensitivity has produced fever,
fainting spells, angioneurotic edema, bronchial
spasms, hypotensive crises (1 fatal case), anuria,
stomatitis, proctitis (1 case), anaphylaxis, agranu-
locytosis and thrombocytopenic purpura, and a
fatal instance of aplastic anemia, but only when
other drugs known to elicit these conditions were
given concomitantly. Fast EEG activity, usually
after excessive dosage. Impairment of visual ac-
commodation. Massive overdosage may produce
drowsiness, lethargy, stupor, ataxia, coma, shock,
vasomotor, and respiratory collapse.
648
The Ohio State Medical Journal
lutazolidinalka
snylbutazone 100 mg.
ed aluminum
Jroxide gel 100 mg.
gnesium trisilicate 150 mg.
■natropine
thylbromide 1.25 mg.
Usually works within 3 to 4 days
in osteoarthritis
e trial period need not exceed 1 week. In
ntrast, the recommended trial period for
lomethacin is at least 1 month.
at’s why it’s logical to start therapy with
tazolidin alka — you’ll know quickly whether
not it works. And usually, it will.
arge number of investigators have re-
rted major improvement in about 75% of
ses. Some patients have gone into remis-
>n. Relief of stiffness and pain may be fol-
ved quickly by improved function and res-
Jtion of other signs of inflammation. And
itazolidin alka is well tolerated, especially
ice it contains antacids and an antispas-
>dic to minimize gastric upset.
'ntraindications
ema, danger of cardiac decompensation;
Jtory or symptoms of peptic ulcer; renal,
patic or cardiac damage; history of drug
ergy; history of blood dyscrasia. The drug
ould not be given when the patient is se-
e, or when other potent drugs are given
ncurrently. Large doses are contraindi-
ted in patients with glaucoma.
^cautions
•tain a detailed history and a complete
I ysical and laboratory examination, includ-
ing a blood count. The patient should be
closely supervised and should be warned to
report immediately fever, sore throat, or
mouth lesions (symptoms of blood dyscrasia);
sudden weight gain (water retention); skin
reactions; black or tarry stools. Make regular
blood counts. Use greater care in the elderly.
Warning
If coumarin-type anticoagulants are given
simultaneously, watch for excessive increase
in prothrombin time. Pyrazole compounds
may potentiate the pharmacologic action of
sulfonylurea, sulfonamide-type agents and
insulin. Carefully observe patients receiving
such therapy.
Adverse Reactions
The most common are nausea, edema and
drug rash. Hemodilution may cause mod-
erate fall in red cell count. The drug may
reactivate a latent peptic ulcer. Infrequently,
agranulocytosis, generalized allergic reac-
tion, stomatitis, salivary gland enlargement,
vertigo and languor may occur. Leukemia
and leukemoid reactions have been re-
ported but cannot definitely be attributed to
the drug. Thrombocytopenic purpura and
aplastic anemia may occur. Confusional
states, agitation, headache, blurred vision,
optic neuritis and transient hearing loss
have been reported, as have hepatitis,
jaundice, and several cases of anuria and
hematuria. With long-term use, reversible
thyroid hyperplasia may occur infrequently.
Dosage
The initial daily dosage in adults is 300-600
mg. daily in divided doses. In most in-
stances, 400 mg. daily is sufficient. When
improvement occurs, dosage should be de-
creased to the minimum effective level: this
should not exceed 400 mg. daily, and is
often achieved with only 100-200 mg. daily.
Also available: Butazolidin®,
brand of phenylbutazone
Tablets of 100 mg.
Geigy Pharmaceuticals
Division of Geigy Chemical Corporation
Ardsley, New York BU-3804 P
Geigy
The Historian’s Notebook
Health Officers of Cincinnati, Ohio
And the Problems of Their Day
1900 to 1960
KENNETH I. E. MACLEOD, M. D., M.P.H.*
PART I
Dr. Clark W. Davis: 1900-1904
DR. CLARK W. DAVIS, who took over the
reins from Dr. W. A. R. Kenney on April
10, 1900, gave the population of the city
that year as 325,902. The deaths numbered 5,412
giving a mortality of 16.60 per 1,000.
"I find that the City of Cincinnati is to be con-
gratulated on entering the 20th century with the low-
est mortality in her career ...” he added.
As to the causes of mortality, the Health Depart-
ment had just adopted the Bertillon system — the
international nomenclature as adopted by the Eighth
International Congress of Hygiene and Demography,
held at Paris in 1900. But like his predecessors,
Dr. Davis had a problem with reporting. "I cannot
urge too strongly upon the attention of physicians
and midwives the vital importance of promptly re-
porting to this office all births . . .” he wrote.
The Dunham Hospital
There is one disease that in cities causes a greater mortality
than any and all other infectious or contagious diseases com-
bined, and more than any epidemic that has prevailed for
a decade, and also about which people are least anxious ow-
ing to their lack of knowledge. I refer to consumption in
all of its forms . . .
Congratulating the city on being "wide awake to
the inroads of the disease,” Dr. Davis noted that
Cincinnati had established "the first municipal hospi-
tal for the exclusive treatment of the disease — The
Dunham Hospital.” The average daily number of
patients treated,
he gave as
follows :
Year
Average
Year
Average
1897
20
1900
45
1898
30
1901
53
1899
38
1902
57
Diphtheria
Dr. Davis established a system of mailing in tubes
whereby each culture is sent to the Department through the
mail by the attending physicians . . . We are particularly
qualified to handle these cultures . . .Also, antitoxin is fur-
*Dr. Macleod, Cincinnati, is Commissioner of Health, City of
Cincinnati.
Submitted March 16, 1966.
nished the poor of our city free of charge. This, however,
is done under the general supervision of our assistant health
officers — the district physicians . . .
Venereal Disease and Prostitution
"On the first of October, 1900, this department
began the medical inspection of the prostitutes of
the city. The result of such inspection has been
phenomenal ...” In this connection, Dr. Davis
praised also Judge Lueders of the Police Court who
encouraged "all evil-doers to lead better lives. He has
given many of these fallen women an opportunity
to reform by sending them to the homes of their
parents and relatives instead of sending them to the
Workhouse ...” But he urged that in order to make
"this system of inspection complete the city must
have a venereal clinic or hospital ...”
Other Problems
Dr. Davis urged the erection of an isolation hos-
pital to take care of the other serious infectious dis-
eases such as diphtheria and scarlet fever. He com-
mended the "fine work” of the laboratory which has
"never had better facilities for expert work than at
this time.” He deplored the fact that
chemicals are being resorted to by a class of milkmen who
find it cheaper to use these adulterants and poisons for the
preservation of milk than to give the proper time and at-
tention requisite for abolute cleanliness of milkbuckets and
milk cans . . .
He was also concerned about the water supply which
"unfortunately is not all that could be desired . . .”
But the new water works "now in course of construc-
tion” would be a major step in improving the supply.
He urged that school buildings meantime, be supplied
with filters.
On school health, he noted that "among 47,000
school children there is a large percentage from
homes infected with disease ...” He urged "there-
fore, the thorough weekly inspection of schools and
school children.”
Among other items, he was concerned with public
dumps, tenement housing, public convenience sta-
( Continued on page 657)
654
The Ohio State Medical Journal
tions, accurate recording of vital statistics and the
inspection of meat. The staff numbered 82 includ-
ing the district physicians, the various inspectors, and
the clerks. But there were still no nurses in the
Department.
Dr. Samuel E. Allen: 1905-1906
One of Dr. Allen’s first acts was to establish a
card index system so that each birth could be recorded
and duly indexed daily. The enactment of child
labor laws had increased the importance of this
branch of the Bureau of Vital Statistics. Employees
were prohibited, under the law, from employing
children under 14 years of age. As well as verifica-
tion as to age, a certificate of schooling was also
necessary, signed by the superintendent of public
schools, as a condition of employment.
In regard to school inspections, Dr. Allen wrote
in his annual report (1906) that
appeals for many years for the establishment of a school
inspection system have at last borne fruit. Such a system
went into force on January 1, 1907 . . . The physician must
put himself in communication with the principal in each
school in his district every day. If his services are required,
he shall visit the school and examine the pupils referred to
him. All pupils who return to school after an absence of
four consecutive days shall also be examined . . .
On accidents in the streets, he noted that there
were 22 such accidents in 1906, with a total of 80
persons injured or killed. There were 13 deaths.
Illustrative of the developing street accident problem,
he noted that "Dr. J. S. Atkin’s auto caught between
two cars on Vine Street Hill exploded, 16 being hurt,
two very seriously . . .”
At a time when only about 3 per cent of the
population attained an age in excess of 65 years, he
noted that "the greatest age attained by a decendent
in 1906 was 96 years ... a widower born in Ger-
many ...”
Dr. Mark A. Brown: 1907-1909
Dr. Brown, now in charge of the Department’s
school health program noted that the following cases
were referred for treatment through the system:
Defective eyesight 3184
Diseases of eyes 502
Defective hearing 272
Otitis media 190
Hypertrophied tonsils 1818
Adenoids 486
Tonsilities 459
As to the importance of the milk supply, he wrote :
The milk Supply is rapidly assuming the most important
place in health department work. With the passage of new
and more stringent laws, the work of the milk inspector has
become more and more arduous ... It is therefore recom-
mended that the corps of assistants be increased . . .
Like his predecessors, Dr. Brown had a problem
in obtaining complete reporting from the physicians.
He expected a large increase in the birth returns, now
that by the law establishing a Bureau of Vital Sta-
tistics "the prompt and permanent registration of all
births and deaths within the State of Ohio” was
required. A penalty of $50 for failure to report
could be extracted under this law.
Vitally concerned with tuberculosis control, Dr.
Brown noted that
the tuberculosis dispensary has continued its career of use-
fulness . . .177 patients applying for relief . . . Probably its
most important work is in the prevention of infection among
those, who by ties of relationship, are compelled to be in
more or less close contact with the tuberculous. During the
past year the reporting of consumptive cases by physicians
has steadily improved, but it has not yet reached as high a
standard as it should . . .
Some 6000 specimens were examined in the public
health laboratory, an increase of 11 per cent over the
previous year (1906). These included 382 Widals
tests for typhoid fever, of which a number of 131
were positive. During 1907 there were 1,252 cases
of typhoid actually reported.
In 1909 the roster of the Department indicates a
total of staff of 78 and three of that number were
school nurses. After this we find gradually more and
more nurses added.
The improved state of the milk was due not only
to the work of the Department, but the interest of the
Milk Commission of the Academy of Medicine. A
system of education was tried out by the milk and
dairy inspectors. This was expected to show "a
material increase on the number of tuberculin tested
herds.”
The death dealers from among the infectious dis-
eases in 1909 were:
Deaths
Cases
Tuberculosis
859
1,058
Typhoid fever
46
1,252
Diphtheria
38
426
Scarlet fever
14
388
Measles
2
400
Whooping cough
21
136
Smallpox
1
253
Chickenpox
0
307
Cerebrospinal fever
11
15
Mumps
0
16
Erysipelas
32
91
Dr. J. H. Landis: 1909-1915
Dr. Landis took over the Department during 1909
with a staff of 89 inspectors, physicians, nurses, lab-
oratory workers and clerks. There were now four
public health nurses — one in anti-tuberculosis work,
the other three in the Bureau of School Hygiene.
The two special "sanitarians” in the Bureau of In-
fectious and Contagious Diseases presumably were
engaged largely in "fumigation.”
In these several reports, school health and milk
inspection are given pride of place as the major ac-
tivities in the Department. The "educational work”
with the dairymen was beginning to pay off. Milk
houses were being built, and sanitary milking pails
"of the closed top” variety were beginning to become
standard.
(To Be Continued in August Issue)
for July, 1966
651
if w ♦ if i Established 1916
ptm • Asheville, North Carolina
An institution for the diagnosis and treatment of psychiatric and neurological illnesses,
rest, convalescence, drug and alcohol habituation. There are ample facilities for classification
of patients
Insulin coma, electroshock, psychotherapy, occupational and recreational therapy are employed. The
hospital is equipped with complete laboratory facilities, including: electroencephalography and x-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town in the beautiful Smoky
Mountain Range, an ideal location for rehabilitation.
WM. RAY GRIFFIN. Jr., M. D. MARK A. GRIFFIN, Sr., M. D.
ROBERT A. GRIFFIN, M. D. MARK A. GRIFFIN, Jr., M. D.
For rates and further information write APPALACHIAN HALL, Asheville, N. C.
Android
(thyroid-androgen)
TABLETS
®
Effectiveness confirmed by another double blind study*
ANDROID
GOOD TO EXCELLENT 75%
PLACEBO
20%
SUMMARY
1. Forty cases reported.
2. Excellent to good results, 75% with Android, 20% with
3. Cites synergism between androgen and thyroid.
4. No side effects in patients treated.
5. Alleviation of fatigue noted.
6. Case histories on 4 patients.
7. Although psychotherapy still needed, role of
chemotherapy cannot be disputed.
CONTRAINDICATIONS - Methyl testosterone is
Placebo not to be used in malignancy of reproductive
organs in male, coronary heart disease, hyper-
thyroidism. Thyroid is not to be used in heart
disease, hypertension unless the metabolic
rate is low.
CAUTION: Federal law prohibits dispensing
without prescription.
*“Sexual impotence treatment with methyl testosterone - thyroid (ANDROID) a
double blind study” - Montesano, Evangelista: Clinical Medicine, April 1966.
REFER TO
ANDROID
Each yellow tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. (1/6 gr.) 10 mg.
Glutamic Acid „ 50 mg.
Thiamine HCL 10 mg.
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
ANDROID-HP
Each red tablet contains:
Methyl Testosterone 5.0 mg.
Thyroid Ext. (1/2 gr.) 30 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
ANDROID
Each orange tablet contains:
Methyl Testosterone 12.5 mg.
Thyroid Ext. (1 gr.) 64 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 or 2 tablets daily.
Available:
Bottles of 60,500.
Write for literature and samples:
( BRolWfc THE BROWN PHARMACEUTICAL CO. 2500 W. 6th St., Los Angeles, Calif. 90057
ANDROID-PLUS
Each white tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. (Vt gr.) 15 mg.
Ascorbic Acid
(Vit. 0 250 mg.
Glutamic Acid 100 mg.
Pyridoxine HCL 5 mg.
Niacinamide 75 mg.
Calcium Pantothenate 10 mg.
Vitamin B-12 2.5 meg.
Riboflavin 5 mg.
Dose: 1 tablet twice daily.
Available:
Bottles of 60, 500.
658
The Ohio State Medical Journal
Many
anxious
patients
need more
than just
calming.
Stelazine
brand of trifluoperazine /
offers
true
tranquilization
Sedative or muscle relaxant-type tranquilizers are often all that's
needed for patients with temporary situational anxiety. But in
the many patients whose anxiety presents a continuing problem
these agents are limited by their generalized dulling effects.
'Stelazine' can attack anxiety directly without producing
annoying dulling effects. On 'Stelazine', patients can react
more normally to day-to-day stress yet remain alert, able to
carry on their normal activities.
Contraindicated in comatose or greatly depressed states due to CNS depressants
and in cases of existing blood dyscrasias, bone marrow depression and pre-existing
liver damage. Principal side effects, usually dose related, may include mild skin
reaction, dry mouth, insomnia, fatigue, drowsiness, dizziness and neuromuscular
(extrapyramidal) reactions. Muscular weakness, anorexia, rash, lactation and
blurred vision may also be observed. Blood dyscrasias and jaundice have been
extremely rare. Use with caution in patients with impaired cardiovascular systems.
Before prescribing, see SK&F product Prescribing Information.
Smith Kline & French Laboratories, Philadelphia
for July, 1966
6 59
Army Medical Department Issues
Edition in History Series
The Medical Department: Medical Service in
the Mediterranean and Minor Theaters; U. S. Army
in World War II, the Technical Services; by Charles
M. Wiltse, Ph. D., Litt. D., chief historian, U. S.
Army Medical Service. (Catalog No. 64-60004,
$5.00 from the Superintendent of Documents, U. S.
Government Printing Office, Washington, D. C.
20402.) The volume opens with a graphic descrip-
tion of the field medical service in action, then
proceeds to an account of medical activities at the
Atlantic bases from Greenland to Brazil, and in Cen-
tral Africa and the Middle East — all areas in which
the establishment of supply routes and a defensive
perimeter preceded and supported combat operations
against the European Axis. The remaining chapters
are devoted to combat medicine, including one on
Anzio, another on the invasion of southern France,
etc.
Dr. Delbert A. Russell, Lorain, was elected presi-
dent of the Eastern States Radiological Society at
the group’s annual meeting in Southern Pines, N. C.
He is a past president of the Cleveland Radiological
Society, and the Ohio State Radiological Society, and
is now counselor for Northern Ohio to the American
College of Radiology.
1966 Edition of New Drug Text
Is Available from AMA
New Drugs Evaluated by the AMA Council on
Drugs, 1966 Edition ($4.00, American Medical Asso-
ciation, 535 N. Dearborn Street, Chicago, Illinois
60610; $3.00 to medical students, interns and resi-
dents). New Drugs has been planned to meet the
specific needs of the practicing physician for a
source of up-to-date, authoritative, and unbiased in-
formation on more recently introduced drugs. This
second annual edition has been enlarged and im-
proved by the addition of five new chapters, mono-
graphs on over 30 recently introduced drugs, etc.
OSU Alumni Honored
Four physicians were honored at the recent reunion
of the Medical Alumni Association of Ohio State
University College of Medicine. Receiving alumni
achievement awards were Dr. Edwin H. Artman,
Chillicothe practitioner, and Past President of the
Ohio State Medical Association; Dr. Samuel Saslaw,
Columbus, professor at OSU, recognized for his re-
search in infectious diseases; Dr. Emmerich von
Haam, professor and chairman of the OSU Depart-
ment of Pathology; and Dr. E. Richard King, chair-
man of the Department of Radiology, University of
Virginia.
in treating topical infections, no need to sensitize the patient
USE ‘POLYSPORINUd
POLYMYXIN B-BACITRACIN
ANTIBIOTIC OINTMENT
broad-spectrum antibiotic
therapy with minimum risk
of sensitization
Caution: As with other antibiotic products, prolonged use may result in overgrowth
of nonsusceptible organisms, including fungi. Appropriate measures should be
taken if this occurs. Contraindication: This product is contraindicated in those
individuals who have shown hypersensitivity to any of its components.
Supplied: In Vz oz. and 1 oz. tubes .
Complete literature available on request from Professional Services Dept. PML.
JZi BURROUGHS WELLCOME & CO. (U.S.A.) INC.,Tuckahoe,N.Y.
660
The Ohio State Medical Journal
Sound Perception
Its Theoretical History and Present Status*
JAMES T. McMAHON, M. D.
T
WO vast areas of knowledge are the physics of
sound and the psychology of hearing. Between
these two is an abyss which the theory of hearing
occupies only partially. The question as to how physi-
cal phenomena are converted into psychological ex-
perience leads one down a difficult and tortuous path.
It demands a multidisciplinary approach, with physics,
anatomy and physiology, psychology, and philosophy
each having a prominent place.
From Philosophy to Biophysics
Greek epistemologists, in their search for the
sources and validity of knowledge, were probably
among the first to survey this unsettled ground.
Primitive thinking began by equating what was
sensed to the outside world. This might be called
the principle of resemblances. It took centuries of
reflection for the development of the idea that per-
ception was analogous to the stimulating physical
event, but no more than that. And indeed, this
may be extended to include all knowledge, from a
solipsistic standpoint. Tmth then, and its human
counterpart, knowledge, are sadly not so closely
related as Bacon would have us believe when he
claimed them to be as like "a ray of light and its
reflection.”
When one forgets the above limitation, common
to all theories and theorizing, difficulties of all sorts
* Thesis presented by the author while a student in Senior Surgery
during the summer quarter, 1965, at The Ohio State University
College of Medicine.
The Author
® Dr. McMahon, Columbus, is a 1966 graduate of
The Ohio State University College of Medicine.
arise. These difficulties are usually reconcilable
through semantic clarification. Every freshman phil-
osophy course has, for example, some problem of
this type. One appropriate to our case in point is:
"If a tree falls in the woods with no one near
enough to hear it, does it make a sound?” This
might serve to digest one class period with a good
bit of verbal and hopefully mental gymnastics. But,
as is often true, the issue is decided by what one
means. The term "sound” has two uses, and al-
though related they are quite distinct as to their
reference. The psychologist or physiologist is refer-
ring to the perception of a physical disturbance of
the transmittting media. The physicist, on the other
hand, concerns himself only with the physical dis-
turbance itself and its transmission.
Written sensory theory began with Empedocles8
circa 450 B. C. His explanation of sound perception
was the mere application of the principle of resem-
blances referred to previously. He stated that the
organ of perception had miniature duplications of
the stimulus which would leak through pores and
impress themselves upon the mind. That is, the eye
665
contained light and the middle ear cavity, air. This
" tympanic air” was allegedly of a particularly refined
type — pure and ethereal. Its origin was explained
by Plato4 to be implanted in utero, an idea it took
2000 years to supplant.
The next major contribution was by Galen, who
contributed to the anatomical knowledge by tracing
the eighth nerve down its bony path.8 In the six-
teenth century, knowledge of the ear shot forward by
great strides with the discovery of the ossicles and
the cochlear windows. When Eustachius, in 1564,
described the tube bearing his name, the connection
between the pharynx and the middle ear cast much
doubt upon the implanted air theory.
In 1566, Coiter wrote De Auditus Instrumento, the
first book dealing specifically with the ear. It was he
who denounced the implantation theory. But a cen-
tury later Perrault revived it by placing the implanted
air in the cochlea, a fact incorrectly assumed but
widely accepted at the time.8 At this same time,
Schelhammer by armchair theorizing, opposed the
implantation theory on the grounds that if air is
the conductive medium it cannot also be the percipient
agency. He reasoned further, "perception requires
that the aerial waves be stopped and their energy
changed to a new form.”8 It was not until 1760,
however, when Cortugno demonstrated fluid in the
cochlea, that the Platonic "implanted air” became
fully discredited.3
It was in 1605 that Caspar Bauhin, then a student
of medicine, formulated his resonance theory of
hearing.1 Due to the paucity of micro-anatomical
information available to him, Bauhin was speaking of
cavity resonance only; but it is still his theory that
one must consider the prototype for that of Helm-
holtz, which was to follow 250 years later. In this
interim, many things were discovered and many
mechanisms proposed. DuVerney localized tones
along the osseous spiral lamina.3 At about this same
time, Corti described his spiral organ.8
It was Helmholtz who colligated these facts and,
through his influential position, drew world-wide at-
tention to the resonance theory of hearing. In 1857,
the modern period of auditory theory was ushered in
when Helmholtz gave his famous public lecture on
the scientific foundations of music.8 By virtue of
his public and professional prominence and the de-
velopment of the theory in connection with problems
of musical harmony and perception, a great popular
interest was generated. Helmholtz was much im-
pressed by the ear’s ability to analyze sound and con-
sidered this to be conclusive evidence for the presence
of specific resonators in the ear. He appealed to
natural reasoning when he said, "When we look
about in nature for an analogue of such analysis of
periodic motion we find none other than the phe-
nomenon of sympathetic vibration.”8
As the histology of the ear was clarified, different
structures were assigned the resonating function, but
none for very long. Later experiments located sounds
along the membranous spiral. This increased the
resonator theory’s credibility and stimulated the pro-
posal of many other "place theories.”
Later, but still in the nineteenth century, frequency
theories began to appear. The most famous and in-
fluential was that of William Rutherford.3 Here,
location of stimulation along the spiral organ was
discounted as impertinent. According to him, sounds
of all kinds are capable of stimulating any of the
hair cells. Sound waves are presumed to be trans-
lated directly into nervous vibrations of the same
frequency, amplitude, and wave form, and the wave
analysis is a higher cerebral function. The ear then
becomes a relay mechanism for the stimulus. In-
terestingly, the upper limit of sound perception at
this time was believed to be from 40,000 to 60,000
cycles per second, but apparently Rutherford did not
consider this order of magnitude to be any obstacle
to the theory.3 This was probably because of the
concomitant lack of knowledge of nerve fiber char-
acteristics. As with the "place theories” before,
many variations on the theme of "frequency” also
appeared.
Lor years these two theories (really two groups
of theories), place and frequency, opposed one an-
other and proponents of each pummeled the other
with invective and occasional experimental corrobo-
ration. But much like the corpuscular and wave
theories of light, the resolution of the battle lay not
in one theory’s triumph over the other but in a com-
promise theory’s triumph over "scientistic” jealousy.
This compromise has come to be called the Duplex
Theory.5
Modern Theory
The external auditory meatus has the dual function
of maintaining a relatively constant temperature and
humidity. This condition maintains the proper
amount of elasticity in the ear drum and performs
the more physical function of being a tubal resonator.
The external auditory meatus can function to increase
the pressure amplitude in the optimal range of 2000
to 5500 cycles per second to from 5 to 10 decibels.
The sound next encounters the tympanum, which
is connected via the ossicular chain to the oval win-
dow. Here two more factors are prominent in giv-
ing mechanical advantage to the transmission.
Lirst, the areal ratio between the tympanum and
the oval window is effectively 14 to 1 (about a 23
decibel gain). Second, since the incus is shorter
than the long process of the malleus, vibrations of
the oval window are reduced in amplitude but in-
creased in power by nearly 2 to 1 (another 3 decibel
gain). This increasing of the power of the vibrations
transmitted to the inner ear is essential when going
from a lighter conducting medium to a heavier one.
Therefore, impedance matching is provided by the
tympanic membrane and ossicular system between the
The Ohio State Medical Journal
i
666
sound waves in the air and sound vibrations in the
fluid of the cochlea.
The basilar membrane is resonant with high fre-
quencies near the base and low frequencies near the
apex. This is mainly for two reasons — the differ-
ence in length of the basilar fibers and the difference
in loading by the cochlear fluid. In addition a stand-
ing wave is set up in the cochlea. This wave begins
at a low amplitude and gradually increases to a
maximum amplitude, then rapidly falls from the
energy having been dissipated. Another feature of
this standing wave is that it travels very fast along
the initial portion of the basilar membrane and
slows at the end. This rapid initial transmission
allows the high frequency sounds to travel farther
into the cochlea, spreads them out and separates them
from each other on the basilar membrane, facilitating
high frequency discrimination.
At the point of maximum amplitude, which is
characteristic for each frequency, the hair cells receive
the greatest mechanical stimulation. This mechanical
stimulation causes a shift of the 150 millivolt poten-
tial which fires the proper cochlear fiber. In addi-
tion, when the basilar membrane vibrates at low
frequencies, at least some of the fibers will fire dur-
ing each cycle of vibration and electrical recording
from the whole cochlear nerve will give a pattern
of discharge that faithfully represents the sound
frequencies entering the ear. Indeed, even up to
frequencies of 4000 cycles per second, a faithful
response can still be attained.
So, both the place and frequency theories are
partially correct and neither is completely correct.
Destruction of the organ of Corti near the stapes
destroys one’s ability to discriminate high frequency
sounds. Destruction of the apical portions of the
cochlea does not destroy one’s ability to discriminate
low tones but does reduce their loudness. Intensity
of sound is a function of the amplitude of the basilar
membrane vibration, the number of hair cells stim-
ulated, and the stimulation of certain high threshold
hair cells.
From the cochlear nerve, the impulses travel to
the dorsal and ventral cochlear nuclei, to the superior
olivary nucleus via the trapezoid body, then through
the lateral lemniscus to the inferior colliculus, the
medial geniculate body, the auditory radiations, and
finally the auditory cortex. The number of synapses
along the way varies from 4 to 6 and fibers may cross
over in at least three areas. These cross-overs are
probably the central mechanism by which the direc-
tion of sound is perceived, relative intensity and phase
lag being the criteria for comparison.
Conclusion
We have followed a mechanical wave motion in an
elastic medium to its realization in the mind, but the
philosophical question has been circumvented. Our
experiences of quality, i. e., tone, color, odor and the
like are highly indirect appreciations of the properties
of physical objects. They are effects produced within
ourselves through the translation of physics into
biology and biology into psychology. The exact na-
ture of this physico-psychic translation remains un-
known. Our senses, the object of our quest and at
the same time the instruments with which we carry
out the search, may never give up this secret.
References
1. Bartelmez, G. W. : The Origin of the Otic and Optic
Primordia in Man. /. Comp. Neurol., 34:201-232, 1922.
2. DeWeese, D. D., and Saunders, Wm. H.: Textbook of
Otolaryngology, ed. 2, St. Louis: The C. V. Mosby Co., 1964
3. Dittrich, F. L., and Extermann, R. C.: Biophysics of the Ear,
Springfield, 111: Charles C. Thomas, 1963.
4. Guggenheim, Louis: Phylogenesis of the Ear, Culver City,
Calif.: Murray and Gee, 1948.
5. Guyton, Arthur C.: Textbook of Medical Physiology, ed. 2,
Philadelphia: W. B. Saunders Co., 1961.
6. Myers, David, et al.: Otologic Diagnosis and the Treatment
of Deafness. Clin. Sympos., 14:39-73, (April-June) 1962.
7. Shortley, George H., and Williams, Dudley: Elements of
Physics, ed. 3, Englewood Cliff, N. J.: Prentice-Hall, Inc., 1961.
8. Wever, Ernest Glen: Theory of Hearing, New York: John
Wiley & Sons, 1949.
OPERATING UNDER THE PROFIT SYSTEM, the pharmaceutical in-
dustry has made enormous contributions to our society. Indeed, nearly
all the valuable new drugs of the last 30 years — penicillin and streptomycin
are notable exceptions — have been discovered in the manufacturers’ laboratories.
Since the October revolution in 1917 the state-owned industry in the U. S. S. R.
has not produced a single new dmg of therapeutic importance. We must there-
fore be careful not to kill the goose which has laid so many golden therapeutic
eggs by excessive bureaucratic restrictions — still less by nationalization. — Quoted
from Sir Derrick Dunlop by J. Mark Hiebert, M. D., at the Pharmacy Colloquium,
University of Kansas, April 13, 1966.
for July, 1966
667
The Middle Ear
A Simplified Discussion of Some Common Disorders
WILLIAM H. SAUNDERS, M. D.
"1 ^ACH of the three parts of the ear — outer,
H middle and inner — has a separate job to do,
— ^and each part is subject to different diseases and
different symptoms.
The external ear is made up of the auricle and the
external ear canal. Its disorders usually come from
two sources. One is infection of the epithelium,
which causes pain. The other is obstruction by ceru-
men, which may cause partial loss of hearing. Cer-
tain lower animals with large external ears — the
bat, for example — may improve their hearing by
"cocking” them. "Cocking” the auricle enables it
to do a better job of collecting sound waves. In
man, however, the external ear contributes very little
to the hearing process. Mainly, its job is to protect
the middle ear.
The eardrum stretches across the deepest part of
the ear canal and separates the external ear from
the middle ear. It is about as large as the eraser
end of a pencil. Actually, it is not as fragile and
as easily damaged as most physicians think for it
has three layers that make it rather tough. Its outer
epithelium is squamous like that of the ear canal,
its inner epithelium is mucosa like that of the middle
ear. Between is a tough fibrous layer. Besides pro-
tecting the middle ear from outside weather and dirt,
the eardrum is an important part of the hearing
mechanism. This function will be explained later.
The middle ear, which lies directly behind the ear-
drum, is a small air-filled space in the tympanic por-
tion of temporal bone. In the middle ear are the
body’s three smallest bones — the malleus, incus and
stapes. In it, too, are the facial nerve and the chorda
tympani nerve — the latter provides taste for the
anterior part of the tongue.
The middle ear has two exits. One, which is
blind, leads into the honey-comb of mastoid cells.
The other, the eustachian tube, opens into the naso-
pharynx. The job of the eustachian tube is to equal-
ize air pressure between the middle ear and the
throat. To feel how it works, hold your nose and
swallow. You will note a sensation of pressure in
the ear as the tube opens and admits air to the middle
ear. Sometimes you must swallow again to relieve
the fullness; this time air is escaping from the middle
ear, where it has been trapped under slight pres-
Submitted November 8, l'XO.
The Author
• Dr. Saunders, Columbus, is Professor and
Chairman, Department of Otolaryngology, The
Ohio State University College of Medicine.
sure. Normally our eustachian tubes are closed.
Whenever we yawn or swallow, however, each tube
opens a little and brings air pressure in the middle
ear to equilibrium with the outside atmosphere.
The three auditory ossicles in the middle ear form
a chain that conducts sound from the eardrum across
the middle ear to the oval window. The first bone,
the malleus, is attached to the eardrum. It joins the
second bone, the incus; an arm of the incus reaches
the third and innermost bone, the stapes. The foot-
plate of the stapes which vibrates in response to
sound waves, fits in an opening of the inner ear
called the oval window. Other parts of the stapes,
besides the footplate, include two crura, a neck and
a head. A very tiny tendon attached to the neck of
the stapes prevents excessive vibration and helps pro-
tect the inner ear against intense sound.
The mucosa of the middle ear extends into the
eustachian tube and runs along the tube until it joins
with the lining of the upper part of the throat. Mid-
dle ear mucosa also lines the inner side of the ear-
drum. It is entirely separate from the epithelium
on the outer side of the eardrum, which is derived
from skin. Later we will see what happens when
skin grows through a perforation in the eardrum and
lines the middle ear.
About the Function of the Ear
The outer ear affords protection; the middle ear,
as we will see later, amplifies sound pressure. But
the inner ear contains the organ of hearing and is
the only part of the ear with which we actually hear.
For protection, the organ of hearing with its thou-
sands of delicate, filament-like processes called "hair
cells” is bathed in endolymph. It is contained in a
fragile duct suspended in a separate and larger body
of liquid called perilymph. Besides protecting the
hair cells, endolymph also provides them nourishment.
To understand how the ear works, we must look
back millions of years to the time when all animal
668
The Ohio State Medical Journal
life was in the sea. Sounds made in the ocean
traveled through seawater directly to similar liquids
in the inner ears of aquatic animals. These animals
had no external or middle ears; theirs was a simple
arrangement. Only a membrane separated the sea
from their inner ear. Vibration of this membrane
produced hearing.
When animals crawled out of the sea to live on
land, many adjustments were necessary. For example,
the aquatic ear had to be modified if it were to work
efficiently in its new environment of air. When
sound pressure traveling in air meets water, most
of the sound striking the water is absorbed or re-
flected back into the air. Thus a fisherman in his
boat may talk without fear of disturbing the fish,
since 99-9 per cent of the sound energy of his voice
is reflected when it strikes the surface of the lake;
only one part in a thousand is transmitted to the
water. For that very reason, the early land-dwelling
animals with their aquatic ears had a hearing problem.
The liquids of their inner ear reflected most of the
sound energy which originated in their new environ-
ment— air. Only 0.1 per cent was effective in pro-
ducing hearing. To overcome this great loss, the
middle ear evolved.
Two arrangements enable the middle ear to work
as it does. First, the middle ear bones are arranged
in a lever system that amplifies sound as it traverses
them. The second and more important amplification
results from the difference in size between the two
parts connected by the chain of ear bones — the
relatively large eardmm which collects sound, and
the relatively small footplate of the stapes, which
delivers it to the inner ear. You can understand
how this arrangement works if you recall what would
happen if a woman in high heels -were to step on
your foot. Her entire weight, transmitted to a tiny
area, would drive the heel forcibly; if her weight -were
distributed more widely by a flat shoe, damage would
be less. By virtue of the mechanical advantage pro-
vided by the lever system and, more importantly, by
the differences in the area of the eardrum and the
footplate of the stapes, called the areal ratio, the
middle ear regains a great deal of the sound pressure
lost in transferring air borne sound pressure to a
liquid medium.
When sound pressure reaches the inner ear, the
perilymph and endolymph are agitated. The agita-
tion, in turn, causes a commotion of the hair cells.
Hearing results. Here is a point that deserves to
be emphasized: The only "way in which hearing can
occur is by stimulation of auditory hair cells. There-
fore, any disease that impedes the progress of sound
pressure along its route to the inner ear diminishes
hearing. But the only disease that causes total deaf-
ness or even a severe loss of hearing is one which
directly affects the hair cells or their central con-
nections. In other words, no one who has lost his
eardrum or even his entire middle ear is totally deaf
so long as the inner ear remains intact.
Sound pressure that stimulates hair cells is delivered
through the oval window into a solid bony chamber.
For there to be effective movement of inner ear
liquids and stimulation of the hair cells, there must
be a second opening for relief of pressure. The
round window provides such relief. What would
happen if sound pressure were to meet both round
and oval 'windows at exactly the same time? The
effect would be a cancellation; the ear would hear
poorly even if the sound were intense. Experi-
mentally, such an arrangement is possible. When
two sounds of equal intensity and in the same "phase”
are delivered simultaneously to the round and oval
windows of an experimental animal, there is no
hearing.
Under normal circumstances, however, such a
thing does not happen. For as the eardrum collects
sound energy and transmits it to the oval window, it
also shields the round window from sound. By doing
so, it further increases the discrepancy between the
levels of sound pressure delivered to the two win-
dows. In disease, when the eardmm is perforated,
some hearing is lost because the eardmm, no longer
intact, cannot effectively shield the round window.
Some Diseases of the Middle Ear
Causing Hearing Loss
1. Otosclerosis produces loss of hearing by fixing
or immobilizing the footplate of the stapes in the
oval window. The cause of otosclerosis is unknown,
but it has nothing to do with previous ear infections.
The disorder tends to mn in families, and it is more
common in women than men. Characteristically, the
hearing loss starts during the teens, but it is so grad-
ual that patients seldom realize their disability for
several years. It gradually worsens over the next
10 to 20 or more years. As a rule, both ears are af-
fected, although often not equally. The new growth
of bone about the stapes blocks its movement so that
it is no longer free to vibrate effectively in response
to sound pressure. At first, there is little interference.
In time, however, as the process advances, the
stapes becomes so firmly fixed that it cannot move
at all. You might think such a patient would be
totally deaf since his stapes is useless. Actually, he
can still hear very well any sounds brought to his
inner ear by "bone conduction.” In short, although
he hears poorly by the usual route, he hears clearly
if a tuning fork, for example, is applied to his skull.
Distinguishing between the patient’s ability to hear
by air and bone conduction is important in diagnosing
otosclerosis. When a patient with a normal eardrum
and a history of sloud ) progressive hearing loss hears
as well by bone conduction as by air conduction, or
hears better — he almost certainly has otosclerosis.
Otosclerosis is an excellent example of a disease
causing a serious hearing loss in which hearing can
for July, 1966
669
be restored surgically. Sometimes, in advanced cases,
the nerve of hearing has deteriorated. Then an oper-
ation is not indicated. Ordinarily, however, the
neural apparatus is unaffected.
The surgical problem is largely a mechanical one.
With the stapes fixed in the oval window, the surgeon
must either break it loose so it can move again, or
remove it completely and replace it with an artificial
"bone.” Most surgeons agree that only to free up
the stapes (the "stapes mobilization” operation) is
not enough; they think it is better in most cases, to
remove the entire bone. Stapedectomy (removing
the stapes) is generally preferred to the stapes mobil-
ization operation because, although the mobilization
operation restores hearing for a time, the otosclerotic
process continues and eventually refixes many of the
"mobilized” stapes. Patients with good hearing right
after the mobilization operation are disappointed
when their hearing later drops back to what it had
been. We will not discuss the mobilization operation
here. You can better understand otosclerosis and its
surgical treatment by learning about the stapedectomy
operation.
To enter the middle ear for stapedectomy, the
surgeon must turn or reflect the eardrum. With the
patient under local anesthesia, he makes a curved
incision deep in the ear canal close to the rim of
the eardmm. He does not cut the eardrum itself.
The back half of the eardrum, freed from its at-
tachment to the bone of the ear canal, is folded
forward on itself like an omelette. As seen through
the operating microscope which provides excellent
illumination and also magnification up to 25 times,
the tiny middle ear bones appear large and clear.
In otosclerosis, the footplate of the stapes is
solidly attached to the margins of the oval window
and, at operation, pulling on the head of the stapes
usually does not remove the entire bone; instead, the
crura break off at the footplate. Head, neck and both
crura lift out, but the footplate remains fast. So, to
dislodge and remove the footplate (size 1 by 3 mm.)
sometimes in one piece, sometimes in several, the
surgeon uses a fine needle, various picks or hooks, an
electric drill, or a combination of these instruments.
Once the footplate is out, the surgeon must seal the
open oval window. An older method was to use a piece
of vein from the back of the hand. Placed in the
ear, the vein grows across the window as a graft.
It not only seals the liquids of the inner ear, but it
also forms a vibrating diaphragm for sound transmis-
sion. But even with the obstructive footplate out
and the vein graft across the oval window, the sound
conducting mechanism is still not restored. With
the stapes gone, there is no connection between the
incus and the inner ear. The final step, then, is to
link the two with a plastic or metal "piston.” The
surgeon places one end of the piston so that it
dimples the center of the vein graft. He slips the
other end under the incus. The piston conducts
sound from incus to vein graft, and the system is
complete.
There are other newer and equally good ways of
conducting sound from incus to inner ear. After
the stapes and its footplate have been removed, the
surgeon can use a preformed loop of wire to which a
pad of Gelfoam® is attached. One end of the wire
is crimped over the incus while the Gelfoam on the
other end seals the oval window. Later, as the
Gelfoam absorbs, a membrane forms across the oval
window and incorporates the end of the wire in itself.
In that way the wire attached to the incus becomes a
plunger-like mechanism for sound transmission.
After stapedectomy, hearing improves in the great
majority of patients. This is not to say that com-
pletely normal hearing is restored, although often
it is, or that in a rare instance hearing may not become
even worse. Stapedectomy is done on only one ear
at a time. The patient’s course after operation is
ordinarily smooth, but an occasional patient may ex-
perience vertigo for a few days. The usual hospital
stay is for two or three days.
2. Middle ear infections also cause loss of hear-
ing. If the infection is new, it is called "acute”;
medical measures, such as administration of anti-
biotic drugs, usually cure the patient and restore
hearing. If the infection has been present for months
or years, it is called "chronic”; then medical measures
usually fail, and surgical treatment is required. Often
patients with chronic ear infections have tried all
sorts of medical treatments, including antibiotics and
eardrops, and they have consulted a number of physi-
cians. The patient’s ear drains most of the time, and
often the drainage is foul.
A chronic ear infection started with an acute
upper respiratory infection. The infection pro-
duced pus, and when the eardrum broke under its
pressure, pus drained from the middle ear into the
external ear canal. When the pressure was re-
lieved, the earache was relieved; but the infection
failed to clear, and the patient was left with a
perforation in his eardrum. After a time, the squa-
mous epithelium that normally lines the outer surface
of the eardrum and the ear canal grew through the
perforation into the middle ear and into the nearby
air spaces of the mastoid bone. Why "skin” from
the ear canal should grow into the middle ear where
it doesn’t belong is not clear, but when it does "skin”
lines part of the middle ear and mastoid. Elsewhere
on the body dead skin peels off. It doesn’t collect
because it is on the surface and gets washed or rubbed
off. But in the ear where the dead skin can’t get
out, it forms a soft white ball called cholesteatoma.
Growing larger, year by year, the cholesteatoma de-
stroys bone and sometimes interferes with the function
of nearby structures. Some of these adjacent struc-
tures such as the facial nerve or cochlea are important,
and others, such as the meninges are even vital. In
670
The Ohio State Medical Journal
short, a patient with an expanding ball of cholestea-
toma is in danger of developing a complication of
middle ear disease.
Not every patient with chronic disease of the mid-
dle ear and mastoid has cholesteatoma. Some just
have infection; others, however, have both cholestea-
toma and infection. In a few patients, the ear-
drum perforation is large enough to permit adequate
cleansing of the abnormal skin-lined cavity, although
usually it is not, and almost all patients with choles-
teatoma are surgical candidates. At this point it is
worth emphasizing that there are still other patients
with perforations of the eardrum who have no active
disease and no symptoms except a mild or moderate
loss of hearing. In them the middle ear has remained
normal, no skin has grown in the ear, and they are
in no danger.
When it is apparent that medical measures cannot
clear a patient’s chronic middle ear infection, his
physician may advise him to have an operation. Sev-
eral different operations are designed to eliminate
infection or to restore hearing in patients with ear
infections. The aim of all operations should be,
first, to eliminate infection, and second, to restore
hearing if possible.
The radical mastoidectomy operation, an old and
still excellent procedure, converts the draining, dan-
gerous ear into a dry, safe ear. Usually by the time
the radical mastoidectomy operation is indicated,
hearing is already at a non-serviceable level. Remov-
ing remnants of the eardrum or middle ear bones,
then does nothing to worsen hearing. It is a popu-
lar misconception that we cannot hear without the
eardrum. That, of course, is not true since the only
conditions that cause really severe deafness are those
which destroy the neural part of the hearing mechan-
ism. Radical mastoidectomy leaves a large defect in
the temporal bone and this cavity is apt to become
superficially reinfected and so after radical mastoidec-
tomy many patients have trouble with intermittent
aural discharges. Modified radical mastoidectomy is
done when the disease process is limited and when
there is likelihood of saving useful hearing.
Tympanoplasty is the name of a group of relatively
new operative procedures to restore the middle ear
and to attempt to improve hearing in patients who
have had chronic ear disease. Other occasional uses
for tympanoplasty include ears injured by trauma
or by congenital defects. For the most part, how-
ever, tympanoplasty in its several forms is used to
repair a perforation in the eardrum which resulted
from old infection, or to restore the function of the
middle ear in a patient who, formerly, would have
had to settle for mastoidectomy and poor hearing.
3. Obstruction of the eustachian tube produces
yet another type of middle ear hearing loss. The
tube often blocks during an upper respiratory infec-
tion when the adenoid tissue or mucosal lining of the
tube swells. Children, especially, are afflicted in this
way because of their relatively large amount of ade-
noid tissue. The blocking keeps air from entering
the eustachian tube whenever the patient yawns or
swallows, and the capillaries absorb what little air
there is in the middle ear. As a result, there is a
partial vacuum in the middle ear. Blood serum,
seeping through capillary walls, offsets this negative
pressure. But as blood serum fills the middle ear,
it has a damping effect on movements of the eardmm,
which no longer vibrates against an air-filled middle
ear but against one partly or even completely filled
with liquid.
This condition is less common in adults than in
children because adults have larger tubes and also
less adenoid tissue to block the tube. Even when
adenoid tissue is absent, however, obstruction of the
eustachian tube can result simply from swelling of
the membranes that line the tube itself. Sometimes,
after rapid descent during air travel, one’s ears are
"blocked” and they fail to clear as usual. If such
a "block” persists, serum may collect behind the ear-
drum just as in the child with adenoidal obstruction.
If the condition is recurrent, the treatment is to
remove the adenoid. Ordinarily this operation solves
the problem. Occasionally, though, especially in
children who come from families with allergies, the
adenoid regrows and the adenoidectomy must be
repeated. The surgeon can easily remove all of the
tonsil because it is surrounded by a capsule or mem-
brane, but he finds it difficult or even impossible to
remove all of the adenoid because it is not so
contained.
The child who has tubal obstruction from time to
time is likely to have recurrent episodes of hearing
loss. When the tube is obstructed, hearing is down;
when serum drains and air is admitted to the middle
ear, hearing improves. In short, the hearing fluctuates.
Another procedure, now' used very commonly, is
the insertion of a small hollow plastic "button”
through the eardrum. The "button” has a cuff on
each end. The inner cuff fits just inside the middle
ear to prevent the button from falling out. These
buttons, which admit air to the middle ear, may be
left in place several weeks or even several months.
Parents often think the hard of hearing child,
particularly if he has trouble only intermittently, is
just not paying attention. But for a child of normal
mentality, that is never true. Children are curious
and astute; when they seem to be hard of hearing,
they are.
In addition to these comomn disorders of the mid-
dle ear, there are others which are less common.
Diagnosis in all cases depends upon careful otologic
and audiometric examination. In general there is
available medical or surgical treatment for most dis-
orders of the external and middle ears while most
diseases of the inner ear do not respond to treatment.
for July, 1966
671
Psychiatric Aftercare
A Discussion of the Importance of Predischarge Planning
THEODOR BONSTEDT, M. D„ and HOOSHANG KHALILY, M. D.
I. Introduction
T
G || AHE TITLE of this paper contains some terms
which probably ought to be explained before-
hand. The "predischarge planning” refers to a
continuous plan of treatment of a psychiatric patient,
a plan which is worked out by his psychiatrist, usually
in collaboration with other professional people in the
hospital and community, concerning what will be
done with and for the patient prior to and after his
discharge from the hospital. The term itself is meant
to imply that such a plan is to be conceived and be
ready for implementation before an order for dis-
charge from the hospital is issued. Some authors use
the term "postdischarge planning”1; we prefer our
term as it emphasizes the necessity for planning to
be done early in the course of hospitalization.2
The concept of "aftercare” is so relatively new that
the term is not even included in the psychiatric dic-
tionary by Hinsie and Campbell (I960) nor in "The
Psychiatric Glossary” of A.P.A. (2nd Ed., 1964). In
common usage, it refers to the totality of treatment
and rehabilitation efforts on behalf of a recently dis-
charged psychiatric patient (the discharge having
taken place within a short period prior to the time
when the "aftercare” is begun). Thus, this concept is
essential for the continuity of care and treatment, as
some kind of attempt to build upon and enlarge the
gains previously made in the treatment of the patient
while he was still hospitalized.
It is also important to consider the background of
our discussion within the context of our particular
time. This happens to be a time when the so-called
"community psychiatry” is coming to play an ever
more influential role in any mental health planning,
with a stress being laid on the comprehensiveness
of mental health care. It is a time when our Federal
Government, for the first time, has not only called
attention officially to the importance of mental illness
but also has been advocating a model of a "Commu-
nity Mental Health Center.” This Center is con-
ceived not as some new organizational or physical
structure that would replace any of the previously
This paper was presented on September 17, 1965, in Cincinnati
to the (Ohio) Association of Medical Superintendents of the Di-
vision of Mental Hygiene Institutions.
The Authors
• Dr. Bonstedt, Cincinnati, is Chief, Outpatient
Service, Rollman Psychiatric Institute; Instructor
in Psychiatry, The University of Cincinnati Col-
lege of Medicine.
• Dr. Khalily, Cincinnati, is Third Year Resident
Physician, Rollman Psychiatric Institute.
existing facilities, but rather as a local network of
already existing agencies, and perhaps some added
new ones, all coordinated in such a way as to leave
no gaps in treatment experience of the patients as they
are moving from one agency to another.3
It is understood that each new agency will provide
for the patient that which he needs most at the
particular time; also, that the agency will be the
best one qualified to do so; and finally, and this per-
haps is the most important modern change or trend,
that the continuity of treatment as experienced by the
patient will be secured by the professionals working
with him previously. All too often it was, and in the
majority of communities still is, a situation where the
patients would receive the best of care from one
agency and then would be given proper and conscien-
tious advice upon discharge, to apply in turn to cer-
tain different agencies in the community (for in-
stance, a mental health clinic, a family service agency,
a rehabilitation agency, etc.). Each new agency in turn
would have its own procedure of application, screen-
ing, and requirements of admission. The inevitable
result has been what some people have come to call
"a game of musical agencies” in which patients would
be sent from one agency to another only to experience
repeated rejections for the very valid local reasons of
their being ineligible under the existing circumstances.
To put it in another way, there exist in nearly every
community some important gaps in the available
spectrum of services, these gaps being usually cen-
tered around certain "problem” patients or clients
such as alcoholics, borderline mentally deficient, ado-
lescents, and certain types of sexual sociopaths. Pa-
tients subjected to this frustrating and time-consum-
672
The Ohio State Medical Journal
ing procedure of trying to find the proper agency
(when none of the existing ones seem to offer serv-
ice quickly) would as often as not relapse and reach
a stage where they would be more disturbed and had
to be still more dependent on their communities,
oftentimes being sent back to the psychiatric hospital.
Meanwhile, each agency would feel that it certainly is
doing its best with what resources it has available.
It is precisely the realization of this type of poor co-
ordination, and an attempt to overcome it for the
best of our patients, which is a part of the modern
trends in the so-called "community psychiatry.”
When it comes to medical agencies in particular,
the comments which were just made would mean to
a community-oriented psychiatrist two things: first,
that until now, these medical agencies have faith-
fully followed the "medical model.” By this is
meant the traditional approach of general practice
and other specialties, in which by and large the physi-
cian sees himself as the one crucial person who is
to plan the treatment for his patient, who decides
when to terminate it and to release him— "after
the maximum benefit of treatment has been reached”
— back to his regular life. Thus, when today in
modern mental health planning we are trying to
become community oriented for the aforementioned
reasons, is also means that in a sense the tradi-
tional "medical model” would have to be some-
what modified in accordance with our understanding
of the important social forces at work in the lives
of our patients and our willingness to adjust our-
selves in the planning of treatment to this newly
won understanding.
II. Historical Review
It is well to remember at least the more recent
American history on this subject, in order to under-
stand better the position taken today. Until the
second half of the nineteenth century, there was no
specific planning for the mentally ill on any signi-
ficant scale; rather, they were thrown together with
the other "liabilities of the community” (the poor
and the delinquent) in alms houses and jails. Thus,
it was a responsibility of the local community but
without specialized planning.
In the second half of the nineteenth century, the
state governments took upon themselves the task of
providing the best treatment which was then known
for the mentally ill - --isolation for custodial care in
large centers awn 1 rom the local communities of
most of the patients The isolation was not broken
by the revolutionary ideas of Freud, which permeated
the psychiatry of this country in the first half of
our century, since treatment of patients was continued
to be conceived in terms of the "medical model”
(Freud himself spoke, eg, of how he felt at a loss
with relatives of patients, who are like meddlesome
spectators at a delicate surgical operation). The
psychoanalytic model of treatment through relation-
ship required so much time and manpower that
under the existing circumstances the large masses of
patients in state hospitals had to remain isolated with
primarily custodial care.
It was during the 195 0’s that a decisive change
began to take place, with a wide use of the new
tranquilizing drugs. For the first time in American
history, the census of patients in public mental hospi-
tals began to decline, and people who until then
were doomed to an indefinite stay in long-term
psychiatric hospitals began to return to the commu-
nity. With this then came the new problem of
"aftercare” on a large scale. Today it continues to
command a great part of our attention and efforts in
the mental health field.
By coincidence, it was also during the 1950’s
that studies of group dynamics and social forces came
into prominence, further weakening the assumed
adequacy of using the medical model in this area
of psychiatric endeavor. Psychiatrists quickly learned
the fmstration of seeing their patients discharged in
seemingly good spirits and then seeing them return
"crushed” by the effort of living in the original local
community, where stresses of their family life, job,
and school situation remained unchanged. An official
expression of the professional and national concern
with these matters was given in the creation of the
Joint Commission on Mental Illness and Health which
worked for five years and produced "Action for
Mental Health” report (1961) — indeed an historical
document pointing up the need for modifications in
our approaches to mental health problems in this
country in general, and to problems of aftercare in
particular.4 The report underscored the necessity of
psychiatric help in the local community, spotlighting
the locally existing shortcomings, and initiating vari-
ous attempts to orient and mobilize local communities
toward better mental health services.
III. Current Difficulties
As the new influences in the field of mental health
are beginning to be felt across the country, the in-
evitable result is that local situations represent quite
a scatter or diversity of what actually is being done
for the psychiatric patients. With respect to after-
care, in many quarters the medical model is still
followed faithfully in that the patient is simply dis-
charged from the psychiatric hospital with the hope,
expressed or implied, that somehow another hospital-
ization would not become necessary. He then goes
on and tries to do this much on his own, but does he
succeed? In a paper presented at the A. P. A. Meet-
ing in 1964 entitled "Aftercare: The Uncrossed
Bridge,” the author states:
The increased rate at which patients are leaving mental
hospitals has been one of the major achievements of our
profession in the past two decades. The deplorably high
rate at which they return — often repeatedly — remains
one of our major unsolved problems.5
This has also been our experience and impression.
It led us to take a searching look at predischarge
for July, 1966
673
planning in several accessible psychiatric hospitals.
The following clinical situations were chosen to high-
light the subsequent discussion.
Case 1. For several weeks prior to discharge of a pa-
tient, her social worker (with the knowledge of the attend-
ing psychiatrist) was making plans to have this patient
enlist the help of a local family service agency immediately
following discharge. This was felt to be the most appro-
priate solution under the circumstances of her particular
problems. A week after discharge, the social worker was
startled to see this patient in the Outpatient Clinic attached
to the hospital, and upon inquiry she found out that the
patient was told by her hospital doctor to make this ap-
pointment for follow-up in the Outpatient Clinic (which
in such a case had to mean transfer to one of the psy-
chiatrists attached to the Clinic). Needless to say, the
patient seemed as bewildered as was the social worker.
Case 2. A man in his fifties had been followed as an
outpatient by a psychiatrist for two years, but due to an
intercurrent increase in stress (and concomitant increase in
symptoms of agitation, insomnia, suicidal preoccupation)
psychiatric hospitalization was recommended. The patient
was hospitalized and the information was left on admis-
sion forms that the referring psychiatrist would be glad to
follow-up this patient after discharge, as such would prob-
ably seem advisable. However, the patient should not be
permitted to follow any impulse to leave the hospital as
quickly as possible. The referring psychiatrist was startled
to see this patient on his daily appointment roster some
three weeks later, with no prior message from the doctor or
social worker who were in charge of this patient while he
was in the hospital. From the patient’s story and from
the study of the hospital record, it appeared that he twice
signed the notice of discharge against medical advice, and
the second time he could not be persuaded to withdraw the
notice. Thus administrative approval for discharge was
given (as his being in the community represented no great
risk at the moment), and there it ended. The original psy-
chiatrist had to make momentary decisions entirely alone,
without the benefit of the experience obtained in the hospital.
We wish to make it clear that it is not our intention
to single out the individuals or hospitals that may
have been involved in these or similar cases. This
kind of failure of communication is baseline of at-
tempts to clear up inter-agency difficulties in commu-
nication as they are bound to occur between the
discharging hospital and the outside agencies. From
our experience, it appears reasonable to assume that
patients with similar "preparation” appear in many
medical and paramedical agencies of various commu-
nities following their psychiatric hospitalization. On
the other hand, it should be emphasized that in
order to improve this situation, some kind of broad,
long-range coordination of treatment efforts would
be necessary. It would miss the point if we were,
eg, simply to attempt "screening of all patients to
be referred to Clinic X.” The need here is not just
for "screening” on behalf of one agency. It is an
issue of how best to help patients in using all kinds
of agencies in our communities (including psychiatric
clinics) through all kinds of actions (including
screening — but also taking care of relaying informa-
tion, establishing proper contact, assuring this con-
tinuity of proper care by all available means) .
IV. Optimal Model of Predischarge Planning
Let us now see how this new understanding can be
put to work in a psychiatric hospital setting in such
a way as to increase the efficiency of treatment. In-
asmuch as this approach is characterized by its long
range (in time) and its comprehensiveness (in terms
of taking into account all factors infringing on pa-
tient’s fate and using them therapeutically), the
planning for what should happen at the time of dis-
charge and afterwards will have to start early in a
patient’s hospitalization — technically, as soon as the
diagnostic formulation has been worked out and
general treatment plans are formulated. The very
initial decisions about treatment to be given in the
hospital should include thinking about the future.
If drugs are going to be used, is this the kind of
patient who will depend on them and who will
avoid sharing any important feelings in psychother-
apy? Will he thereby succeed in leaving the hospital
as unprepared as before to meet the community stress ?
He will, unless, at the very beginning, individually
tailored corrections are made, such as ordering drugs
of a type and in such a manner that this particular
dependence could not be established.
If psychotherapy is to be used, is this perhaps the
patient whose problems are to a large extent rooted
in realistic family factors such as a hostile spouse,
and if so, will he be prepared to meet this stress
after discharge? He will not be unless, while the
patient is in the hospital, pressure is exerted upon
the family to come in for casework. Experience has
shown that, if the same pressure is applied after the
patient is discharged, the families of patients are
much less motivated to respond. Since the crisis in
their lives connected with the hospitalization has
just passed, why should they undertake the unpleasant
effort of exposing themselves to remedial casework?
If this is a patient whose problems lie mostly in
the area of the real social factors of vocational skills
or difficulty in finding employment, would it not be
best to discourage his interest in sharing much inti-
mate material with the doctor even if he happens
to be so motivated, and if he appears "interesting”?
Would it not be better to begin, while he is still in
the hospital, making contacts with a community
agency which could subsequently help him with such
a vocational problem? The facts of life are that such
agencies are few and far between. They have their
own complicated and involved procedures of appli-
cation and admission and usually take several weeks
to process a case. These will probably be, without
proper predischarge planning, precisely those weeks
immediately following discharge when the patient
would once more experience the same stress and,
just as unprepared, might have to be rehospitalized.
It was mentioned already that the period of hospi-
talization is the stretch of time during which the rel-
atives of the patient are much more likely to co-
operate in discussion and agreement on plans for
future follow-up and treatment after discharge from
the hospital. The same is true about community
agencies such as schools, employers, and family physi-
cians, to name only a few. A high school teacher
674
The Ohio State Medical journal
is likely to react less favorably if a few days after
discharge from the hospital she meets her teenage
pupil in the midst of some odd behavior on his
part, and then only she has to find out that there is a
psychiatrist involved, and she has to call him asking
for advice. In this situation, the teacher more likely
will send a desperate message, eg, "we shall absolutely
not have him here unless you, as a doctor, first guar-
antee that he is not going to do these various things
of which we are afraid.”
How much easier is it by comparison — and how
much more efficient — for a psychiatrist who treats
this same patient in the hospital to call the teacher
some weeks prior to the planned discharge and to
have a conference. Here, first the problem is de-
scribed as it is seen by the teacher and the psy-
chiatrist. Then the psychiatrist spells out his advice
and gives his reassurance to the teacher concerning
all those practical classroom situations which puzzle
and worry the teacher. Obviously, in the latter case,
the likelihood of avoiding repeated breakdown is
greater. Situations with employers and supervisors
on the job are very much similar to the school situa-
tion on all the listed points.
But what about the family doctor? It has been
reported by several nationwide surveys that the gen-
eral practitioners have complained about the way psy-
chiatrists do not brief them about the progress of their
patients in psychiatric treatment (in particular at the
time of discharge from the hospital). The possibility
will have to be considered early in planning for his
discharge whether the patient might benefit from a
general practitioner whom he had seen previously,
and who understands him and his family. Psychiatric
manpower is not only generally scarce and more ex-
pensive but it also often carries with it a stigma.
Furthermore, the patient may require a concomitant
treatment by a family physician for the concurrent
physical illnesses. Whether as a partner on the
therapeutic team, or as the only physician involved,
the family doctor will need a close contact through
sharing of information by the hospital doctor not
only about the diagnostic impression at the hospital
but also about the treatment used, an explanation
about the future expectations, and advice on how to
deal with foreseeable complications. Many cases
of patients getting along well on chemotherapy and
"pure support,” and not well suitable for intensive
psychotherapy, are best treated by general practition-
ers. Referring such patients routinely to a psychiatric
clinic for aftercare creates a situation in which other
patients, who would need a more specialized out-
patient skill, have to be refused for lack of available
professional time.
We hope to have shown by now why it is indeed
necessary for the best progress of our patients that
this planning for help to be offered after discharge
would take place early during the hospitalization
and that information would be shared ahead of time
with those professionals who will next care for the
patient. This is the essence of the principle of
"continuity of care.” If someone were to attempt
to do it within the last few days of the hospitalization,
he would find that it is already too late. In most of
the cases, the appropriate agency would not find it
possible on such short notice to do a meaningful
contribution to planning, such as giving advice about
still other agencies or trying to expedite the patient’s
application.
If any extramural agency is to be consulted, it
should be done early enough in the hospitalization
when all the factors involved in future planning
(beginning from patient and his relatives and on
to type of treatment and auxiliary resources) are still
available for free manipulation and adjustment of
attitudes. From this it follows that early in a pa-
tient’s hospitalization, when his case is being dis-
cussed within the hospital staff, careful attention
should be paid to the predischarge planning as it is
outlined in this paper. This properly timed plan-
ning cannot be substituted by even a most thorough
letter or message of referral at the last minute to
the professional person about to take over respon-
sibility for the discharged patient, even though it is
true that such transfer message to any extramural
agency is a professional necessity without which the
treatment of a patient receives another blow with re-
suiting lack of continuity.
The realization that continuity of treatment is
lacking, and that our efforts are not the best they
could be, can be made only by the psychiatric pro-
fessional. Patients may feel a vague dissatisfaction
at such discontinuity, but they will be unable to
question the whole mystifying and specialized com-
plex of medical procedures in any of its parts. Thus
it comes to be that a system without adequate pre-
discharge planning may "work” in the sense that
there will be no specific complaints and the totality
of failures will be ascribed to other causes. It is up
to the psychiatric profession to recognize this particu-
lar contributing cause. This has been done in some
training centers, at least one of which has documented
this recognition with appropriate research.2
From all that has already been said, it can be seen
that where the same doctor continues to see a patient
after discharge, some of the difficulties of the pre-
discharge planning will be automatically overcome.
This is one of the reasons why follow-up of one’s
own discharged patients is always encouraged. Not
only is it best for the patients, but in psychiatrist’s
own training and experience it results in a more
complete exposure to the successive realities of treat-
ment, rather than in a fragmented experience: "Until
now I have been in charge and now somebody else
will take over and I don’t have to worry about it.”
It can usually be shown that, where a doctor expects
to follow up a particular patient after discharge, he
for July, 1966
675
is also likely to be more careful in preparing for
discharge.
There is at least one well documented research
project which shows what happens when aftercare
is offered without preparation and generally with-
out securing a continuity of care from the intramural
program to the extramural efforts of psychiatric
agencies. The project is commonly referred to as
"The Denver Aftercare Study.”2 Using a design
in which continuity of care was absent, the author
states :
We found that the patients who participated in our after-
care program did not vary significantly in their hospital
readmission rate from the control group who received no
aftercare. In attempting to understand the apparent lack
of effect of our aftercare program in contrast to the pub-
lished results of other programs, we were most impressed
with the many instances in which the discontinuity of care
in our study seemed to be the most obvious relevant
variable.
This author also states that
the most critical period for our patients fell within the first
several months following discharge, and this was the time
when we were of least help to them. The aftercare offered
was not infrequently refused or rendered less effective be-
cause of the patient’s suspiciousness of an unknown person.
Aftercare planning did not precede discharge. Inter (and
intra) agency communication was not adequate.
And still further:
Without the benefit of predischarge planning and con-
tinuity of patient care, in our program it took from four to
six weeks (and sometimes longer) after discharge before an
individual rehabilitation program could actually be put into
operation. We concluded that this was much too late, for
by this time many patients had already begun to experi-
ence an exacerbation of their symptoms. We soon began
to appreciate the difficulties that our discharged mental
patients were experiencing, not only because of their lack of
awareness of community resources, but also in following
through on referrals to the proper agencies. Simply telling
them where to go was not enough. It is probably only the
healthier patients who are able to utilize agency referrals
on an independent basis. Some of the services which agen-
cies stated to exist actually do not exist in practice, or if
they did, it was difficult for psychiatric patients to meet
their eligibility criteria. We now feel that in any after-
care program it is essential that the social worker be more
strongly identified with the patient than the agency. In our
experience, the social worker who is most likely to do
this is the social worker who has known the patient for
some time.
The discharge information which we received from the
hospital into aftercare program was in too many instances
incomplete, outdated, or simply erroneous. . . . We con-
cluded that an ideal aftercare program should be a planned
integral part of the intramural program of the hospital.
There should be as much continuity of care as is possible,
and the same staff who treats the patient in the hospital
should if at all possible, follow through with the aftercare
program.
Summary
We hope to have shown with this presentation that
properly planned and effective aftercare, as the most
important aspect of treatment beyond hospitalization,
has to start with an adequate predischarge planning.
This must be timed well in advance of discharge
from the hospital — as soon as diagnostic evaluation
is made, and plans are shaped for treatment within
the hospital. This in turn can only be achieved
where the professional staff deliberately attempts to
secure a maximum continuity of care, as by main-
taining the same treatment team for any given pa-
tient after his discharge, or by securing early and
thorough consultative involvement with the extra-
mural professionals who are to take over the care of
this patient at a later date.
Acknowledgment: The authors wish to express their in-
debtedness to Lowell O. Dillon, M. D., Superintendent, Roll-
man Psychiatric Institute, Cincinnati, Ohio, for his help in
reading and correcting the manuscript.
References
1. Herz, Marvin I.; Willensky, Harold, and Earle, Ann: "Prob-
lems of Role Definition in the Therapeutic Community.” Resource
Paper, Amer. Psychiatric Assn. Annual Mtg. , New York City, May,
1965.
2. Lewis, F. A.: "The Denver After-care Study,” in Steinhilber,
R. M. (ed. ) : Psychiatric Research in Public Service, Washington,
D. C.: American Psychiatric Association, 1962, pp. 146-153.
3. Glasscote, R.; Sanders, D.; Forstenzer, H. M., and Foley, A.
R. : The Community Mental Health Center — An Analysis, of Existing
Models, Washington, D. C.: American Psychiatric Association, 1964.
4. Action for Mental Health — Final Report of the Joint Com-
mission on Mental Illness and Health, 1961, New York: Basic Books.
5. Wayne, G. J. : "After-care: The Uncrossed Bridge.” Presented
to the Annual Meeting, American Psychiatric Association, Los An-
geles, California, May, 1964. (In press)
AFTERCARE OF STATE HOSPITAL PATIENTS. — Of all the problems
facing patients released from a state hospital, the most serious one is adjust-
ment. Failure here means a return to the hospital. The present aftercare pro-
gram of the Department of Mental Hygiene does not and is not intended to
meet all of the patient’s needs. It must rely upon other agencies to assist. It
must rely upon the general practitioner to provide the continuity of care which is
so important to successful rehabilitation. The general practitioner can often make
return to a state hospital unnecessary by an accurate assessment of the patient’s
problems, by effective intervention, by utilizing available consultation and by judi-
cious referral. When services are not available, he can do much to make them
available through the effective use of his professional channels. — Elmer F. Gali-
oni, M. D., Sacramento: California Medicine, 104:22-25, January 1966.
676
The Ohio State Medical Journal
Placental Localization
DONALD W. SHANABROOK, M. D.
The Author
• Dr. Shanabrook, Tiffin, formerly on staff at St.
Luke’s Hospital, Cleveland, presently is staff mem-
ber, Woman’s Clinic, Tiffin, and Associate Staff
member, Mercy Hospital in Tiffin.
VAGINAL bleeding in the last trimester of
pregnancy is a serious complication, and
placenta previa is one of the common causes
of this problem, the incidence being one in about
200 pregnancies.1 Maternal and fetal welfare can be
jeopardized by injudicious management of a placenta
previa condition.
The most characteristic symptom of placenta previa
is painless hemorrhage in the last trimester of preg-
nancy. The most common sign of placenta previa is
a soft, succulent cervix with a patulous external os,
through which the characteristic sponge like placental
tissue can be palpated. However, in the diagnosing
of placenta previa, there is the danger of massive
hemorrhage by disturbing the placenta with vaginal
examination and palpation. Vaginal bleeding can be
so profuse as to cause maternal and/or fetal death
in a matter of minutes. In fact, Eastman has stated
that placenta previa has caused massive vaginal hem-
orrhages, but he is unaware of a case in which this
occurred without previous vaginal examination.2
Clinical experience with low lying placenta has
demonstrated two basic facts: the initial hemorrhage
is rarely, if ever, fatal; rectal and vaginal examination
often precipitate severe hemorrhage. Therefore, it
behooves us to find a safe method of placental local-
ization without vaginal examination so that definitive
treatment may be carried out in the case of a preg-
nancy at or near term, or expectant management may
be attempted in the case of a premature infant to gain
time and increase fetal survival.
There are many methods of placental localization,
most of which leave something to be desired, either in
safety or accuracy. Most of these methods subject the
patient and fetus to large amounts of ionizing radia-
tion and are 10 to 20 per cent inaccurate, especially
in the first half of the third trimester of pregnancy.3
However, the use of isotope localization by the Saint
Luke’s Obstetrics Department and Nuclear Medicine
Laboratory has demonstrated this to be a safe, ac-
curate, and practical method of placental localization.
Radioisotopes were first used for placental localiza-
tion by J. C. McClure Brown in 1951. 4 The technic
was further perfected by Weinberg in 1957, using
radioactive iodine-labeled human serum albumin.5
This is considered a more suitable tracer than radio-
active sodium as used by Brown because it remains in
the intravascular compartment for sufficient time to
make careful and repeated counts, and its half-life
is sufficiently short to prevent excessive radiation.
Submitted September 3, 1965.
Method
The patient is placed supine on a table and 5 micro-
curies of radioactive iodinated serum albumin are in-
jected into the antecubital vein. The abdomen is
marked into nine equal squares (Lig. 1) during the
Fig. 1. The uterus is palpated through the abdominal wall
and its size and shape is determined. It is divided into
nine approximately equal segments by marking the abdomen.
ten minutes required for equilibration of the tracer
substance in the intravascular space. A recording is
taken over the xiphisternum for one minute and
recorded as representative of the cardiac pool, and a
baseline. The probe mounted on a counter balanced
arm is adjusted at the skin surface by hand to record
in the anterior posterior plane. Lollowing this, a
count is taken over each abdominal segment for one
minute. The count is repeated in each abdominal
segment in reverse order in an attempt to reduce varia-
tion by averaging the two counts.6’7 A 2 by 2 inch
sodium iodide crystal scintillation counter was utilized
for July, 1966
677
for this procedure. The signal from the detector was
received directly by a "Nuclear Measurement Corp.
Decade Scalier 1-A.”
The calculations required are illustrated in the fol-
lowing case. A 26 year old white woman, gravida II,
Para I, was admitted to Saint Luke’s Hospital at 32
weeks gestation because of mild vaginal bleeding
without pain. In performing a placenta scan, the
abdominal and xiphisternum recordings were noted
and averaged as follows:
Xiphisternum
1724
1908
1816 average
Abdomen
1683
1760
1721
1600
1575
1587
1646
2055
1850
1663
1689
1761
1587
1712
1643 average
1761
1790
1651
1709
1709
1749 average
1937
1859
1996
2030
1966
1944 average
The average abdominal section counts were then
expressed as a percentage of the xiphisternal cardiac
pool as follows:
1721 x 100
= 95%
1816
The other segments were calculated and a diagram
constructed as in Figure 2.
rule.
The average of the highest and lowest abdominal
segment percentage was noted. According to the
formula of Cavanagh, a reading in the three lower
uterine segments which exceeds this average is sig-
nificant and indicates placenta previa.8 In this case
again the average of the highest and lowest abdomi-
nal segments was
87% + 108%
= 97%
2
The lower segments in Fig. 2 were all greater than
97 per cent, indicating the presence of a placenta
previa. A total placenta previa as indicated by the
placenta scan was confirmed with abdominal delivery
three weeks later.
In some determinations, we have also added an-
other segment not described by other authors. This
consists of a probe directed toward the lower ab-
domen through the perineum. We have found it
useful in further confirming the evidence of a total
placenta previa. The large amount of blood contain-
ing radioactive iodinated serum albumin in the mater-
nal sinus directly under the placental implantation
site is believed to localize the placenta.9 Should dif-
ficulty arise in interpretation of the results, the count-
ing procedure can be repeated without re-injection
for as long as one to two hours.
In Fig. 3-a-b-c are examples of typical placenta-
678
The Ohio State Medical Journal
Fig. 3 — (b ) . Piacentascan can be very accurate indeed , here
a low lying lateral placentation site was found.
scans that were obtained and confirmed at the time of
delivery.
Results
There have been 20 placentascans, using the tech-
nic described, performed at Saint Luke’s Hospital.
The placenta site was not determined after delivery in
two of these cases, and both were vaginal deliveries.
In one, a fundal placenta was predicted, and the pa-
tient delivered without any complications. In the
second case, the patient had a clinical history sug-
gestive of placenta previa. On piacentascan, a diag-
nosis of low lying anterior placenta was made. The
patient delivered vaginally, with moderate intra-
partum bleeding, and no total placenta previa was
found. However, after delivery, the placenta de-
livered spontaneously before the placental implanta-
tion site could be determined. Tabulating these two
cases as failures, the accuracy of this method is 90
per cent.
In none of the studies was there a finding of total
placenta previa where none was predicted, and this
also held true for the converse situation. Therefore,
in 100 per cent of the cases, the study answered the
question concerning the absence or presence of a
total placenta previa without vaginal examination.
We also had an interesting piacentascan in a pa-
tient at 30-32 weeks’ gestation, in which the results
indicated a placenta previa and a fundal implantation.
At cesarean section, the sites of implantation were as
indicated in the piacentascan, as this was a twin
gestation.
Comment
We have here a diagnostic method, which can be
used to obviate many of the dangers of diagnosing
placenta previa.
Some difficulty has arisen in interpretation as to
whether the placenta is located on the anterior or
posterior uterine wall, especially with a fundal im-
plantation. Counts taken over the flanks can help
with this problem. However, in the management of
placental previa, this is not of primary importance.
Accuracy in deciding whether the placenta is located
in the lower segment is what is required, and our
success is 90 per cent in this series. Knowledge of
the placental location helps the management of pla-
cental previa immeasurably, and this technic can
replace the use of dangerous vaginal examination.
Radiation hazard in isotope localization is small
compared to other diagnostic methods. The total
irradiation to the fetus has been previously calculated
as 70 milliroentgens allowing for total decay of the
isotope, as well as for both beta and gamma radiation,
versus 0.2 roentgen with a single x-ray film of the
abdomen. Other radiographic localization methods
usually require at least two exposures. Maternal
radiation has been previously calculated to be 60
milliroentgens total body radiation, which is 25 per
cent of the radiation received in I131 uptake studies,
for July, 1966
679
and 5 per cent of the maximum tracer dose recom-
mended by the Atomic Energy Commission.8’ 10
In addition to this safety factor, maternal ingestion
of potassium iodide greatly reduces the uptake of
radioactive iodine by the fetal or maternal thyroid.
We have given a saturated solution of 10 drops of
potassium iodide three times a day at least one day
prior to the procedure to block thyroid uptake of
Ii3i.il This is accomplished through the saturation
of the maternal and fetal thyroid gland with non-
radioactive iodine. As a result, counts run on the
fetal cord blood show little or no radioactivity.i2
The disadvantage of this method lies chiefly in
that it requires special equipment, found only in
radioisotope laboratories. However, there are no
contraindications to the use of this test, save for
active bleeding which requires immediate corrective
action.
Summary
The importance of placental localization in the
treatment of certain types of third trimester bleeding
has been emphasized. A method of placental local-
ization has been presented which immeasurably assists
in the management of this distressing and potentially
dangerous condition. The use of this method of
placental localization enables a physician to accurately
and rapidly obtain information essential to the cor-
rect management of third trimester bleeding. A
series of 20 placentascans is reported, with an ac-
curacy of 90 per cent for complete localization, and
100 per cent in predicting the presence or absence
of low lying placenta.
Acknowledgment: Acknowledgment is given to the
Isotope Laboratory at Saint Luke’s Hospital, Cleveland,
Ohio, to Clarence E. Everhart, M. D., to Miss Charlene
Workman, R. N., and the members of the Obstetrics-
Gynecology staff of St. Luke’s Hospital for their assistance.
References
1. Eastman, N. J., and Heilman, L. M. (eds): Williams’ Ob-
stetrics, ed. 12, New York: Appleton-Century Crofts, 1961, p. 629.
2. Ibid., p. 636.
3. Watson, H. B., et al. : Placentography in Management of
Placenta Previa. Brit. Med. J., 2:490-494 (Aug. 31) 1957.
4. Browne, J. C. M., and Veall, N.: Localization of the Placenta
by Means of a Radioactive Isotope. Postgrad. Med. J., 28:422-425
(Aug.) 1952.
5. Weinberg, A.: Placentography: Radiological Determination of
Placental Site. Obstet Gynec Survey, 10:461-486 (Aug.) 1955.
6. McGee, J., and Duron, D.: Placentography Using Radioactive
Iodinated Serum Albumin. Obstet Gynec., 15:643-645 (May) I960.
7. Visscher, R. D., and Baker, W. S., Jr.: Isotope Localization
of the Placenta in Suspected Cases of Placenta Previa. Amer. J.
Obstet. Gynec., 80:1154-1160 (Dec.) I960.
8. Cavanagh, D., et al.: Placenta Previa: Modern Methods of
Diagnosis with Special Reference to Isotopic Placentography. Obstet
Gynec., 18:403-411 (Oct.) 1961.
9. Durfee, R. B., and Howieson, J. L.: Localization of the
Placenta with Radioactive Iodinated Serum Albumin. Amer. J. Ob-
stet. Gynec., 84:577, 1962.
10. Cavanagh, D., Gilson, A. J., and Powe, C. E.: Isotopic
Placentography: an Evaluation Based upon a Study of 50 Patients.
Southern Mea. J., 54:1340-1346 (Dec.) 1961.
11. Heagy, F. C., and Swartz, D. P.: Localizing the Placenta
with Radioactive Iodinated Human Serum Albumin. Radiology, 76:
936-944 (June) 1961.
12. Weinberg, A., et al.: Localization of the Placenta Site by
Radioactive Isotopes. Obstet Gynec., 9:692-695 (June) 1957.
A HOPEFUL EMOTIONAL ATTITUDE can actually prolong the life of a
cancer patient. Patients who have hope of being well-remembered by
family or friends or who have hope for an afterlife or some future existence live
longer than non-hopeful and depressed patients. Hopelessness and depression
actually speed the death of cancer patients. Patients with metastatic cancer, who
died within two months after initial evaluation, had significantly lower hope for
the future and even a future life than the group who lived longer. The pa-
tients with higher hope levels did not become depressed after intensive treatment.
Those who become depressed immediately after treatment were the ones who died.
Some of these patients say, "I will be in heaven”; others say, "I will con-
tinue living through my children or through my work.” The hopeful group
realize they have cancer. They realize they are going to die. But they refuse
to admit that death will end everything for them.
A patient’s degree of hope or lack of hope is often conveyed to hospital
personnel, and experienced ward personnel are often uncannily accurate in pre-
dicting the clinical course of individual cancer patients. — University of Cincin-
nati Medical Center News Release (April 10, 1966) of preliminary report by
Louis A. Gottschalk, M. D., Research Professor, and Robert L. Kunkel, M. D.,
Instructor, Department of Psychiatry, University of Cincinnati College of Medicine.
680
The Ohio State Medical Journal
Idiopathic Retroperitoneal Fibrosis
Report of a Case
WAI-MAN LEUNG, M. D., and CHARLES L. C0GBILL, M. D.
The Authors
• Dr. Leung, Dayton, is a member of the Gen-
eral Surgery Resident Staff of the Veterans Admin-
istration Hospital, Dayton, Ohio.
• Dr. Cogbill, Dayton, is Chief, Surgical Service
of the Dayton Veterans Administration Hospital,
and Clinical Instructor in Surgery of The Ohio
State University College of Medicine, Columbus.
IDIOPATHIC retroperitoneal fibrosis was first re-
ported as a clinical entity by Ormond1 in 1948,
although Kay2 cites several other earlier writers
who described conditions which may well have rep-
resented this disease. In his 1963 article Kay2 stated
that he had found 125 cases in the world literature.
On account of the rarity of reported cases it ap-
pears worthwhile to add a case recently seen by us.
The etiology, pathology, clinical findings, and treat-
ment of this condition will be discussed briefly.
Case Report
The patient was a 70 year old man admitted to the hos-
pital October 18, 1964, complaining of abdominal pain,
chills, and fever of 24 hours’ duration. The pain was
acute in onset, involved the entire right side of the ab-
domen, and radiated into the right flank. He had had
intermittent, mild pain in the right side of his abdomen
and lower back for about two years. During this time he
complained also of weight loss, lethargy, anorexia, and
constipation. Shortly before the onset of these symptoms
he was hospitalized for the treatment of deep thrombophle-
bitis of the left leg and since that time had edema of both
legs. There was a history of pulmonary tuberculosis 20
years before admission.
On physical examination, the temperature was 104°F,
pulse rate 90 per minute and blood pressure 110/65. He
appeared acutely ill and dehydrated. There was right upper
and right lower quadrant abdominal tenderness and re-
bound. Both legs were edematous.
The hemoglobin was 15 Gm, hematocrit 46.5 per cent, and
white blood cell count 23,700 with 91 per cent neutrophils.
The urinalysis showed acid urine with specific gravity of
1.020; the urine contained no sugar nor albumin but was
loaded with white blood cells. The VDRL was positive and
the Wassermann reaction was plus 4. The blood urea
nitrogen was 12 mg/ 100 ml. The serum electrolytes were
normal except for a moderate hypochloremia. The sedi-
mentation rate was 33 mm. per hour. Chest x-ray showed
bilateral calcified foci in the upper lung fields, with no
evidence of recent disease.
Two days after admission the patient became oliguric
and the blood urea nitrogen rose to 56 mg./ 100 ml. In-
travenous pyelography showed no visualization of the right
kidney and faint visualization of the left. Retrograde pyel-
ography showed complete obstruction of the right ureter
low in the pelvis. There was narrowing and irregularity
with partial obstruction of the left ureter (Fig. 1). A
right nephrostomy was done with prompt improvement in
the patient’s condition and return of the blood urea nitro-
gen to normal levels.
On Dec. 8, 1964, transperitoneal exploration of the
ureters was carried out. Both were encapsulated by grayish-
white fibrous tissue at the sacral promontory; in this region,
From the Surgical Service of the Veterans Administration Center,
Dayton, Ohio, and The Ohio State University College of Medicine,
Columbus, Ohio. Submitted August 11, 1965.
Address requests for reprints to: Charles L. Cogbill, M. D., 4100
West Third Street, Dayton, Ohio 45428.
the iliac veins were also compressed by the same tissue.
The ureters were so firmly encased in the surrounding
fibrous-tissue mass they could not be freed and, at length,
both were divided and end-to-end anastomoses performed.
The left ureteropelvic junction was compressed by addi-
tional firm fibrous connective tissue but was dissected free
without difficulty. Generous biopsies of the tissue obstruct-
ing the ureters were taken. The patient recovered from this
operation without incident but within four months’ time
Fig. 1. Retrograde pyelogram. The right ureter is com-
pletely blocked low in the pelvis. The left ureter is mark-
edly narrowed at the ureteropelvic junction and lower down
near the pelvic brim.
for July, 1966
681
both ureters became obstructed again and bilateral nephros-
tomies were performed. He has done well to the present
time.
Microscopically, the tissue removed at operation was a
lipogranuloma showing various stages of development.
There was intense, dense collagen deposition with a few
scattered granules of calcium. There were chronic inflam-
matory cells throughout (Figs. 2, 3 and 4).
Discussion
Etiology. The etiology of retroperitoneal fibrosis
is poorly understood although a number of theories
have been offered. Focal infection from the lower
urinary tract or gastrointestinal tract with spread by
lymphatic channels to the retroperitoneal space has
been suggested by some.3’4’5 Coppridge6 postulated
a relationship with Weber- Christian disease based on
the finding of fat-filled macrophages and giant cells
in the fibrotic tissue. Reidbord and Hawk7 and
Frazier and Small8 felt that the pathologic picture
suggested hyperallergic reaction and indicated that
retroperitoneal fibrosis was related to polyarteritis
nodosa and necrotizing arteritis.
Pathology. The envelopment of retroperitoneal
structures by a grayish-white plaque of fibrous tissue
is the basic disease process. A few cases have been
reported in which the fibrosis involved also the extra-
peritoneal tissues of the anterior abdominal wall and
and the mediastinum.9- 10 It is sometimes difficult
grossly to distinguish this disease from retroperitoneal
malignancy. Histologic features are nonspecific. Nor-
mal fibroblasts and collagen with chronic inflam-
matory cells are generally found. In some cases there
Fig. 2. Photomicrograph showing fibrous connective tissue ,
chronic inflammatory cells and fatty infiltration — a lipo-
granuloma.
Fig. 3. Photomicrograph showing granulomatous inflam-
mation with multinucleated giant cells, lipid laden macro-
phagus, lymphocytes, and fibrosis.
Fig. 4. Photomicrograph showing dense collagenous con-
nective tissue and adipose tissue.
682
The Ohio State Medical Journal
may be fat necrosis, granulomas with giant cells, or
necrotizing vasculitis.
Clinical Findings. A majority of patients are
within the fifth and sixth decades of life with a male
to female ratio of 2:1. Early general symptoms and
signs often are mild and nonspecific and may precede
the appearance of acute symptoms by months or
years. Obscure pain in the right and left lower ab-
domen and back, weight loss, fatigue, anorexia,
eructation, and stomach distress with occasional nausea
and vomiting may be present. There may be inter-
mittent low-grade fever. Constipation and transient
hematuria may occur. Some have reported chest pain,
pericardial friction rub and pleural effusion.2-9’11’12
Edema of the legs may occur. Oliguria and anuria
occur late, as well as symptoms and signs of urinary
tract infection. In general, symptoms and signs de-
pend upon the organ or organ system that is com-
pressed by the adjacent fibrous tissue.
Genitourinary Tract. Usually the first structures
to be involved are the ureters. This may be mani-
fested by chronic low-back pain and increased fre-
quency of urination; a rather sudden onset of oliguria
or anuria is not uncommon. Intravenous pyelography
often reveals medial deviation of the ureters.12’ 13
Retrograde pyelography is usually not difficult; the
common site of obstruction is at the sacral promontory.
Vascular Involvement. The iliac veins commonly
are compressed with resultant edema of the lower
extremities. This was the situation in the present
case. Obstruction of the vena cava has been reported
in a number of cases.11’ 14-16 Narrowing of the aorta
by fibrous tissue compression has been reported by
Furlong and Connerty,17 intermittent claudication by
Cameron et al,11 and a case of gangrene of the foot
by Croal.18 Generally, however, the veins are the
vessels which are obstructed, the arteries usually not
being affected.
Laboratory Findings. Hypochromic microcytic
anemia has been reported in 50 to 60 per cent of
cases. The erythrocyte sedimentation rate is in-
creased in most cases. Urinalysis may reveal normal
urine or urine containing white blood cells. Depend-
ing upon the degree of ureteral obstruction, varying
degrees of azotemia may be noted.
Diagnosis and Treatment. The diagnosis may be
suspected from the symptomatology, especially the
late symptoms of oliguria or anuria. Pyelography is
useful in determining the site and degree of obstruc-
tion. The diagnosis can be established with cer-
tainty, however, only by exploration and biopsy.
Ureteral obstruction usually can be relieved by ureter-
olysis and this is the procedure of choice. If this is
not feasible other means of relieving the obstruction
must be used, such as division of the ureter and an-
astomosis, ureteral-ileal transplants, cutaneous ureter-
ostomy, or nephrostomy. X-ray therapy (Cameron
et al11), and steroid therapy (Hawk and Hazard9)
are reported to be useful but are difficult to evaluate.
Surgery is indicated for the relief of obstruction. The
disease is believed to be self-limited2 and if ureteral
obstruction is satisfactorily relieved patients may live
for prolonged periods.
Summary
Retroperitoneal fibrosis is a rare disease of un-
known etiology. It is characterized by masses of
fibrous connective tissue encasing retroperitoneal struc-
ture, principally the veins and ureters. Ureteral ob-
struction is the commonest finding. Surgical relief
of the obstmction is the only satisfactory treatment.
If this is accomplished the mortality of the disease
is low and the prognosis good for prolonged survival.
Acknowledgment: We wish to express our appreciation
to Dr. Pauline Garber and to Dr. William H. Kirkham,
Laboratory Service, of the Dayton Veterans Administration
Hospital, for selecting and interpreting the photomicrographs.
References
1. Ormond, J. K.: Bilateral Ureteral Obstruction Due to En-
volopment and Compression by Inflammatory Retroperitoneal Process.
/. Urol., 59:1072-1079 (June) 1948.
2. Kay, R. G.: Retroperitoneal Vasculitis With Perivascular
Fibrosis. Brit. J. Urol., 35:284-291 (Sept.) 1963.
3. Bradfield, E. O. : Bilateral Ureteral Obstruction Due to En-
velopment and Compression by Inflammatory Retroperitoneal Process.
J. Urol., 69:769-773 (June) 1953.
4. Mirabile, C. S., and Spellane, R. J.: Bilateral Ureteral Com-
pression with Obstruction From a Nonspecific Retroperitoneal In-
flammatory Process; Case Report. J. Urol., 73:783-787 (May) 1955.
5. Oppenheimer, G. D., et al. : Radiotherapy in Treatment of
Nonspecific Inflammatory Stricture of the Ureter. /. Urol., 67:476-
478 (April) 1952.
6. Coppridge, W. M. : Sclerosing Lipogranuloma. Southern
Med. ]., 48:827-833 (Aug.) 1955.
7. Reidbord, H. E., and Hawk, W. A.: Idiopathic Retroperi-
toneal Fibrosis and Necrotizing Vasculitis; Report of a Case with
Autopsy Findings and Etiologic Consideration. Cleveland Clin.
Quart., 32:19-27 (Jan.) 1965.
8. Frazier, C. N., and Small, A. A.: Allergic Dermatitis; View
of its Immunologic and Biochemical Implications. Amer. J. Med.,
3:571-585 (Nov.) 1947.
9. Hawk, W. A., and Hazard, J. B.: Sclerosing Retroperitonitis
and Sclerosing Mediastinitis. Amer. J. Clin. Path., 32:321-334
(Oct.) 1959.
10. Partington, P. F.: Diffuse Idiopathic Fibrosis. Amer. J. Surg.,
101:239-2 44 (Feb.) 1961.
11. Cameron, D. G., et al. : Idiopathic Mediastinal and Retro-
peritoneal Fibrosis. Canad. Med. Ass. J., 85:227-232 (July 29) 1961.
12. Raper, F. P.: Bilateral Symmetrical Peri-ureteric Fibrosis.
Proc. Roy. Soc. Med., 49:736-740 (Sept.) 1955.
13. Ormond, J. K.: Idiopathic Retroperitoneal Fibrosis: Estab-
lished Clinical Entity. J.A.M.A., 174:1561-1568 (Nov. 19) I960.
14. Blanc, W. A.: "Syndromes Nouveaux de Pathologie Adipeuse”
(Paris: Masson & Cie), 1951.
15. Chisholm, E. R., et al.: Bilateral Ureteral Obstruction Due
to Chronic Inflammation of Fascia Around Ureters. J. Urol., 72:
812-816 (Nov.) 1954.
16. Dineen, J., et al.: Retroperitoneal Fibrosis. An Anatomic
and Radiologic Review with a Report of Four New Cases and an
Explanation of Pathogenesis. Radiology, 75:380-390 (Sept.) I960.
17. Furlong, J. H., Jr., and Connerty, H. V.: Compression of
the Aorta and Ureters by a Retroperitoneal Inflammatory Mass; Case
Report. Delaware Med. ]., 30:63-67 (March) 1958.
18. Croal, A. E.: Retroperitoneal Fibrosis. Canad. Med. Ass. ].,
85:793-795 (Sept. ) 1961.
IT IS UNFORTUNATELY TRUE that the use made of an investigation de-
pends more on the ease of performance than on the refinement of the result.
— E. F. de Bono, M. D.: British Medical Jottrnal, 2:1040, October 30, 1965.
for July, 1966
683
A Clinicopathological Conference
From The Ohio State University Hospital, Columhus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
J. B. McMILLAN, M. B., Ch. B., President
PRESENTATION OF CASE
F^irst Hospital Admission: A white man, aged
29, entered University Hospital for evaluation
of hemoptysis. Four months before admis-
sion he noticed a postnasal discharge which persisted
for a month. In the following three months he had
intermittent episodes of hemoptysis which produced
a teaspoonful of blood daily, a mild cough, and sev-
eral episodes of fever and sweating. He had no
weight loss or chest pain. A month before admission
he became aware of dyspnea on exertion. This was
progressive and at the time of admission he frequently
had to rest during his work at a lead mold in a
mbber factory.
The patient had smoked one and a half packages
of cigarettes daily for several years but had stopped
smoking at the onset of his illness, without significant
change in symptoms. There was no family history of
tuberculosis or of exposure to it. The past history
and review of systems were not remarkable except for
a one-month history of dark urine without irritative
bladder symptoms.
On physical examination the patient was well-
developed and well-nourished and in no acute distress.
The temperature was 98.6°F., the pulse rate 82 per
minute, the respiratory rate 18/min., and the blood
pressure 150/80. There was no lymphadenopathy,
no heart murmurs, no edema, and the lungs were
clear to percussion and auscultation.
The laboratory examinations showed a hemoglobin
of 9-1 Gm.; hematocrit 30 per cent; white blood cell
count 8,345 with 68 per cent neutrophils, 22 per
cent lymphocytes, 6 per cent eosinophils, 4 per cent
monocytes. The urine was yellow and turbid; pH
5.0; specific gravity 1.003; protein 640 mg. per 100
ml.; there were rare coarsely granular casts, 2 to 5
white blood cells and many red blood cells per high
power field. The serologic tests for syphilis were
negative. Smear and culture of 24-hour sputum for
Submitted April 22, 1966.
Presented by
• John E. Jesseph, M. D., Columbus, and
• Nils Ringertz, M. D., Karolinska Institute,
Stockholm, Sweden.
Edited by Emmerich von Haam, M. D., Columbus.
acid-fast bacilli were negative; routine sputum cul-
ture yielded no growth of pathogens. A tuberculin
skin test was negative.
A chest x-ray was interpreted as showing a slight
decrease in the volume of the middle lobe with a
few patches of bronchopneumonia. A bronchogram
was interpreted as showing extrinsic pressure on the
middle lobe bronchus, most probably caused by in-
flamed lymph nodes. There was associated spasm
due to inflammatory changes. The middle lobe
bronchial orifice was considered normal. No bron-
chiectasis or tumor was seen.
The patient was discharged to continue on ferrous
gluconate therapy and to return in two months for a
repeat bronchogram.
Second Hospital Admission
The patient remained at home for three weeks.
His hemoptysis continued with the production of 1
tablespoon of blood daily. This had been streaks
of blood mixed with sputum until the day before his
second admission, at which time he coughed up a
tablespoonful of bright red blood. In the three clays
prior to admission his chronic dyspnea worsened so
that he was dyspneic at rest and unable to walk
more than a few steps because of shortness of breath.
He had noted blurring of his vision with each heart
beat for two days. There had been occasional streaks
of bright red blood on the toilet tissue. His urine
had been dark during this interim period.
On physical examination the patient was alert,
very pale, and dyspneic at rest. His pulse rate was
684
The Ohio State Medical Journal
110, respirations 40, temperature 98.2°F., and blood
pressure 180/90. No significant lymphadenopathy
was present. The chest was symmetric with no in-
crease in anteroposterior diameter. Bilateral basilar
rales and rhonchi were heard which were greater on
the right. A grade II/ VI systolic ejection murmur
was heard at the apex of the heart. The pulmonic
and aortic second sounds were equal. Examination
of the abdomen, extremities, and nervous system re-
vealed no abnormalities.
The laboratory examinations showed a hemoglobin
of 4.5 Gm.; hematocrit 17 per cent; white blood cell
count 14,800 with 75 per cent neutrophils, 19 per
cent lymphocytes, 2 per cent basophils, 4 per cent
monocytes. The urine had a pH of 5.0, specific
gravity 1.003; protein 80 mg.; 0-1 waxy casts,
rare coarsely granular casts, 3 to 5 white blood cells
and 5 to 8 red blood cells per high power field. The
blood urea nitrogen was 110 mg. per 100 ml. The
serum iron was 43 meg. per 100 ml., the iron
binding capacity 413 meg. A chest x-ray was in-
terpreted as showing diffuse consolidation of the
right lung, enlarged superior mediastinal lymph
nodes, and splenomegaly. The over-all appearance
suggested an unusual inflammatory process.
The patient was treated with intermittent positive
pressure breathing, general supportive care, and
transfusion of whole blood. The tachycardia con-
tinued. His respirations were rapid and shallow.
Hemoptysis of bright red blood persisted, and a few
hours after admission his blood pressure fell, he be-
came cyanotic, and died.
CLINICAL DISCUSSION
Dr. Passi: We have the honor today of having
as our pathological discussant Dr. Nils Ringertz,
Professor of Pathology of the Karolinska Institute of
Stockholm, Sweden. Dr. John Jesseph will present
the clinical discussion.
Dr. Jesseph: I have no qualms about admitting
at the outset that when I first read this protocol it
was obvious to me that I didn’t know what disease
this was. It then followed by sheer logic that since
I didn’t recognize anything about the disease it
must not be very common.
It is pretty clear that this young man, who was,
we presume, entirely well until the onset of his ill-
ness, had some disease which was lethal within a
total span of less than five months. It is pretty
clear that over the entire period of his illness he
never really got any better. There was a period
before his second admission when he was probably
clinically stable, but it is clear that he undement
no real remission.
His first admission was for hemoptysis which was
of relatively sudden onset. This was accompanied by
pulmonary infiltrates which were sort of evanescent.
He had evidences of middle lobe syndrome with partial
obstruction of the middle lobe bronchus. He had
increasing dyspnea and this, actually, was probably
his principal complaint along with hemoptysis. The
dyspnea in this man was relentless. He just never
was without shortness of breath once this disease
began. He also developed hypertension of modest
to mild degree and a fairly pronounced anemia, and
then nephritis.
Renal Vein Thrombosis?
There are three or four disease processes loosely
categorized with various names and descriptions which
could explain all these symptoms. He had an acute
lethal disease characterized by simultaneous involve-
ment of the respiratory and the renal systems, with
other features added. One acute process that could
account for this might be renal vein thrombosis with
a subsequent nephrotic syndrome and secondary pul-
monary thrombo-embolism. In renal vein throm-
bosis, whatever the cause, there is a sudden flank
pain associated with the thrombotic episode itself.
These patients then have fever, leukocytosis, abdomi-
nal pain, and of course proteinuria with casts in the
urine. In many instances secondary thrombo-embol-
ism to the lung will lead to hemoptysis. In this
particular patient, however, this would mean putting
the process backward. We don’t know that this man
had an acute episode that might have been character-
ized as a renal vein thrombosis. He gave no his-
tory of trauma nor of any infectious process that
would predispose to this, and we usually see this
process most commonly in newborn infants, al-
though it does occur spontaneously in young males.
The definite diagnosis of renal vein thrombosis
would have to depend on a renal biopsy, and we have
none in our present case. Renal biopsy in case of
renal thrombosis would show after a suitable period
of time tubular atrophy and other ischemic changes,
as well as thickening of the basement membrane of
the glomeruli. But we can only speculate. The
rapidity and the extent of the occlusion in the renal
vein, and whether or not it is unilateral or bilateral,
will determine the nature of the process and will of
course determine the prognosis. In adults this proc-
ess usually comes as a consequence of thrombosis of
the inferior vena cava secondary either to a trau-
matic or septic process in the extremities or pelvis.
There was no history of that in our patient. So
although we could reason logically that renal vein
thrombosis with secondary pulmonary embolization
might account for his symptoms, we would have to
distort the history and we would have to assume
certain things that are not presented in the protocol.
Wegener’s Granulomatosis?
Another possibility is a syndrome which has been
described as Wegener’s granulomatosis, thought to
be a variant of polyarteritis nodosa. Patients with
this disease typically present initially pulmonary
for July, 1966
6 85
lesions and widespread fibrinoid necrosis of blood
vessels suggesting some sort of hypersensitivity phe-
nomenon. The lesions can be found anywhere in
the respiratory tract from the nares to the distal
alveoli and are granulomatous processes with an
early necrosis through fibrinoid necrosis and throm-
bosis of small arteries. This disease is commonest
in men in their thirties and forties, so that while he
is a little young for it, it might fit this patient.
Hemoptysis occurs early in this process, the patient
will have pleurisy, and the necrotic pulmonary lesions
will form small cavities which will produce second-
ary hemoptysis. These patients typically fail to re-
spond to antibiotics, with which they are usually
treated on the presumption of some kind of viral
or bacterial pneumonia. By the time multiple system
involvement suggests a more generalized process, the
patients are usually recognized as representing a
variant of a collagen disease and are given steroids.
The course in this disease tends to be fulminant
and the patients typically die within a few months
from secondary pulmonary infection and/or uremia
because of the necrotizing arteritis in the kidneys.
It is said that in Wegener’s granulomatosis the
process tends to remit to some extent with steroids
but the benefits from these are rather transient. Well,
some things about this particular patient don’t fit this
diagnosis. I think that he did not have this much
pulmonary difficulty. The course of his disease was
not consistent with a progressive, relentless pulmo-
nary process but rather suggested a granulomatous
process, and the kidney changes were more pro-
nounced in our patient than they are in typical
Wegener’s disease.
Strep Infection?
Hemolytic strep pneumonias with glomerulone-
phritis are a common kind of disease. This was
particularly so in the pre-antibiotic days, but since
I did not grow up in the pre-antibiotic days in medi-
cine I can’t certify this from personal experience.
But we do know that patients with upper respiratory
infection and pneumonia due to hemolytic strepto-
coccus frequently develop these forms of acute
glomerulonephritis, and I think that’s seen even to-
day to a certain extent. These changes are all part
of an acute infectious disease typically limited in
time, and the protocol describing our present patient
is not consistent with acute respiratory infection sec-
ondary, or even primary, to hemolytic strep pneu-
monia and the kind of glomerulonephritis that would
go with it. Rather, his disease ran a biphasic course.
He was acutely ill with an evanescent pulmonary
problem during which he had pulmonary changes
which tended to remit somewhat. He really never
had an acute febrile pneumonic process with con-
solidation of one or more segments of lobes. So
clinically our patient just didn’t have an acute
pneumonia.
Pneumococcal Pneumonia?
The same thing can be said of pneumococcal
pneumonia with acute renal failure. Transient pro-
teinuria occurs sometimes in the course of pneu-
mococcal pneumonia and it is possible in this infec-
tion, as it is in almost any infectious process,
particularly the pulmonary ones, to have transient
renal changes. Our patient’s renal disease, however,
was much more than transient. He had a significant
lesion and yet it was not of the acute failure type;
he did not have acute tubular necrosis and he did not
really die in renal shutdown. The protocol rather
suggested that although he had a significant renal
lesion his death was pulmonary and his symptoms
throughout his disease were predominantly pulmonary
rather than renal.
Goodpasture’s Syndrome?
There is another disease which seems to me to be
a much more logical explanation for this patient’s
illness and that is Goodpasture’s syndrome. In
1919 Dr. Goodpasture,1 who was a pathologist at
Boston, described some of his extensive experience
with the influenza epidemic and became interested
in the pathogenesis of certain forms of influenza and
what could be deduced from the pulmonary changes
about the nature of the causation of influenza. Dr.
Goodpasture described two interesting patients, one
of whom had a lesion much like our patient today,
and since that time about 50 cases of this particular
syndrome have been described in the literature. Dr.
Goodpasture originally described a process with re-
current hemoptysis, dyspnea, some mild renal in-
volvement, and eventual death in a man age 18. At
autopsy, Dr. Goodpasture was nonplussed to find
that despite very careful bacteriological studies he
was able to isolate no organism whatever from this
man’s lung even though the lung itself was filled
with hemorrhagic fluid and the alveolar spaces were
lined by large macrophages containing debris and
fibrin. Partially on the basis of this evidence, Dr.
Goodpasture proposed that the primary etiologic agent
in some of these peculiar processes in the lung might
be an unknown virus which gained admittance to
the respiratory tract through the respiratory passages.
But was Dr. Goodpasture really describing what
we nowadays call Goodpasture’s syndrome, which is
my diagnosis in this case? I am not sure it is. Dr.
Goodpasture described a man who was sick for about
three months, much like our patient, who began with
a pulmonary infection of a sort of nondescript nature
and then had increasing hemoptysis, but nowhere,
unfortunately, does Dr. Goodpasture give us a lot of
detail about the findings in this man’s urine. He
was said to have a trace of albumin, but we really
don’t have any more evidence than that for nephritis.
He would like to insist on cylindruria or some white
casts in the urine, we would like to see an occasional
red cell, and to satisfy the present-day criteria of
686
The Ohio State Medical Journal
this disease I would like to find an increasing pro-
teinuria. These things are entirely deleted from Dr.
Goodpasture's description. Perhaps he was simply
describing a patient with hemorrhagic viral pneu-
monia who had incidentally a touch of albuminuria
which can accompany almost any disease from severe
headache to a fractured leg.
Well, in this disease the whole process begins
similarly to what we see in idiopathic pulmonary
hemosiderosis; that is, there may be fever, chills,
cough, easy fatigability, insidious development of
anemia as hemoptysis persists, and then somewhere
in the mid-course of the disease, which typically runs
from one to six months and almost always less than
a year, the patients develop nephritis and hyperten-
sion which is usually only mild to moderate. The
serum iron in these patients is usually low, and the
pulmonary sequestration of blood and blood break-
down products leads to alveolar plugging, hyper-
trophy of macrophages lining the alveoli, and typi-
cally these patients have increasing dyspnea which
brings them to the hospital, as with our patient.
After following a relentless course that is rarely
modified by any treatment, these patients die typically
in pulmonary failure with the added complication
of azotemia of a degree proportionate to the damage
to the kidney. A study2 of 69 patients with idio-
pathic pulmonary hemosiderosis showed that five had
some renal lesions similar to what we see in this
process described by Goodpasture. So it has been
speculated that perhaps this disease is really a variant
of idiopathic pulmonary hemosiderosis.
As I said at the beginning, this is not a surgical
process, it certainly is not a very common one, and
since I didn’t know anything about it everything I
have said today I have taken from the literature. It’s
clear to me that this patient couldn’t have been con-
sidered a candidate for any operative therapy since
there is nothing to take out from a patient with this
disease. I think that this man was admitted with
what appeared to be a partially obstructing process
in the right middle lobe bronchus, which was simply
a red herring.
Dr. Passi: May we now have a discussion of
the radiologic findings in this case?
Dr. Harris: As you correctly assumed, his first
problem was in the right middle lobe. There was an
infiltration of the right middle lobe and you see some
mosaic findings in the lateral view suggesting that
there may be loss of volume. For this reason a
bronchogram was undertaken three days later, at
which time we observed some incomplete filling of
the right middle lobe. All of the right middle lobe
main-stem bronchus was open. The films that really
are of greatest interest were taken at the time the
patient was readmitted. Here I believe you can see
a consolidation throughout the major portion of the
right lung, which would be consistent with some form
of periarteritis or hemorrhagic pneumonia such as is
seen in Goodpasture’s. I do not believe I could
make a specific diagnosis on the basis of these
films, as this is not the classical appearance of
Goodpasture’s.
CLINICAL DIAGNOSIS
Goodpasture’s syndrome: (a) pulmonary hemo-
siderosis; (b) glomerulonephritis.
PATHOLOGIC DIAGNOSIS
Goodpasture’s snydrome: (a) pulmonary hemo-
siderosis; (b) glomerulonephritis.
DISCUSSION OF PATHOLOGY
Dr. von Haam: I would like to introduce my
good friend Dr. Ringertz, who is Professor of Path-
ology at the Karolinska Institute in Stockholm. He
was invited to give the Maud Abbott Memorial Lec-
ture at the American Congress of Pathology, in which
he discussed clear-cell carcinoma of the kidneys. Dr.
Ringertz is particularly interested in tumors of the
respiratory tract including the lungs, bronchi, trachea,
and nasopharynx. He will discuss the pathological
findings.
Dr. Ringertz: I thank you very much, Dr.
Haam, for your nice introduction, and I must say
that you sprang a real stinker on me by giving me a
case unlike any that I had ever seen before.
I think it is best to state at the beginning that
Dr. Jesseph’s suggestion of Goodpasture’s syndrome
was correct. I may say that the interesting autopsy
findings are really restricted to two organs — the
lungs and the kidneys. Everything else was rather
unremarkable; for example, there were no evidences
of generalized hemorrhagic diathesis, no petechiae in
peritoneum, pericardium, pleura, skin or anywhere.
Naturally there were enlarged lymph nodes in the
mediastinum; you couldn’t expect anything else with
such severe lung changes. There were also some
enlarged mesenteric and retroperitoneal nodes, and
the spleen was about double normal weight — 350
Gm. — and appeared congested. The lungs weighed
1550 and 1350 Gm. The external surfaces had a
bluish-gray appearance and the cut surface showed
confluent nodular consolidations of deep purplish or
blackish color. Both kidneys were enlarged and
each weighed 300 Gm. The external surfaces were
pale and the cut surfaces showed a thickened corti-
cal zone and a markedly congested medulla.
The microscopic sections of the lungs showed
most of the alveolar spaces filled with large macro-
phages containing brownish pigment. The inter-
alveolar septa were thickened and contained many
chronic inflammatory cells including deeply pig-
mented macrophages. Special stains proved that the
brown pigment within the septa and the macrophages
was iron. The cells resembled typical heart failure
for July, 1966
687
cells but they were much more numerous and were
present without evidence of chronic passive congestion.
Microscopic sections of the kidneys showed marked
infiltration of the glomeruli with inflammatory cells,
with numerous crescents in the Bowman’s space.
Special stain showed a marked thickening of the basal
membranes of the affected glomeruli. The tubules
contained hemoglobin casts and granular casts which
gave a positive iron and PAS reaction. The micro-
scopic picture of the mediastinal lymph nodes
showed marked anthracosis and many iron-positive
marcrophages. The histological examination of the
remaining organs failed to give any evidence of
systemic vascular disease.
The pathologic findings fully agree with the clinical
diagnosis made by Dr. Jesseph — that of Goodpas-
ture’s snydrome, which he described in 1919 and
which was re-introduced into the literature by the
report of Stanton and Tange3 in 1958. Several good
reviews on the subject have been written recently and
over a hundred cases have now appeared in the liter-
ature; unfortunately no case was available to me in
Stockholm for study.
The disease has two components — the pulmonary
and the renal. The lung disease consists of patchy
intra-alveolar hemorrhage followed by fibrosis and
mild inflammatory reactions. The amount of blood
lost by hemoptysis is not indicative of the much
larger amount of blood which is sequestered into the
alveolar tissue, from which it cannot be successfully
reabsorbed for re-utilization. This leads to a true
iron deficiency anemia with corresponding response
by the bone marrow. The accompanying renal lesion
is that of glomerulonephritis which has many
similarities to the renal lesion found in Wegener’s
granulomatosis.
Goodpasture’s syndrome as it is known today be-
longs probably to the immune pathologic diseases
which show some relationship to the group of col-
lagen diseases. It has some similarity to idiopathic
pulmonary hemosiderosis described many years ago by
the German pathologist, Professor Ceelen.4 The
difference between the two conditions is more clini-
cal than pathological since Ceelen’s disease usually
affects young individuals (children 1 to 6 years of
age) and progresses more slowly, finally leading to
death from pulmonary insufficiency or heart failure
within three to six years. Another point of dif-
ference is the rarity with which renal complications
are found in idiopathic pulmonary hemosiderosis.
General Discussion
Dr. Passi: This patient was admitted at the sec-
ond time with an anemia of 4.5 Gm. This implies
a considerable loss of blood since his previous hemo-
globin determination, which was over 9 Gm. Dr.
Jesseph, do you think this blood loss could be at-
tributed to his hemoptysis or does it mean blood
loss from other areas?
Dr. Jesseph: There is a remark in the protocol
that he had just a touch of rectal bleeding, but we
don’t have any evidence that he was bleeding sig-
nificantly from anywhere else. To answer your ques-
tion more directly, it is conceivable to have this much
anemia just from the hemoptysis. The blood is
sequestered into the lung and only part of it is
coughed up, and this process continuing for this long
a time can produce this much anemia since the iron
from the blood that is sequestered in the lung is lost
for re-utilization.
Dr. Passi: The other factor which should be
mentioned in the explanation of his anemia may be
his splenomegaly found on his second admission.
It is my understanding that large volumes of blood
can be sequestered and lysed in the spleen.
The patient was bronchoscoped and I would like
to ask Dr. Togut if one can make the differential
diagnosis between Wegener’s granulomatosis and
Goodpasture’s syndrome on bronchoscopy.
Dr. Togut: I will admit that I don’t know. If
this process is confined to the alveoli or predomi-
nantly involves the alveoli, bronchoscopy could not
give you the diagnosis. You might see blood in the
bronchial tree, but I don’t believe you could make the
diagnosis by bronchoscopy. I wonder if we would
have come close to a clinical diagnosis if we had ex-
amined the sputum and discovered the many macro-
phages containing iron. I also wonder if this could
be a case of chronic lead poisoning.
Dr. Ringertz: I cannot answer the last question,
but I am certain that his sputum must have contained
many so-called heart failure cells. The fact that
they appeared in this patient who had no signs of
heart failure might have been a clue to put one on the
right track.
Dr. von Haam: Thank you very much, Profes-
sor Ringertz.
References
1. Goodpasture, E. W. : Significance of Certain Pulmonary Lesions
in Relation to Etiology of Influenza. Amer. ]. Med. Sci., 158:863-
870, 1919.
2. Heptinstall, R. H., and Salmon, M. U. : Pulmonary Hemor-
rhage with Extensive Glomerular Disease of the Kidney. ]. Clin.
Path., 12:272-279, 1959.
3. Stanton, M. C., and Tange, J. D.: Goodpasture’s Syndrome
(Pulmonarv Hemorrhage Associated with Glomerulonephritis). Aust.
Ann. Med., 7:132-144, 1958.
4. Ceelen, W.: "Atmungswege und Lungen,” in Henke, F., and
Lubarsch, O. (eds.): Handbuch der Speziellen Pathologischen
Anatomie und Histologie, Berlin: Springer, 1931, vol. 3, p. 20.
A TTENTION PROGRAM CHAIRMEN: We are most anxious to receive
for consideration manuscripts, abstracts, or news items based upon lectures,
symposia, etc., presented to Ohio physicians or those presented by Ohio physicians
to other groups. — The Editor.
6 88
The Ohio State Medical Journal
Effectiveness: Lomotil possesses a unique degree of
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Children: 3 to 6 months — 3 mg. i}/i tsp.* t.i.d.)
6 to 12 months— 4 mg. (Vi tsp. q.i.d.)
1 to 2 years — 5 mg. (Vi tsp. 5 times daily)
2 to 5 years — 6 mg. (1 tsp. t.i.d.)
5 to 8 years — 8 mg. (1 tsp. q.i.d.)
8 to 12 years —10 mg. (1 tsp. 5 times daily)
Adults: 20 mg. (2 tsp. 5 times daily or 2 tablets 4 times daily)
*Based on 4 cc. per teaspoonful.
Maintenance dosage may be as low as one-fourth the therapeutic
dose.
Precautions: Lomotil, brand of diphenoxylate hydrochloride with
atropine sulfate, is a Federally exempt narcotic preparation of very
low addictive potential. Recommended dosages should not be
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Side Effects: Side effects are relatively uncommon but among those
reported are gastrointestinal irritation, sedation, dizziness, cutane-
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sion and general malaise.
SEARLE
Research in the Service of Medicine
Presenting Officers and Councilors
Elected at the Annual Meeting
m HE HOUSE OF DELEGATES of the Ohio State Medical Association named a President-
Elect and two new Councilors at the 1966 Annual Meeting held in Cleveland, May 24-28,
■ where the Incoming President was installed and several other members of The Council re-
elected. Following are biographical sketches of these new officers with additional information
on other members of The Council.
Dr. Robert E. Howard, of Cincinnati, was named President-Elect of the Association, and
will assume the Presidency at the 1967 Annual Meeting in Columbus the week of May 14. He
has served four years on The Council as Councilor of the First District. A practicing physician for
some 35 years in Cincinnati, he specializes in otolaryngology.
Dr. Howard was born in Dayton and took part of his undergraduate training at Ohio Wes-
leyan University. Continuing his studies at the University of Cincinnati, he earned the A. B.,
B. S., and B. M. degrees, before he was awarded the M. D. degree from the College of Medicine
in 1928. Postgraduate training included study tours at the University
of Pennsylvania and the University of Vienna, as well as at Cincin-
nati General Hospital and the University of Cincinnati College of
Medicine. Long a member of the faculty at the University of Cin-
cinnati College of Medicine, he is now associate professor of otolar-
yngology, and lectures in otology and clinical anatomy of the head
and neck. He is certified by the American Board of Otolaryngology
and is on the staffs of nine Cincinnati hospitals.
Dr. Howard was first elected as Councilor of the First District
in 1962 and was re-elected in 1964. He is a Past President of the
Academy of Medicine of Cincinnati, and further served the Academy
as Secretary-Treasurer and as member of the Board of Trustees. He
also has been President of the Cincinnati Medical-Dental-Hospital
Bureau, and the Cincinnati Speech and Hearing Center.
Before being named to The Council, Dr. Howard served in the House of Delegates, rep-
resenting Hamilton County. Among additional services on the state level, he was chairman of
the Auditing and Appropriations Committee of the Association and chairman of the Medical Ad-
visory Committee to the Ohio State Society of Medical Assistants. The International Alpha Kappa
Kappa Medical Fraternity recently named him as First Grand Vice-President.
Among other professional affiliations, he is a member of the American Medical Association
and the American Academy of Ophthalmology and Otolaryngology.
He has three sons and a daughter; and his wife Betty is a graduate nurse from Bethesda
School of Nursing in Cincinnati.
Incoming President Is Installed
Dr. Lawrence C. Meredith, of Oberlin and Elyria, was installed as President at the close of
the 1966 Annual Meeting, and will serve in that office until the 1967 Annual Meeting in Columbus
the week of May 14. He was named President-Elect at the 1965 Annual Meeting after serving
five years on The Council as Councilor for the Eleventh District.
As President-Elect during the past year, Dr. Meredith has followed a busy schedule and has
attended numerous functions in behalf of the medical profession. His travels on official busi-
Dr. Howard
692
The Ohio State Medical Journal
ness have taken him from Philadelphia to Chi-
cago, and to many other points outside of Ohio
as well as in the State. In addition to func-
tions of the State Association itself, he has at-
tended numerous meetings of the OSMA
Committees.
Long active in medical organization work,
Dr. Meredith is a former secretary-treasurer of
the Lorain County Medical Society and for
Dr. Meredith
many years was editor of the Society’s news-
letter. He was first elected to The Council, as
Councilor of the Eleventh District, in I960 and
was twice re-elected to that office, being in the
midst of his third term when named to the
higher office.
Dr. Meredith took his undergraduate work
at Oberlin College and at Ohio State Univer-
sity. The medical degree was received from
Ohio State University College of Medicine in
1945, and internship followed at University
Hospitals in Columbus. Fraternal affiliation
is Alpha Kappa Kappa.
During World War II, he served in the
Army Medical Corps and attained the rank of
captain. Among assignments, he was post sur-
geon in Panama.
Residency training in otolaryngology was at
University Hospitals in Cleveland. Since 1950
he has limited his practice to the ear, nose
and throat specialty and in 1953 was made a
Diplomate of the American Board of Otorhi-
nolaryngology. In addition to his hospital ap-
pointments, he has served as secretary-treas-
urer, vice-president and president of the staff
at Elyria Memorial Hospital.
In addition to his memberships in the local
Medical Society and the State organization, he
is a member of the American Medical Associa-
tion, a Fellow of the American Academy of
Ophthalmology and Otolaryngology, a mem-
ber of the Ohio Committee on Trauma, mem-
ber of the Cleveland Otolaryngological Club,
the Cleveland Medical Library Association and
the Elyria Chamber of Commerce; also the Con-
gregational Church in Oberlin.
Dr. and Mrs. Meredith are the parents of
two sons and a daughter.
First District Councilor
The House of Delegates elected Dr. Paul N.
Ivins, of Hamilton, as Councilor of the First
District to succeed Dr. Howard who was named
President-Elect of the Association.
Dr. Ivins is a practicing physician in Hamil-
ton and specializes in gastroenterology. Among
activities in professional organization work, he
has served as president of the Butler County
Medical Society and the
Hamilton Academy of
Medicine, and has repre-
sented the Butler County
Medical Society in the
OSMA House of Dele-
gates. Another position
of responsibility in his
professional work was
that as chief - of - staff at
the Fort Hamilton Hos-
pital.
Dr. Ivins was born in Hamilton and educated
in the local schools. In 1931 he received an
A. B. degree from Miami University at Oxford,
and in 1934 earned his M. D. degree from
Western Reserve University School of Medi-
cine. An internship followed at the Methodist
Hospital, Indianapolis, where he remained for
residency training in pathology.
During World War II, Dr. Ivins served for
88 months of active duty with the U. S.
Army, 24 months of that tour in the south-
west Pacific area. He attained the rank of
lieutenant colonel and for the last 18 months
of his military tour was chief-of-laboratory serv-
ice and pathologist at Wakeman Hospital
Center.
He resumed his practice in Hamilton in
1946. Among other activities, Dr. Ivins was
chairman of the advisory council of the
Hamilton Board of Health from 1951 to
I960, and was medical director of the Ohio
Life Insurance Company from 1961 to 1966.
He is married to the former June Miller of
Indianapolis. They make their home on a
fruit farm which they operate as an avocation.
Dr. Ivins
for July, 1966
693
Seventh District Councilor
The House of Delegates elected Dr. San-
ford Press, of Steubenville, as Councilor of
the Seventh District, to succeed Dr. Benjamin
C. Diefenbach, who had completed the maxi-
mum of three terms in that office.
Dr. Press was reared in Cleveland, attended
the Cleveland public schools, and entered West-
ern Reserve University for some of his under-
graduate studies. He transferred to continue
his studies at Ohio State
University where he
graduated in the summer
of 1934.
Being accepted at
Wayne University Medi-
cal School, he went to
Detroit and after grad-
uating in 1938, took his
internship at Harper
Hospital, followed by a
residency in obstetrics
and gynecology at Woman’s Hospital, Detroit.
In 1940, he began the general practice of
medicine in Steubenville with a tendency to-
ward the field of obstetrics and gynecology.
With the events of World War II, he joined
the U. S. Air Force in 1942 and served as flight
surgeon in the China-India-Burma Theater,
where he rose to the rank of major. In 1946,
he returned to Steubenville to resume his
practice.
Dr. Press is a member of the American Medi-
cal Association, Associate Member of the In-
ternational College of Surgeons, member of the
Academy of General Practice, and director for
the Seventh District for the Ohio Academy of
General Practice, as well as chairman of the
program committee for the OAGP Annual Sci-
entific Assembly in August of this year. He is
president-elect for the 1966-1967 term of the
Fort Steuben Academy of Medicine, an organ-
ization dedicated to promotion of postgraduate
activities for physicians in the area.
At present, Dr. Press is an authorized exami-
ner for the Pennsylvania Railroad and the Fed-
eral Aviation Agency. He is team physician
for Steubenville "Big Red’’ High School, a posi-
tion he has held with satisfaction for the past
ten years. For 16 years he has been physician
to the Jefferson County Home for the Aged.
He is a past president of the Lion’s Club of
Steubenville, is a member of the Elks Lodge,
has held the position as president of his Syna-
gogue for the last five years, and is a member of
the Osiris Shrine and a 32nd Degree Mason.
His main hobby is photography, and he en-
joys a good game of tennis. Dr. and Mrs.
Press have two daughters — Susan, a student
at the School of Pharmacy of the University
of Cincinnati, and Sandy, who attends Steuben-
ville High School.
Other Members of The Council
Dr. Henry A. Crawford, Cleveland, as Im-
mediate Past President, will serve an additional
year on The Council.
Dr. Frederick T. Merchant, Marion, was re-
elected Councilor for the Third District. He
was first elected to that office in 1964.
Dr. P. John Robechek, Cleveland, was re-
elected Councilor of the Fifth District. He
was first elected to that office in 1964.
Dr. George N. Spears, Ironton, was re-elected
Councilor of the Ninth District. He was first
elected to that office in 1964.
Dr. William R. Schultz, Wooster, was elect-
ed to his first full term as Councilor of the
Eleventh District. He was elected in 1965 to
fill one year of the unexpired term of Dr.
Meredith who was named President-Elect at
that time.
Councilors in the midst of two-year terms
are Dr. Theodore L. Light, Dayton, Second
District; Dr. Robert N. Smith, Toledo, Fourth
District; Dr. Edwin R. Westbrook, Warren,
Sixth District; Dr. Robert C. Beardsley, Zanes-
ville, Eighth District; and Dr. Robert L. Fulton,
Columbus, Tenth District.
Dr. Philip B. Hardymon, Columbus, is serv-
ing a three-year term as Treasurer.
Ohio State Heart Association
Elects Officers for Year
Dr. George Morrice, Jr., Columbus, was elected
President of the Ohio State Heart Association at its
annual meeting in Cleveland on May 25. Mrs. Carl
A. Strauss, Cincinnati, was re-elected to a second
term as Chairman of the Board. Dr. A. P. Ormond,
Akron, was re-elected Secretary, Newton D. Baker
III., Cleveland, treasurer, and Raymond A. Brown-
sword, Akron, Assistant Treasurer.
Other physicians elected to the Executive Com-
mittee were: Dr. John A. Rogers, Youngstown; Dr.
Sanford R. Courter, Cincinnati; Dr. J. Lester Kobac-
ker, Toledo; Dr. Burton G. Must, Dayton; Dr.
Jack S. Silberstein, Columbus, and Doctors Simon
Koletsky and John W. Martin, Cleveland.
Dr. Press
694
The Ohio State Medical Journal
Proceedings of the House of Delegates
1966 Annual Meeting
MINUTES OF FIRST SESSION
THE first session of the House of Delegates of
the Ohio State Medical Association was held in
the Gold Room of the Sheraton-Cleveland
Hotel, Cleveland, Tuesday evening, May 24. A
dinner was held in the Whitehall Room preceding
the business session.
The Reverend Frederick T. Schumacher, The First
Church in Oberlin, offered the invocation.
Following the invocation, Dr. David Fishman,
Cleveland, President of the Academy of Medicine of
Cleveland and Cuyahoga County, welcomed the dele-
gates to Cleveland and introduced President Henry
A. Crawford, Cleveland, who delivered his presi-
dential address. (See pages 718-722 for Dr. Craw-
ford’s address.)
Report on Delegates Present
The Credentials Committee reported 157 delegates
seated and eligible to vote. A number of alternate-
delegates, officers and executive secretaries of county
medical societies were in attendance.
1965 Minutes Approved
The minutes of the 1965 sessions of the House of
Delegates, as published in the July, 1965, issue of
The Ohio State Medical Journal, were approved by
official action.
Introduction of Honored Guests
Dr. Crawford introduced the following honored
guests :
Dr. Seigle W. Parks, Charleston, West Virginia,
president of the West Virginia State Medical As-
sociation; Dr. James S. Klumpp, Huntington, West
Virginia, past-president of the West Virginia State
Medical Association; Dr. Harold E. Barlow, Akron,
president, Ohio State Dental Association; Mr. Wil-
liam Slabodnick, Norwalk; president-elect, Ohio Hos-
pital Association; Mr. Eugene B. Imholt, Toledo,
president-elect, Ohio State Pharmaceutical Associa-
tion; Dr. Roger Grundish, Columbus, vice president,
Ohio Veterinary Medical Association; Mrs. Marta L.
Reeder, Ashland, president, Ohio State Nurses As-
sociation; Miss Sylvia Klotz, Toledo, president, Ohio
State Society of Medical Assistants; Mrs. Frances
Creamer, Dayton, past president, Ohio State Society
of Medical Assistants; Mrs. Herbert F. Van Epps,
Dover, president, Woman’s Auxiliary to the Ohio
State Medical Association; Mrs. James Wychgel,
Cleveland, president-elect, Woman’s Auxiliary to the
Ohio State Medical Association.
OSMA Past Presidents Introduced
The following Past Presidents of the Association
also were introduced: Dr. Edwin H. Artman, Chilli-
cothe; Dr. Frank Mayfield, Cincinnati; Dr. Edward
J. McCormick, Toledo; Dr. Horatio T. Pease, Wads-
worth; Dr. George W. Petznick, Cleveland; Dr. L.
Howard Schriver, Cincinnati; Dr. George A. Wood-
house, Miami Shores, Florida.
Also introduced were former members of The
Council: Dr. Fred P. Berlin, Lima; Dr. George T.
Harding, Columbus; Dr. George J. Schroer, Sidney.
Other guests introduced were: Dr. Hoyt D. Gard-
ner, Louisville, Kentucky, member of the Board of
Directors, American Medical Political Action Com-
mittee; Dr. Ralph K. Ramsayer, Canton, a member
of the Ohio State Medical Board; Mr. Charles S.
Nelson and Mr. George H. Saville, Columbus,
former Executive Secretaries of the Ohio State Medi-
cal Association.
AMA-ERF Checks Presented
The following representatives of Ohio’s medical
schools were presented checks from the American
Medical Association Medical Education and Research
Foundation by President Crawford: Dr. Robert F.
Parker, assistant dean, Western Reserve University
School of Medicine; Dr. Robert M. Woolford, repre-
senting the University of Cincinnati College of
Medicine; and Dr. John A. Prior, Associate Dean,
Ohio State University College of Medicine.
AMA Certificates of Humanitarian Service
Certificates of humanitarian service were awarded
to ten Ohio physicians for their service in South Viet-
nam by the American Medical Association. Present
to receive their certificates were the following Ohio
physicians: Dr. William Barratt, Painesville; Dr.
C. W. Hullinger, Springfield; Dr. Alexander Miller,
Cleveland Heights; Dr. Buel S. Smith, Akron and
Dr. John E. Stephens, Columbus. Not present to re-
ceive the certificates were the following physicians:
Dr. Frank Gatti, Portsmouth; Dr. Aaron Isaac Groll-
man, Cincinnati; Dr. Charles U. Hauser, Hamilton;
for July, 1966
695
Dr. Hobart E. Klaaren, Dayton; Dr. Paul R. Miller,
Columbus.
Ceremonies for Dr. Herbert M. Platter
Dr. Meredith was recognized and asked that the
rules be suspended and that Resolution No. 1 honor-
ing Dr. Herbert M. Platter be adopted. Resolution
No. 1 was adopted by unanimous standing vote and
acclamation. Dr. Meredith read the resolution, the
text of which follows:
WHEREAS, Herbert Morris Platter, M. D., served the citi-
zens of Ohio as Secretary of the State Medical Board of
Ohio from 1917 through 1965, and has been a symbol of
the purposes of this Association in promoting the science
and art of medicine and the protection of public health,
and
WHEREAS, Dr. Platter:
Conducted statewide investigations into epidemics of
typhoid, scarlet fever and polio in 1908;
Established the first health program for the Columbus,
Ohio, Public Schools in 1913;
Compiled the first Public Health Code for the State
of Ohio in 1914;
Served as President of the Ohio State Medical Asso-
ciation in 1932-1933;
In 1964 was presented a Certificate of Merit by the
American Medical Association for his initiation of the
first scientific exhibit to be shown at an AMA Con-
vention, held in Columbus in 1899;
Was awarded a certificate of appreciation by the Presi-
dent of the United States and was awarded a bronze
plaque of recognition by the Federation of State Medi-
cal Boards of the United States in 1964, NOW
THEREFORE BE IT
RESOLVED, that this 1966 Annual Meeting of the Ohio
State Medical Association be dedicated to Herbert Morris
Platter, M. D., in appreciation for his many years of serv-
ice, as a physician and a citizen, to the people of Ohio,
AND BE IT FURTHER
RESOLVED, that the Ohio State Medical Association and
the physicians of Ohio hereby express their admiration
and gratitude to Dr. Platter for his outstanding leader-
ship, guidance and counsel.
A copy of the resolution inscribed in bronze was
presented to Dr. Platter along with a color television
set.
Honors from the Governors
Lieutenant Governor John W. Brown presented
Dr. Platter with a special message from Governor
Rhodes, following which Lieutenant Governor
Brown addressed the House paying tribute to Dr.
Platter and recalling many incidents during which he
and Dr. Platter had worked together during their
careers in the service of the State of Ohio.
Report of Woman’s Auxiliary President
At this time Mrs. Herbert F. Van Epps, Dover,
President of the Woman’s Auxiliary to the Ohio
State Medical Association, was presented and gave a
report on Auxiliary activities to the House of Dele-
gates. (See pages 729-730 for the text of Mrs. Van
Epps’ address.)
Reference Committees Appointed
The following House of Delegates Reference Com-
mittees were reported by the President:
Credentials of Delegates — David Fishman, Cuya-
hoga County, Chairman; Chester J. Brian, Preble
County; William Dorner, Jr., Summit County; Sol
Maggied, Madison County.
President’s Address — Joseph L. Bilton, Cuya-
hoga County, Chairman; Paul N. Ivins, Butler
County; Edwin W. Burnes, Van Wert County; John
R. Huston, Franklin County; William R. Graham,
Huron County.
Resolutions Committee No. 1 — Frederick P.
Osgood, Lucas County, Chairman; Carl A. Minning,
Clermont County; Isador Miller, Champaign County;
Dwight L. Becker, Allen County; Robert A. Irvin,
Lake County; Charles W. Stertzbach, Mahoning
County; Norman L. Wright, Coshocton County; Ken-
neth E. Bennett, Washington County; Richard E.
Bullock, Vinton County; Jasper M. Hedges, Pick-
away County; Charles H. McMullen, Ashland
County.
Resolutions Committee No. 2 — John H. Budd,
Cuyahoga County, Chairman; Robert M. Woolford,
Hamilton County; Robert A. Bruce, Montgomery
County; Donald R. Brumley, Hancock County; V.
William Wagner, Ottawa County; Maurice F. Lieber,
Stark County; Robert E. Rinderknecht, Tuscarawas
County; James A. L. Toland, Guernsey County; Wil-
liam M. Singleton, Scioto County; Homer A. Ander-
son, Franklin County; Albert Burney Huff, Wayne
County.
Resolutions Committee No. 3 — James C. Mc-
Larnan, Knox County, Chairman; Thomas E. Fox,
Warren County; Maurice M. Kane, Darke County;
Walter A. Daniel, Seneca County; William J. Neal,
Fulton County; William F. Boukalik, Cuyahoga
County; James W. Parks, Summit County; James F.
Sutherland, Belmont County; Carl E. Spragg, Mus-
kingum County; Roger P. Daniels, Meigs County;
Ben V. Myers, Lorain County.
Tellers and Judges of Election — James G. Tye,
Montgomery County, Chairman; Daniel V. Jones,
Hamilton County; Robert S. Oyer, Auglaize County;
Shepard A. Burroughs, Ashtabula County; Leonard
V. Phillips, Summit County; Sanford Press, Jefferson
County; Jay Ross Wells, Licking County; Thomas
W. Morgan, Gallia County; Joseph A. Bonta, Frank-
lin County; Emil J. Meckstroth, Erie County.
Nominating Committee Elected
The next order of business was the election of a
Nominating Committee. The House of Delegates
nominated and elected the following persons, one
from each district, for the Committee on
Nominations:
First District — Daniel V. Jones, Hamilton
County.
Second District — George J. Schroer, Shelby
County.
696
The Ohio State Medical Journal
Third District — Fred P. Berlin, Allen County.
Fourth District — Edwin C. Winzeler, Flenry
County.
Fifth District — Paul A. Mielcarek, Cuyahoga
County.
Sixth District — Edward A. Webb, Portage
County.
Seventh District — Elias R. Freeman, Harrison
County.
Eighth District — Kenneth E. Bennett, Wash-
ington County.
Ninth District — Thomas W. Morgan, Gallia
County.
Tenth District — Lewis W. Coppel, Ross County.
Eleventh District — William R. Graham, Huron
County.
Dr. Crawford then announced that under a system
of rotation approved by the House of Delegates in
1963, chairman of the committee for this year would
be the nominee from the Fourth District, Dr. Edwin
C. Winzeler, Henry County.
Introduction of Resolutions
Dr. Crawford then called for the introduction of
resolutions. He ruled that resolutions which had been
presented within the 60-day time limit and had been
distributed to the delegates in advance of the meet-
ing should be read by title only for referral. Forty-
three resolutions were read by title only and referred
to the resolutions committees.
New Resolutions Presented
Dr. Crawford then called for the presentation of
new resolutions. He ruled that any delegate wishing
to present a resolution not submitted 60 days before
the meeting should explain the purpose of the resolu-
tion and why it could not have been submitted in
advance. He announced that such resolutions then
could be received upon consent of two-thirds of the
delegates present. The following resolutions were
then submitted. They were accepted by the House of
Delegates and were referred to the Resolutions
Committees.
RESOLUTION NO. 45
Subscribers to Part B of Medicare Are Entitled
To Treatment as Private Patients
(By the Academy of Medicine of Cleveland)
WHEREAS, the "Modification of Proposed Third Principle
Payment for Sendees Involving Residents and Interns, "as
embodied in Part B of the Medicare Law, states, as
follows:
"In the case of Major Surgical Procedures, as defined
by the Joint Commission on Accreditation of Hospitals,
and other complex and dangerous procedures or situa-
tions, such personal and identifiable direction must in-
clude supervision in person by the attending physician,”
and
WHEREAS, since this principle is designed to safeguard
that high caliber of professional care which the profession
is committed to provide, and
WHEREAS, The American College of Surgeons Committee
on Medicare has proposed modification of this principle
in such mat . er that the patients, for whom payment will
be made under Title #18 of the Medicare Law, would,
in many ;nstitutions, be placed under the "complete re-
sponsibility ” of interns and residents in training, and
that this furd.er connotes lack of personal supervision by
the attending physician, and
WHEREAS, such a modification would approve a procedure
wherein a physician would receive compensation for serv-
ices which he did not personally provide to the patient,
and
WHEREAS, such receipt of compensation would be both
unethical and dishonest, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association hereby
records itself in support of the principle that subscribers
to Part B of Medicare, by payment of premium, have
purchased the same rights to personal medical care enjoyed
by any other private patient, AND BE IT FURTHER
RESOLVED, that the Ohio State Medical Association hereby
records itself in support of the principle that professional
responsibility of a physician, for services rendered by an
intern or resident implies personal supervision and direc-
tion, in order to be considered identifiable and compen-
sable service, AND BE IT FURTHER
RESOLVED, that the Ohio State Medical Association in-
struct its Delegation to the American Medical Association
to present this Resolution at the annual meeting of June
26-30, 1966, seeking its adoption. AND BE IT FUR-
THER
RESOLVED, that a copy of this Resolution be forwarded
to the Secretary of The Department of Health, Education,
and Welfare.
RESOLUTION NO. 46
Compliance with the Civil Rights Act of 1964
(The Second Councilor District)
All Physicians, as citizens of the United States, are bound
by the laws of the United States. There is no need to
demean them by asking an oath of compliance to those
laws and their regulations. Especially not for the receipt
of remuneration for sendees rendered to welfare recipients.
The Ohio Department of Welfare has again notified physi-
cians of Ohio that, "We regret very much that we are
not in a position to pay the enclosed bills without the
assurance of compliance with the Civil Rights Act of 1964
as required by federal law and regulations.”
In October 1965 the House of Delegates of the American
Medical Association passed a resolution stating that the
House of Delegates directs the Board of Trustees and the
Officers of this Association to oppose actively and force-
fully this and any future attempts by HEW or any other
federal agency to impose conditions and pledges upon the
medical profession. THEREFORE BE IT
RESOLVED, that the House of Delegates of the Ohio State
Medical Association petition the Board of Trustees and
the Officers of the American Medical Association to ac-
tively and forcefully oppose the requirement of the fed-
eral law and regulations that ask assurance of compliance
with the Civil Rights Act of 1964 from individual citi-
zens, even through the Supreme Court.
One Resolution Inadvertently Omitted
A resolution on reimbursement to county medical
societies for costs of collection of OSMA and AMA
dues was inadvertently omitted from the printed
resolutions. The President ruled that it was in order
for such resolution, therefore, to be considered by
the House and it was assigned to Resolutions Com-
mittee No. 1 and numbered Resolution No. 47.
RESOLUTION NO. 47
Reimbursement of Costs for Collection of Dues
(By Academy of Medicine of Cincinnati)
WHEREAS, the Ohio State Medical Association and the
American Medical Association have increased the demands
on local County Medical Societies for additional services;
and
WHEREAS, the increase in demands by Ohio State Medical
for July, 1966
697
Association and the American Medical Association through
extended programs require additional expenditures by
County Medical Societies; THEREFORE, BE IT
RESOLVED, that the County Medical Society be reimbursed
for costs expended in the collection of dues and the cer-
tification of membership to both the Ohio State Medical
Association and the American Medical Association.
Following announcements about meetings of the
reference committees and the second session of the
House of Delegates, the House recessed until Friday
morning, May 27.
MINUTES OF SECOND SESSION
The second session of the House of Delegates of
the Ohio State Medical Association at the 1966 An-
nual Meeting was held on Friday morning, May 27,
in the Gold Room, Mezzanine Floor of the Sheraton-
Cleveland Hotel.
The meeting was called to order by President
Crawford. He introduced the following guests who
addressed the House: Dr. William B. West, Hunt-
ingdon, Pennsylvania, president of the Pennsylvania
Medical Society; Dr. Donald K. Dudderar, Newport,
Kentucky, vice president of the Kentucky Medical
Association; Dr. Seigle W. Parks, Charleston, West
Virginia, president of the West Virginia State Medi-
cal Association; Dr. Luther R. Leader, Royal Oak,
Michigan, president of the Michigan State Medical
Society. Also introduced were Dr. Kenneth O. Neu-
mann, Lafayette, Indiana, president of the Indiana
State Medical Association; Dr. James S. Klumpp,
Huntington, West Virginia, past president of the
West Virginia State Medical Association; Dr. Thomas
L. Dwyer, Mexico, Missouri, president of American
Association of Physicians and Surgeons; Dr. Wm.
P. Smith, Jr., Columbus, president, Ohio Academy
of General Practice; Dr. Carl A. Lincke, Carrollton
and Dr. George W. Petznick, Cleveland, Past Presi-
dents of the Association. Messrs. Joel Ginsberg, R.
Dennis Blose and Frederick Mueller, representatives
of the Student AMA Chapter, Ohio State University.
Dr. David Fishman, Cuyahoga County, Chairman
of the Committee on Credentials of Delegates, re-
ported that 151 delegates were seated and eligible to
vote. Also present were alternate-delegates, officers and
other guests.
Committee on President’s Address
President Crawford called for a report of the
Reference Committee on the President’s Address,
which was presented by Dr. Joseph L. Bilton, Cleve-
land, delegate from Cuyahoga County and chairman
of the committee. It read as follows:
"Your Committee on the President’s Address first
wishes to commend our President who took the reins
of our organization at a critical time when the "ax
was about to fall” and vowed he would not preside
over a wake. Throughout his speech he has indicated
an aggressive policy, with apologies to no one. It is
our impression that, with the aid of all parties con-
cerned, we are coming out of a very difficult situa-
tion with the best possible advantage. We are par-
ticularly proud of this aggressive and non-apologetic
approach in that we feel that no apology is due from
a profession that has performed as well as our’s over
the years.
"President Crawford has pointed out our multiple
activities and, indeed, our leadership, not only in
professional matters, but in the socio-economic and
legislative problems that have beset our profession in
recent years. In connection with this topic, he com-
mends our leadership and our Association, for the
foresight, imagination and courage in initiating and
pursuing the "USUAL AND CUSTOMARY FEE”
schedule, first, with the O.M.I. and, next, with the
Ohio Bureau of Workmen’s Compensation. As Dr.
Crawford has indicated, he hopes that we will be
honest, fair and cooperative in the pursuit of these
gains so that we do not lose the advantage of the
usual and customary fee schedules which it is hoped
will grow to include all negotiations where third
party payments are concerned.
"A major theme running through much of our ,
President’s address stressed the preservation of
physician-patient relationship. He urged us to pursue
this relationship in all matters concerning our
profession.
"Again, our President reiterated our policy of
support to all elements of the medical profession in
our effort to remain free and unfettered in relation-
ship with our patients, to help repel third party con-
trol, and to assist all those who are not now free to
gain this status.
"Throughout his speech, we discern certain pride
in the activities, accomplishments and dynamism of
our leadership. He notes the increased and intelligent
interest of our delegates, our councilors, state officials
and AMA delegates. Particularly, we share his
pleasure in the accomplishment and special credits
that accrue to such members of our delegation as Drs.
John Budd, Charles Hudson, and others who have
placed Ohio in the forefront of the national medical
scene, but, more importantly, have exercised a de-
termined leadership that has helped direct our pro-
fession through these critical times.
"Dr. Crawford states, and we are inclined to agree,
that the main theme of his speech is the "new look”
and here we quote: 'The atmosphere in which we
practice is taking on a new look. We must adjust
... we must adapt . . . and we must dedicate our-
selves to the task of meeting this new look, the new
conditions and responsibilities that confront us.’
"There is no doubt that we must change our think-
ing in many areas. Many of our older concepts, once
revered, now appear as out of place as a double-
breasted suit in this 'jet’ age. But more than ever,
as our President points out, we must assume our re-
sponsibilities in conducting our affairs, promoting our
image and maintaining a high caliber of medical
practice. We can no longer afford to 'let George do
698
The Ohio State Medical Journal
it’ for today, 'George’ is Blue Cross, the Federal
Government, Hospital Council and many other
organizations who are not only too willing to do it
for us but are also eager to tell us how to do it. He
points out that we, therefore, must accept the fact
that we are going to be subject to some controls. We
now have an opportunity to control ourselves, or we
have the alternative of having controls imposed upon
us by outsiders, perhaps not unlike those being im-
posed upon the drug industry today.
"With a loud Amen, we commend his reference to
the Medical Practice Act.
"Strongly emphasized was our need to keep our-
selves aware of the socio-economic changes in medi-
cal practice as they occur from week to week or
month to month, and the steps our Association is
taking to counter or implement these changes as our
judgment dictates. We noted our President’s rather
petulant mood in chastising us for failing to keep
ourselves informed and supporting the leadership.
We can assure him that at least the members of this
Committee have read Newsletter No. 3.
"Regarding post graduate education, he points out
that the tide of medical information is overwhelming
and surpasses what we can pick up with random
meetings. He implies that perhaps some organized
post graduate study should be considered and spon-
sored by our profession.
"Finally, will there be light, or will there be dark-
ness? Will we complain about the darkness or light
a candle? We believe our President has 'lighted the
candle’ so that we may all see our way. He has urged
us to enter actively into not only medical affairs but
in community activities, into socio-economic affairs of
our community, to re-establish and improve the image
of the 'M. D.’ as a community force.
"Mr. President, I move the adoption of this report.
"I wish to thank the members of my Committee
for their careful study and evaluation of an outstand-
ing address by an outstanding President of this As-
sociation. They are: Paul N. Ivins, Butler County;
Edwin W. Burnes, Van Wert County; John R.
Huston, Franklin County; William R. Graham,
Huron County; Joseph L. Bilton, Cuyahoga County,
Chairman.”
On motion made and seconded, the House of
Delegates by official action approved the report of
the Committee on the President’s Address.
Dr. Annis Introduced
At this time Dr. Edward R. Annis, Miami, Florida,
a past president of the American Medical Associa-
tion, was introduced and he received a standing ova-
tion by the members of the House. Dr. Annis asked
for renewed purpose and direction on the part of a
profession that will not be subjugated by direction
from any source. He called for determination that
this country continue to have an independent medical
profession in a free society.
Report of Resolutions Committee No. 1
Dr. Frederick P. Osgood, Lucas County, reported
for Resolutions Committee No. 1, of which he was
chairman. The report read as follows:
"I have the privilege of presenting to the House
of Delegates the following report of Resolutions
Committee No. 1. The committee had 16 resolutions
for consideration, including one emergency resolu-
tion introduced on the floor of the House, by consent
of two-thirds of the delegates.
RESOLUTION NO. 2
Dues Exemption for Financial Emergencies
(By The Council of the Ohio State Medical Association)
WHEREAS, Amended Resolution No. 8, as adopted by the
1965 OSMA House of Delegates, has directed that an ap-
propriate amendment regarding dues exemption for finan-
cial emergencies be prepared by the legal counsel, under
the supervision of The Council of the Ohio State Medical
Association, for submission to the 1966 OSMA House of
Delegates, the following resolution is offered in compli-
ance therewith: THEREFORE BE IT
RESOLVED, that Section 1 of Chapter 2 of the By-Laws
of this Association be amended and supplemented by ad-
ding at the end thereof the following paragraph:
A member of this Association for whom payment of
his regular dues in this Association constitutes a finan-
cial hardship may request The Council of this Associa-
tion for an adjustment of dues. Such request shall be
in writing, signed by such member and filed with the
secretary of such member’s local medical society. If
the society, or the council of the society, finds that
payment by such member of his regular dues in this
Association shall constitute a financial hardship and
certifies such finding to The Council of this Association.
The Council will make such adjustment of his OSMA
dues for such period of time, and subject to such con-
ditions, as The Council may deem appropriate and
advisable.
"The first resolution considered by the committee
was submitted by The Council of the Ohio State
Medical Association. This resolution was reviewed
thoroughly. Many of the delegates spoke to the
resolution favorably. It was the consensus that this
resolution be adopted as introduced and, Mr. Presi-
dent, I so move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 2 be
adopted as introduced, was approved.
RESOLUTIONS NO. 3, NO. 4, NO. 5, NO. 6
Mental Health
"Resolution No. 3 entitled 'Mental Health Legisla-
tion,’ submitted by The Council of the Ohio State
Medical Association; Resolution No. 4 entitled 'For
Reorganization of Ohio State Mental Health Activi-
ties,’ submitted by the Academy of Medicine of
Cleveland; Resolution No. 5 entitled ’Policy State-
ment on Sendees to the Mentally 111,’ submitted by
the delegates of the Summit County Medical Society;
and Resolution No. 6 entitled 'Admissions of Men-
tally Retarded Children’ and submitted by the Put-
for July, 1966
699
nam County Medical Society, were considered
together.
"The content in each of the first three resolutions
was directed essentially at the same objective. We
were indeed fortunate to have the very wise counsel
of many very knowledgeable members.
"Your committee wishes to submit a composite
resolution in lieu of Resolutions 3, 4 and 5, as
follows:
SUBSTITUTE RESOLUTION ON MENTAL HEALTH
WHEREAS, Ohio State facilities for treatment of mental
illnesses are supervised by a Director of Mental Hygiene
and Correction who also oversees the penal system, thus
linking the mentally ill and criminals under one system
to the detriment of both, it is believed that creation of
a separate Department for Mental Health would be a
major step toward providing more nearly adequate facil-
ities for this State of Ohio. THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association take
steps to initiate and to support in the next session of the
Ohio Legislature, legislation which will
(1) Create a separate Department of Mental Health
and Retardation in the State of Ohio;
(2) Establish a position of 'Director of Mental Health’
with cabinet status who, if possible, would be a
doctor of medicine ; and
(3) Establish a Board of Mental Health composed of
5 to 7 members appointed by the Governor, who
shall serve overlapping terms. At least four mem-
bers shall be doctors of medicine of recognized
competence in the care of the mentally ill and re-
tarded, AND BE IT FURTHER
RESOLVED, that said Board of Mental Health shall have
the following functions:
(1) Advise and assist in the establishment and imple-
mentation of policies for the Department of Men-
tal Health.
(2) Recommend to the Governor candidates for the
position of Director of the Department of Mental
Health.
(3) Meet several times yearly to consider all matters
pertinent to effective function of the Department
of Mental Health.
(4) Submit to the Governor annual reports which shall
be made public, AND BE IT FURTHER
RESOLVED, that the House of Delegates direct the Asso-
ciation’s Committee on Mental Health to develop separate
legislation calling for statutory autonomy for mental
retardation within the Department of Mental Health,
AND BE IT FURTHER
RESOLVED, that the principles developed above be the
official policy of the Ohio State Medical Association.
However, the desirability of OSMA sponsorship of such
legislation in the 107th General Assembly shall be de-
termined by The Council, AND BE IT FURTHER
RESOLVED, that efforts be directed toward the adoption
of a Community Mental Health Services Act which places
in the local community the responsibility for specific
treatment programs.
"Mr. President, I move the adoption of the Sub-
stitute Resolution on Mental Health.”
By official action the recommendation of the
committee, namely, that the Substitute Resolution
on Mental Health be adopted, was approved with
an amendment from the floor which is indicated
by the words in Italics.
(For text of Resolutions 3, 4, 5, see pages 481,
482, May, 1966 issue OSMJ.)
RESOLUTION NO. 6
Admissions of Mentally Retarded Children
"Resolution No. 6 was submitted by the Putnam
County Medical Society. On the basis of the action of
the committee relative to the previous resolution, it
was felt that the problem presented in Resolution
No. 6 could be properly and adequately handled by
the resultant organizational setup. For this reason, I
move that Resolution No. 6 be not adopted and, Mr.
President, I so move.”
By official action the recommendation of the
committee, namely, that Resolution No. 6 NOT
be adopted, was approved.
(For text of Resolution No. 6 see page 482, May,
1966 issue OSMJ.)
RESOLUTION NO. 24 AND RESOLUTION NO. 4l
Claims Form
"Consideration was next given to Resolution No.
24 entitled 'Standardized Claims Form,’ introduced
by the Mahoning County Medical Society, and
Resolution No. 41 entitled 'Regarding "forms” for
Participants of Part B of Medicare,’ introduced by
the Huron County Medical Society.
"There are at the present time forms available
which are, we are advised, in the process of revision.
The committee was in complete accord with an at-
tempt to simplify and standardize forms for third
party payments. Inasmuch as Resolution No. 24
encompasses the import of Resolution No. 41 and
permits a much wider use, the committee recom-
mends that Resolution No. 41 be not adopted and,
Mr. President, I so move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 41 NOT
be adopted, was approved.
(For text of Resolution No. 41 see pages 490 and
491, May, 1966 issue OSMJ.)
"The committee recommends that Resolution No.
24 be amended as follows: In the second line of the
first RESOLVE in the place of the words 'to be
used’ insert 'which may be used,’ and delete the
words 'the Department of HEW or its.’ Mr. Presi-
dent, I move the adoption of Amended Resolution
No. 24, which reads as follows:
AMENDED RESOLUTION NO. 24
Standardized Claims Form
WHEREAS, under Public Law 89-97 (Medicare) a claims
form has been proposed by the Department of Health,
Education, and Welfare for the implementation of Part B
of the Act, and
WHEREAS, the completion of such form together with the
physicians’ signature, may establish precedence with ref-
erence to future and even more objectionable forms, and
WHEREAS, it is reasonable to provide essential medical
information for the purpose of reimbursement, and
WHEREAS, a standardized claims form is desirable for all
third party claims, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association adopt
a standardized claims form which may be used in lieu of
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any proposed form submitted by a fiscal intermediary.
AND BE IT FURTHER
RESOLVED, that the Ohio State Medical Association make
available to all its members who desire to use it, a claims
form similar to the one submitted in the printed resolu-
tions (quod vide) modified as necessary by the presently
acting committee.
By official action of the House, the recom-
mendation of the committee, namely, that
Amended Resolution No. 24 be adopted, was
approved.
(For text of Resolution No. 24 see page 486, May,
1966 issue OSMJ.)
The resolution as approved reads as follows:
RESOLUTION NO. 39
To Upgrade the Education of the Deaf and
Hard of Hearing
"Resolution No. 39, introduced by the Fourth Dis-
trict Councilor, was considered in great detail. The
experts who spoke to this resolution were desirous
of having the word 'deaf’ changed to 'hearing handi-
capped.’ With this suggestion in mind, it is recom-
mended that in all places where the word 'deaf’
is used it be changed to read 'hearing handicapped’
and that the second RESOLVE read as follows:
’RESOLVED, that the Council of the Ohio State Medical
Association promote a broad public educational program
beamed through the Parent-Teacher Associations, Mothers'
clubs, Child Conservation Leagues and civic organizations
for the purpose of urging an improvement in the educa-
tion of the hearing handicapped in the State of Ohio.’
"Mr. President, I move the adoption of the edi-
torially changed Resolution No. 39.”
By official action, the recommendation of the
committee, namely, that editorially changed Res-
olution No. 39 be adopted, was approved.
EDITORIALLY CHANGED RESOLUTION NO. 39
To Upgrade the Education of the
Hearing Handicapped
(By the Fourth District Councilor,
Robert N. Smith, M. D., Toledo)
WHEREAS, the problems of the hearing handicapped are
founded in the loss of auditory communication, and
WHEREAS, these problems can be largely overcome by
proper special education, and
WHEREAS, in the 1963 research of the Division of Special
Education of the State of Ohio it was estimated that one
child in every 20 in school or at the preschool level had
a significant hearing loss, and
WHEREAS, only fifteen per cent of today’s young people
with hearing handicaps successfully complete the full
scale high school academic program, and
WHEREAS, the hearing handicapped are conceded to have
potentially normal intelligence when tested by standard-
ized nonverbal tests, and
WHEREAS, it is the duty of the physician to promote re-
habilitation when he cannot cure; THEREFORE BE IT
RESOLVED, that the House of Delegates of the Ohio State
Medical Association urge that the State Board of Edua-
tion be instructed by the Governor to upgrade education
of the hearing handicapped in the State of Ohio
(a) by promoting oral education of the hearing handi-
capped child in contrast to the manual method;
(b) by providing more educational facilities, properly
staffed and equipped, with a goal of one special
education unit for the hearing handicapped per
county, or small group of counties;
(c) by integrating these special education units with
regular elementary and high school facilities,
where possible;
(d) by constantly recruiting young people to enter the
field of education of the hearing handicapped as
a profession, and
(e) by seeking adequate funds from the legislature to
support a proper program; AND BE IT FUR-
THER
RESOLVED, that the Council of the Ohio State Medical
Association promote a broad public educational program
beamed through the Parent-Teacher Associations, Mothers’
clubs, Child Conservation Leagues and civic organizations
for the purpose of urging an improvement in the educa-
tion of the hearing handicapped in the State of Ohio;
AND BE IT FURTHER
RESOLVED, that all physicians, especially those in general
practice and the specialities of pediatrics and ear. nose
and throat, be adequately prepared to advise their patients
as to the scientific techniques and special educational
facilities which are available for the education and re-
habilitation of the hearing handicapped child or adult.
RESOLUTION NO. 26
Changes in Certificate of Live Birth
"Resolution No. 26 was submitted by the Mont-
gomery County Medical Society.
"The discussion that was heard relative to this res-
olution developed the fact that the birth certificate is
a legal document and, as such, is open to public scru-
tiny. It was pointed out that the birth certificate is
not intended as a statistical survey. For these rea-
sons the committee recommends that Resolution No.
26 be not adopted and, Mr. President, I so move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 26 be
NOT adopted, was approved.
(For text of Resolution No. 26 see page 486, May,
1966 issue OSMJ.)
RESOLUTION NO. 29
Training More General Pracdtioners
"The committee next considered Resolution No.
29, submitted by the Huron County Medical Society.
There was a lively discussion from the floor and let-
ters were introduced from the dean of the Ohio State
University College of Medicine and written comments
from the Department of Preventive Medicine of
Ohio State University.
"The committee felt that the intent of the resolu-
tion was quite in accord with the expression of opin-
ion of the OSMA House of Delegates for many
years past, but that there had been no useful purpose
served by the introduction of personalities. For this
reason a substitute resolution is presented which
reads as follows:
SUBSTITUTE RESOLUTION NO. 29
Training More General Practitioners
WHEREAS, it is a statistical fact that Ohio communities
request family physicians (OSMA Physicians’ Placement
Service) 15 times more often than specialists, and
WHEREAS, it would be a realistic and functional respon-
sibilty of the medical schools in the State of Ohio, in a
democratic spirit of supply and demand free enterprise
system, to meet the demands (needs) of the citizens of
Ohio pertinent to a need of more family physicians;
THEREFORE BE IT
RESOLVED, that the House of Delegates of the Ohio State
Medical Association express most sincere thanks as a
for July , 1966
701
token of gratitude to the Joint Committee of the Ohio
State Medical Association — Ohio Academy of General
Practice for their untiring efforts to bring about the ful-
fillment of the most realistic, dire, and critical need for
an increase in the numbers of family physicians in the
State of Ohio — and even nationally; BE IT FURTHER
RESOLVED, that the suggestions of this resolution be acted
upon swiftly and commensurate with the acute and dire
critical need for more family physicians, both Statewide
and nationally. The latter action to be taken wholeheart-
edly, most diligently, and most sincerely by the various
deans of the medical schools in the State of Ohio as a
fulfillment of their responsibilities as medical leaders, as
has been voiced by the President of the American Medi-
cal Association.
"Mr. President, I move the adoption of Substitute
Resolution No. 29.”
By official action, the recommendation of the
committee, namely, that Substitute Resolution No.
29 be adopted, was approved.
(For text of Resolution No. 29, see page 488, May,
1966 issue OSMJ.)
RESOLUTION NO. 31
Procedure for Amendments to the Medical
Practice Act of the State of Ohio
"Resolution No. 31, introduced by the Academy
of Medicine of Cincinnati, was reviewed.
"The acting secretary of the State Medical Board
had informed the chair that at the present time the
recommendations of this resolution were already in
the process of study and change. The Council of the
Ohio State Medical Association is collaborating in
this effort and for this reason, Mr. President, I move
that Resolution No. 31 be not adopted.”
By official action, the recommendation of the
committee, namely, that Resolution No. 31 be
NOT adopted, was approved.
(For text of Resolution No. 31 see page 488, May,
1966 issue OSMJ.)
RESOLUTION NO. 33
Industrial Commission Usual and Customary Fee
(By Charles H. McMullen, M. D., Delegate, Ashland County)
WHEREAS, the Industrial Commission of Ohio and the
Bureau of Workmen’s Compensation have initiated a pro-
gram of reimbursing physicians their usual and customary
fees for professional medical care of Workmen’s Compen-
sation cases, and
WHEREAS, this program demonstrates a spirit of coopera-
tion with and confidence in the physicians of Ohio, and
WHEREAS, this usual and customary fee program reflects
sound leadership in the administration of the respon-
sibilities of the commission and the bureau, THEREFORE
BE IT
RESOLVED, that this House of Delegates of the Ohio State
Medical Association officially commends the Industrial
Commission of Ohio and the Bureau of Workmen’s Com-
pensation for this program, AND BE IT FURTHER
RESOLVED, that the component county medical societies
and their members continue to extend their full coopera-
tion and assistance in helping to insure the successful ad-
ministration of this usual and customary fee program.
"Resolution No. 33 was introduced by Dr. Charles
H. McMullen, delegate from Ashland County. This
resolution was accepted for discussion. It commends
the Industrial Commission of Ohio for its forward
and ongoing program of adequate compensation.
"The committee recommends the adoption of Res-
olution No. 33, as submitted, and Mr. President, I
so move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 33 be
adopted as submitted, was approved.
RESOLUTION NO. 38
Traffic Accidents and Medically Incompetent Aged Drivers
"Resolution No. 38 was submitted by the Lorain
County Medical Society. There was considerable dis-
cussion from the assembled delegates pointing to the
fact that this resolution is discriminatory and, fur-
ther, to the fact that the determination of medical
infirmities should not be the proper purview of the
Highway Department; and that the inabilities to
properly manage a motor vehicle insofar as physical
infirmities are concerned have no dependency on
chronologic age. Your committee, therefore, is in
agreement that Resolution No. 38 be not adopted
and, Mr. President, I so move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 38 be
NOT adopted, was approved.
(For text of Resolution No. 38 see page 490, May,
1966 issue of OSMJ.)
RESOLUTION NO. 44 AND RESOLUTION NO. 46
"Resolution No. 44 entitled 'Medical Ethics’ was
submitted by the Huron County Medical Society. Res-
olution No. 46 entitled 'Compliance with the Civil
Rights Act of 1964’ was introduced by the Councilor
of the Second District on the floor of the House.
These resolutions were considered together. While
Resolution No. 44 is entitled 'Medical Ethics’ the
content and import of the resolution was such that
the committee felt it should not be immediately re-
manded to The Council on the basis of its ethical
content. However, Resolution No. 46 pointed out
that action had already been initiated in the House
of Delegates of the American Medical Association
at the October, 1965, meeting. It was further
pointed out that in spite of the action taken at the
AMA meeting there were still many problems with
billing in the State of Ohio for welfare cases. Since
Resolution No. 46 supersedes Resolution No. 44, the
committee recommends that Resolution No. 44 be
not adopted and, Mr. President, I so move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 44 be
NOT adopted, was approved.
(For text of Resolution No. 44 see page 491, May,
1966 issue OSMJ.)
RESOLUTION NO. 46
Compliance with Civil Rights Act of 1964
"Resolution No. 46, which was introduced on the
floor of the House, read as follows:
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The Ohio State Medical Journal
The entire Annual Meeting was dedicated to Dr. Herbert M. Platter. Here, at the first session of the House of
Delegates, President Crawford is presenting Dr. Platter with a copy of the dedicatory resolution inscribed in bronze.
Hart F. Page, OSMA. Executive Secretary, is holding the color television set also presented to Dr. Platter.
Past Presidents of the Association are shown here at the dinner meeting of The Council. Front row, from left, Drs.
H. T. Pease, George A. W oodhouse, Paul A. Davis, H. M. Platter, L. Howard Schriver; Carl A. Lincke, and Harve Al.
Clodfelter. Standing, from left, are Drs. Edwin H. Art man, Robert E. Tschantz, Frank H. Maypeld, George W . Petz-
nick, Charles L. Hudson, Henry A. Crawford ( Outgoing President) , and George J. Hamwi.
for July, 1966
703
All physicians, as citizens of the United States, are bound
by the laws of the United States. There is no need to
demean them by asking an oath of compliance to those
laws and their regulations. Especially not for the receipt
of remuneration for services rendered to welfare recipients.
The Ohio Department of Welfare has again notified phy-
sicians of Ohio that, "We regret very much that we are
not in a position to pay the enclosed bills without the
assurance of compliance with the Civil Rights Act of
1964 as required by federal law and regulations.”
In October 1965 the House of the American Medical As-
sociation passed a resolution stating that the House of
Delegates directs the Board of Trustees and the Officers
of this Association to oppose actively and forcefully this
and any future attempts by HEW or any other federal
agency to impose conditions and pledges upon the medical
profession. THEREFORE BE IT
RESOLVED, that the House of Delegates of the Ohio State
Medical Association petition the Board of Trustees and
the Officers of the American Medical Association to ac-
tively and forcefully oppose the requirement of the federal
law and regulations that ask assurance of compliance with
the Civil Rights Act of 1964 from individual citizens,
even through the Supreme Court.
"The committee recommends an editorial deletion
of the last sentence of the first paragraph. Mr. Presi-
dent, the committee recommends the adoption of
Resolution No. 46 with the deletion, and I so move.”
By official action, the recommendation of the
committee, namely, that Resolution No, 46, with
an editorial deletion of the last sentence of the
first paragraph, be adopted, was approved.
The amended paragraph reads as follows:
All physicians, as citizens of the United States, are bound
by the laws of the United States. There is no need to
demean them by asking an oath of compliance to those
laws and their regulations.
RESOLUTION NO. 47
Reimbursement of Costs for Collection of Dues
"Resolution No. 47, introduced by the delegates
from Hamilton County, was inadvertently omitted
from the printed resolutions. It read as follows:
WHEREAS, the Ohio State Medical Association and the
American Medical Association have increased the demands
on local County Medical Societies for additional services;
and
WHEREAS, the increase in demands by the Ohio State
Medical Association and the American Medical Associa-
tion through extended programs require additional ex-
penditures by County Medical Societies; THEREFORE
BE IT
RESOLVED, that the County Medical Society be reimbursed
for costs expended in the collection of dues and the cer-
tification of membership to both the Ohio State Medical
Association and the American Medical Association.
"The committee reviewed the resolution. There
was no one to speak to the resolution. However, it
was pointed out by the executive office that for sev-
eral years at the direction of The Council the rebate
from the AMA had been turned over to the AMA-
ERF fund. It was pointed out further that the dif-
ficulty to be encountered in the OSMA headquarters
office seemed out of proportion to the financial bene-
fits to be derived by the component societies.
"For the above reasons your committee agrees with
what seems to be a proper distribution of this rebate
and recommends that Resolution No. 47 be not
adopted. Mr. President, I so move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 47 be
NOT adopted, was approved.
"I would like to extend a debt of gratitude to all
of those members of the society and visiting experts
who gave of their time and knowledge to enable the
committee to arrive at the decisions. I would per-
sonally like to extend my thanks to the members of
the committee who made the summation and present
report possible. The members of the committee are
as follows: Carl A. Minning, Clermont County;
Isador Miller, Champaign County; D. L. Becker,
Allen County; Robert A. Irvin, Lake County; Charles
W. Stertzbach, Mahoning County; Norman L.
Wright, Coshocton County; Kenneth E. Bennett,
Washington County; Jasper M. Hedges, Pickaway
County; Charles H. McMullen, Ashland County; F.
P. Osgood, Lucas County, Chairman.
By official action, the report of Resolutions
Committee No. 1 as a whole, as amended, was
approved.
Report of Resolutions Committee No. 2
Dr. John H. Budd, Cuyahoga County, reported
for Resolutions Committee No. 2, of which he was
chairman. The report read as follows:
"Resolutions Committee No. 2 considered seven-
teen resolutions having to do with a variety of issues
and subjects. Discussion was frank, sincere and un-
abridged. Where differences of opinion became
evident, they were debated temperately, astutely and
concisely, with conspicuous concern for the welfare
of our patients, and for preservation of highest qual-
ity medical care.
"Resolutions 7 through 14, 19 and 20, 22 and 43
will be dealt with in a group, after consideration of
the resolutions which now follow:
RESOLUTION NO. 21
Military Dependents’ Medical Care
"Resolution No. 21, introduced by the delegates
of Stark County, recommends that the administrative
regulations of the Military Dependents’ Medical Care
program be modified to provide the same options of
reimbursement as are available under Part B, Public
Law 89-97. The committee is in hearty accord with
this provision and recommends adoption of the res-
olution with the addition of a Resolve that a similar
resolution be presented to the AMA House of Dele-
gates at the June meeting.”
BE IT FURTHER RESOLVED, that the OSMA Delegates
to the AMA offer a resolution seeking accomplishment
of this purpose.’
"Mr. President, I move the adoption of Resolution
No. 21, as amended.”
By official action, the recommendation of the
committee, namely, that Resolution No. 21, as
amended, be adopted, was approved.
AMENDED RESOLUTION NO. 21
Military Dependents’ Medical Care
(By the Stark County' Medical Society)
WHEREAS, Public Law 89-97 provides the option of direct
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reimbursement of patients eligible for benefits under Part
B of said law, and
WHEREAS, Public Law 569 (Military Dependents Medical
Care Act) 84th Congress, does not provide such an option,
and
WHEREAS, the lack of such option destroys the physi-
cian-patient relationship, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association
strongly recommends that all necessary actions be taken
in order to provide that patients eligible for benefits
under Public Law 569 be afforded the same option of
reimbursement as is provided for patients eligible for
benefits under Public Law 89-97, Part B.
BE IT FURTHER RESOLVED, that the OSMA Delegates
to the AMA offer a resolution seeking accomplishment of
this purpose.
(For the text of original Resolution No 21. see
pages 485 and 486, May, 1966 issue OSMJ.)
RESOLUTION NO. 32
Voluntary Health Insurance
"This resolution, introduced by the delegates from
Stark County, asks that OSMA encourage the volun-
tary health insurance industry of Ohio to continue of-
fering the benefits of their customary policies to per-
sons over 65. This recommendation has been adopted
by the AMA at a national level.
With minor modification, the committee recom-
mends that the resolution be adopted. The amended
resolution reads as follows:
AMENDED RESOLUTION NO. 32
Voluntary Health Insurance
Preamble
A direct result of organized medicine’s effort to forestall
King- Anderson type legislation was the emergence of a
splendid voluntary health insurance industry which ex-
tended coverage to persons over 65. We believe that there
are many people over 65 who would prefer to continue
their voluntary health insurance, if it is still available to
them.
It is the declared intent of labor to extend the principles
of P. L. 89-97 to persons of all ages. If this effort is suc-
cessful over the American Medical Association’s cam-
paign to repeal portions of the present law, the voluntary
health insurance industry and the public will suffer a
grievous blow.
Blue Cross Plans in some areas of the country already are
announcing that at midnight on June 30, 1966 some con-
tracts for persons 65 or older will be canceled. THERE-
FORE BE IT
RESOLVED, that the Ohio State Medical Association make
every effort to encourage the voluntary health insurance
industry in Ohio not to cancel contracts but to continue
offering improved contracts to persons 65 and older, and
that contracts should not be confined to supplementing
P. L. 89-97 but should be written to meet the wide variety
of needs for persons over 65.
"Mr. President, I move the adoption of Amended
Resolution No. 32.’’
By official action, the recommendation of the
committee, namely, that amended Resolution No.
32 be adopted, was approved.
(For text of Resolution No. 32 see pages 488-489,
May, 1966 issue OSMJ.)
RESOLUTION NO. 35
Aircraft Safety
"This resolution, introduced by the delegates of
the Academy of Medicine of Cleveland, manifests the
concern of the medical profession for safety in air
transportation and interest in constructive, regulative
legislation. After hearing of testimony on this res-
olution and after discussion, your committee recom-
mends the following Substitute Resolution:
SUBSTITUTE RESOLUTION NO. 35
Aircraft Safety
WHEREAS, air travel is a major means of transportation
today, and
WHEREAS, it is used by many persons, and
WHEREAS, the magnitude of an air crash tragedy is usually
proportional to the number of passengers on board, and
WHEREAS, some pilot error and mechanical failure are
inevitable, and
WHEREAS, speedy evacuation of still-living passengers
after a crash is absolutely necessary if their lives are to
be saved, THEREFORE BE IT
RESOLVED, that the Federal Aviation Agency give serious
consideration to ( 1 ) increase in the minimum seating
space per passenger, (2) improved means of emergency
egress, and (3) judicious limitation of the number of
passengers allowed on any one commercial aircraft.
"Mr. President, your Committee recommends the
adoption of Substitute Resolution No. 35, and I so
move.”
By official action, the recommendation of the
committee, namely, that Substitute Resolution No.
35 be adopted, was tabled.
(For text of Resolution No. 35, see page 489, May,
1966 issue OSMJ.)
RESOLUTION NO. 36
Public Health
"This resolution, introduced by the delegate from
Huron County, is concerned with menaces to public
health from commercially imported contaminated ar-
ticles. The committee endorses the intention of the
resolution and offers a substitute resolution, to wit.
SUBSTITUTE RESOLUTION NO. 36
Public Health
WHEREAS, in 1962 and 1965, this country witnessed sev-
eral examples of material, toys, "ice balls,” and trinkets,
grossly contaminated imported from other countries and
being freely sold in this country, thereby creating a po-
tential threat to the public health, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association in-
struct its delegates to the AMA to introduce and support
a resolution instructing the appropriate committee of the
AMA to work with the proper public health authorities
to insure that the health of the American public is better
protected from such dangers.
"Mr. President, I move the adoption of Substitute
Resolution No. 36.”
By official action, the recommendation of the
committee, namely, that Substitute Resolution No.
36 be adopted, was approved.
(For text of Resolution No. 36, see page 489, May,
1966 issue OSMJ.)
RESOLUTION NO. 42
Defining "receipted bill” for Participants of Part B
of Medicare
This resolution, introduced by the delegate from
Huron County, voices a recommendation which in
the opinion of the committee and those who testified,
possesses much merit. It should be pointed out that
for July, 1966
705
the accomplishment of the purpose requires a change
in the present law. Also this policy has been approved
by the AM A by adoption of a similar resolution from
California in December 1965. Accordingly, your
committee recommends that the language of the res-
olution be changed, and that its amended form read
as follows:
AMENDED RESOLUTION NO. 42
Defining "receipted bill” for Participants of Part B
of Medicare
WHEREAS, Public Law 89-97 requires a receipted doctor’s
bill from participants of Part B of Medicare, before
money will be disbursed to said participants, and
WHEREAS, a bill cannot be receipted until paid, and
WHEREAS, this requirement will constitute an unreason-
able hardship for patients, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association rec-
ommend that the Department of Health, Education, and
Welfare establish the principle that a bill for services
rendered by the physician be honored in lieu of a re-
ceipted bill and BE IT FURTHER
RESOLVED, that the Ohio State Medical Association
through appropriate channels seek remedial legislative
action to amend Public Law 89-97, Part B, Title 18 by
deleting the words "receipted bill” and substituting "bill
for services rendered” in Section 1842 (b) (3) (II).
"Mr. President, I move the adoption of the Res-
olution, as amended.’’
By official action, the recommendation of the
committee, namely, that Amended Resolution No.
42 be adopted, was approved.
(For text of Resolution No. 42, see page 491, May,
1966 issue OSMJ.)
Floor amendments to the resolution included the
substitution of the word "disbursed" for the word
"refunded" in the first WHEREAS and substitution
of the words "in lieu of” for the word "as" in the
first RESOLVED paragraph. The two floor amend-
ments to the amended resolution are shown in Italics.
RESOLUTION NO. 45
Subscribers to Part B of Medicare Are Entitled
To Treatment as Private Patients
(By Academy of Medicine of Cleveland)
WHEREAS, the "Modification of Proposed Third Principle
Payment for Services Involving Residents and Interns,” as
embodied in Part B of the Medicare Law, states, as
follows:
"In the case of Major Surgical Procedures, as defined
by the Joint Commission on Accreditation of Hospitals,
and other complex and dangerous procedures or situa-
tions, such personal and identifiable direction must in-
clude supervision in person by the attending physician,”
and
WHEREAS, since this principle is designed to safeguard
that high caliber of professional care which the profes-
sion is committed to provide, and
WHEREAS, The American College of Surgeons Committee
on Medicare has proposed modification of this principle
in such manner that the patients, for whom payment will
be made under Title #18 of the Medicare Law, would,
in many institutions, be placed under the "complete re-
sponsibility” of interns and residents in training, and
that this further connotes lack of personal supervision by
the attending physician, and
WHEREAS, such a modification would approve a procedure
wherein a physician would receive compensation for serv-
ices which he did not personally provide to the patient,
and
WHEREAS, such receipt of compensation would be both
unethical and dishonest, THEREFORE BE IT
RESOLVED, that the Ohio State Medical Association hereby
records itself in support of the principle that subscribers
to Part B of Medicare, by payment of premium, have pur-
chased the same rights to personal medical care enjoyed
by any other private patient, AND BE IT FURTHER
RESOLVED, that the Ohio State Medical Association hereby
records itself in support of the principle that professional
responsibility of a physician, for services rendered by an
intern or resident implies personal supervision and direc-
tion, in order to be considered identifiable and compen-
sable service, AND BE IT FURTHER
RESOLVED, that the Ohio State Medical Association in-
struct its Delegation to the American Medical Associa-
tion to present this Resolution at the annual meeting of
June 26-30, 1966, seeking its adoption, AND BE IT
FURTHER
RESOLVED, that a copy of this Resolution be forwarded
to the Secretary of The Department of Health, Education,
and Welfare.
"This resolution, introduced from the floor, intends
to establish certain principles with regard to bene-
ficiaries and Part B of the Medicare Law and the
reimbursement of physicians supervising professional
services rendered patients by interns and residents in
training. It is recommended that the resolution be
amended by modifying the third WHEREAS, to read
as follows:
"WHEREAS, modification of this principle has
been proposed which would provide that the patients,
for whom payment will be made under Title 18 of
P. L. 89-97 would, in many institutions, be placed
under the 'complete responsibility’ of interns and
residents in training, which modification further con-
notes lack of personal supervision by the attending
physician."
"The committee also recommends the addition of
the words 'and to the Health Insurance Benefits Ad-
visory Council (H.I.B.A.C.) ’ to the last Resolve”
AMENDED RESOLUTION NO. 45
Subscribers to Part B of Medicare Are Entitled
To Treatment as Private Patients
(By Academy of Medicine of Cleveland)
WHEREAS, the "Modification of Proposed Third Principle
Payment for Services Involving Residents and Interns,”
as embodied in Part B of the Medicare Law, states, as
follows :
"In the case of Major Surgical Procedures, as defined
by the Joint Commission on Accreditation of Hospitals,
and other complex and dangerous procedures or situa-
tions, such personal and identifiable direction must in-
clude supervision in person by the attending physician,”
and
WHEREAS, since this principle is designed to safeguard
that high caliber of professional care which the profession
is committed to provide, and
WHEREAS, modification of this principle has been pro-
posed which would provide that the patients, for whom
payment will be made under Title 18 of P. L. 89-97
would, in many institutions, be placed under the "com-
plete responsibility” of interns and residents in training,
which modification further connotes lack of personal su-
pervision by the attending physician.
WHEREAS, such a modification would approve a procedure
wherein a phy.sician would receive compensation for serv-
ices which he did not personally provide to the patient,
and
WHEREAS, such receipt of compensation would be both
unethical and dishonest. THEREFORE BE IT
706
Tbe Ohio State Medical Journal
Three principals among the Association’ s officers for the coming year are shown at the President’ s Reception. From left,
President-Elect Robert E. Howard, President Lawrence C. Meredith, and Immediate Past President Henry A. Crawford.
Shown holding the certifcates of humanitarian service presented at the House of Delegates session for their work tours
in Vietnam are, from left, Dr. John E. Stephens, Columbus; Dr. C. W. Hullinger, Springfield; Dr. William Barratt ,
Painesville; Dr. Buel S. Smith, Akron; and Dr. Alexander Miller, Cleveland Heights. ( Others authorized to receive
the certificates, but not present at the meeting, are Dr. Frank Gatti, Portsmouth; Dr. Aaron Isaac Grollman, Cincinnati;
Dr. Charles U. Hauser, Hamilton; Dr. Hobart E. Klaaren, Dayton; and Dr. Paul R. Miller, Columbus.)
for July, 1966
707
RESOLVED, that the Ohio State Medical Association hereby
records itself in support of the principle that subscribers
to Part B of Medicare, by payment of premium, have pur-
chased the same rights to personal medical care enjoyed
by any other private patient, AND BE IT FURTHER
RESOLVED, that the Ohio State Medical Association hereby
records itself in support of the principle that professional
intern or resident implies personal supervision and direc-
tion, in order to be considered identifiable and compen-
sable service, AND BE IT FURTHER
RESOLVED, that the Ohio State Medical Association in-
struct its Delegation to the American Medical Association
to present this Resolution at the annual meeting of June
26-30, 1966, seeking its adoption, AND BE IT FURTHER
RESOLVED, that a copy of this Resolution be forwarded to
the Secretary of The Department of Health, Education,
and Welfare, and to the Health Insurance Benefits Ad-
visory Council (H. I. B. A. C.).
By official action, the recommendation of the
committee, namely, that Amended Resolution No.
45 be adopted, was approved.
RESOLUTIONS 7, 8, 9, 10, 11, 12, 13, 1 4,
19, 20, 22 and 43
Series of Principles on Government Medical
Care Programs
"As mentioned in the beginning, a large number
of the resolutions were concerned with government-
financed health care programs in general and P. L.
89-97 in particular and their impact on the legal,
ethical, traditional and fiscal aspects of the physician-
patient relationship. Because of the similar subject
matter and the inter-relationships of these resolu-
tions, your reference committee, instead of dealing
with each separately, has considered their lan-
guage and intent, and offers for adoption a series of
principles, parts of which are extracted from the
OSMA Council Policy Statement on Government
Medical Care Programs. We believe that they ex-
press the policies of this Association on the issues
under consideration.”
1. Definitions
Usual — The "usual’’ fee is that fee usually charged
for a specific service provided by an individual physi-
cian for his patient.
Customary — A fee is "customary” when it properly
reflects the extent and nature of the services provided
the patient.
Reasonable — A fee is "reasonable” when it meets the
"usual and customary” criteria or, in the opinion of a
duly constituted medical society review committee, is jus-
tified under what is considered a complexity of treat-
ment which merits special consideration. In cases where
review or mediation may be requested, it is recom-
mended that the standard mediation or review mecha-
nism of the county medical society be utilized. Further,
it is recommended that no special review or mediation
committee be appointed solely to handle cases involv-
ing Public Law 89-97.
2. Ohio’s Usual and Customary Fee Contrasted with Pre-
vailing Fee
(a) Ohio’s individual physician’s usual and customary
fee program is an indemnity type insurance; na-
tional prevailing fee is a service contract.
(b) Ohio’s individual physician’s usual and customary
fee (Ohio Medical Indemnity) program pays all
physicians their usual and customary charges to
persons with incomes of $7,500 or less in counties
where it is offered. In national prevailing fee pro-
grams, the physicians first must submit a detailed
report on all their usual charges and only those
physicians are included whose charges fall within
the 90th percentile of charges submitted.
(c) Under Ohio’s individual physician’s usual and cus-
tomary program, physicians do not have to sign
contracts to participate. Under the national prevail-
ing usual and customary program only those physi-
cians whose charges fall within the 90th percentile
of the areawide charge are offered a contract to
sign and these physicians must then sign a service
contract and agree to accept the payment from the
carrier as payment in full.
3. Physician-Patient Relationship
Once the physician accepts a person as his patient, re-
gardless of what third party might be involved, the
physician’s primary and sole obligation, his contract and
his relationship are with the patient.
Any arrangement between government and a citizen
whereby the government agrees to pay for the citizen’s
medical care does not, directly or indirectly, or by
inference, involve the physician in a contract with the
government.
4. Billing and Reimbursement
It is the official policy of this Association that every
physician bill and receive for his professional medical
services his usual, customary, and reasonable fee. This
policy applies to governmental agencies at all levels.
The physician is requested and urged to deal directly
and only with the patient, both in providing medical
care and in billing for just and reasonable compensa-
tion for the medical care provided.
5. Direct Billing vs Assignment
It is recommended, inasmuch as the agreement for
financial responsibility is between the patient and the
government, that the physician not accept assignment
forms.
It is further recommended that each and every mem-
ber of this Association submit to the patient his own
bill and receive on his own behalf, compensation for
his professional medical services.
6. Maintenance of Quality Medical Care
This association and the AMA are on record as op-
posing any system of medicine which would lead to a
deterioration of the quality of medical care.
In assessing conditions which might lead to deteriora-
tion of this quality, Ohio physicians are advised to give
heed to Section 6 of the Principles of Medical Ethics
which provides "A physician should not dispose of his
services under terms or conditions which tend to inter-
fere with or impair the free and complete exercise of
his medical judgment and skill or tend to cause a de-
terioration of the quality of medical care,” and to the
Nine Principles for Standards of Health Care Programs
submitted by the Ohio delegation to the AMA House
of Delegates (Feb. 6-7, 1965), adopted by that House
of Delegates and since reiterated (Oct. 2-3, 1965).
"Mr. President, your committee recommends the
adoption of this series of principles and I so move.”
By official action, the recommendation of the
committee, namely, that this resolution encompas-
sing a series of principles regarding government
medical care programs be adopted, was approved.
(For text of Resolutions 7, 8, 9, 10, 11, 12, 13,
14, 19, 20, 22 and 43, see pages 482, 483, 484, 485,
486, 491, May, 1966 issue OSMJ.)
SUBSTITUTE RESOLUTION
Date of Implementation of Usual and
Customary Fee Policy for Welfare
Programs in Ohio.
"Acknowledging the valid concern expressed in
several resolutions that the policy of usual and cus-
tomary fees receive prompt and adequate dissemina-
708
The Ohio State Medical Journal
tion to the Association membership and the welfare
agencies involved, your committee has drafted a Sub-
stitute Resolution to accomplish this purpose. The
Substitute Resolution reads as follows:
WHEREAS, governmental agencies of Ohio at all levels
have assumed financial responsibility for medical care of
welfare recipients; THEREFORE, BE IT
RESOLVED, that OSMA notify such agencies that mem-
bers of OSMA will expect usual and customary fees for
professional sendees to welfare clientele beginning July
1, 1966, the date that Part B of P. L. 89-97 becomes effec-
tive.
"Mr. President, I move the adoption of this Sub-
stitute Resolution.”
By official action, the recommendation of the
committee, namely, that the Substitute Resolution
on Usual and Customary Fee Policy for Welfare
Programs in Ohio be adopted, was approved.
"Mr. President, I move the adoption of the com-
mittee report as a whole.”
"It has been a privilege for the members of the
committee to act in your behalf. Your chairman has
been the beneficiary of much wisdom, patience and
indulgence from the committee members. It has
been a stimulating memorable experience. The
names of the committee members are as follows:
Robert M. Woolford, Hamilton County; Robert A.
Bruce, Montgomery County; Donald R. Brumley,
Hancock County; V. William Wagner, Ottawa
County; Maurice F. Lieber, Stark County; Robert E.
Rinderknecht, Tuscarawas County; James A. L. To-
land, Guernsey County; William M. Singleton, Scioto
County; Homer A. Anderson, Franklin County; Al-
bert Burney Huff, Wayne County; John H. Budd,
Cuyahoga County, Chairman.
By official action, the report of the Resolutions
Committee No. 2 as a whole, as amended, was
adopted by the House of Delegates.
Report of Resolutions Committee No. 3
Dr. James C. McLarnan, Knox City, reported for
Resolutions Committee No. 3, of which he was
chairman. The report read as follows:
"Resolutions Committee No. 3 considered 12
resolutions. Discussion was thorough, enlightening
and unrestricted. All who wished to testify were
heard. Testimony was given full and thoughtful
consideration by the committee.
RESOLUTION NO. 27
AAPS Essay Contest
(By the Columbus Academy of Medicine)
BE IT RESOLVED, that the House of Delegates of the
Ohio State Medical Association endorse the Essay Contest
of the Association of American Physicians and Surgeons
with the titles: (l) The Advantages of the American
System of Private Medical Care and (2) The Advantages
of the American Free Enterprise System.
"The first resolution considered by the committee
was introduced by a delegate from Franklin County.
This has been a traditional resolution before the As-
sociation. No objections were heard and this com-
mittee unanimously recommends its adoption. Mr.
President, I so move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 27 be
adopted, was approved.
RESOLUTION NO. 25
Commendation to OSMA Officers, Ohio’s
AMA Delegation and Staff of the OSMA
This resolution was introduced by the Huron
County Medical Society. The committee was in full
accord with the intent of the resolution but amended
it to read as follows:
AMENDED RESOLUTION NO. 25
Commendation to OSMA Officers, Ohio’s AMA
Delegation and Staff of the OSMA
WHEREAS, the officers and all members of the Ohio dele-
gation to the Clinical Conference of the American Medi-
cal Association, November, 1965, showed superb resolve
in action, and put forth untiring efforts in the interest
of the preservation of the private practice of medicine,
and
WHEREAS, they were most loyally complemented and
helped in their efforts by the staff of the Ohio State
Medical Association, and
WHEREAS, as a result of this effort, they were able to
significantly influence the decisions of the American Medi-
cal Association House of Delegates, NOW THEREFORE.
BE IT
RESOLVED that the House of Delegates of the Ohio State
Medical Association, on behalf of the physicians of Ohio,
convey to said officers and members of the Ohio AMA
delegation and the staff of the Ohio State Medical Asso-
ciation their thanks and appreciation.
"The committee recommends the adoption of
Amended Resolution No. 25 and, Mr. President, I so
move.”
By official action, the recommendation of the
committee, namely, that Amended Resolution No.
25 be adopted, was approved.
(For text of Resolution No. 25 see page 486, May,
1966 issue OSMJ.)
RESOLUTION NO. 28
In Opposition to the Fluoridation of Public Drinking
Water Supplies
"This resolution, introduced by Dr. Joseph G.
Crotty, Hamilton County, -was the subject of a
lengthy and spirited debate. I believe that all argu-
ments pro and con 'were heard and the committee
commends the participants in the discussion for their
rational arguments and lack of sensationalism.
"The committee could find no valid arguments
advanced to cause a change in OSMA polity concern-
ing fluoridation, adopted in 1957, 'which reads as
follows :
T. Fluoridation of public w^ater supplies so as
to provide the approximate equivalent of 1 ppm
of fluorine in drinking water has been established
as a method of reducing dental caries in children
up to 10 years of age. In localities ■with w^arm
for July, 1966
709
climates, or where for other reasons the ingestion
of water or other sources of considerable fluoride
content is high, a lower concentration of fluoride is
advisable. On the basis of the available evidence,
it appears that this method decreases the incidence
of caries during childhood. The evidence from
Colorado Springs indicates as well a reduction in
the rate of dental caries up to at least 44 years of
age.
'2. No evidence has been found since the 1951
statement by the Councils to prove that continuous
ingestion of water containing the equivalent of ap-
proximately 1 ppm of fluorine for long periods by
large segments of the population is harmful to
the general health. Mottling of the tooth enamel
(dental fluorosis) associated with this level of
fluoridation is minimal. The importance of this
mottling is outweighed by the caries-inhibiting
effect of the fluoride.
'3. Fluoridation of public water supplies should
be regarded as a prophylactic measure for reducing
tooth decay at the community level and is appli-
cable where the water supply contains less than the
equivalent of 1 ppm of fluorine.
'The Council of the Ohio State Medical Asso-
ciation is of the opinion that projects involving
fluoridation of public water supplies should have
the prior approval of the county medical society
and the local dental society serving the area, as
well as the appropriate agencies of local govern-
ment.’
"The Committee recommends, therefore, that this
resolution not be adopted and, Mr. President, I so
move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 28 NOT
be adopted, was approved.
(For text of Resolution No. 28 see page 487, May,
1966 issue OSMJ.)
RESOLUTION NO. 37
Health Insurance for Migrant Workers
"Resolution No. 37 was introduced by the Huron
County Medical Society. The discussion brought forth
the need for some type of health insurance coverage
for migrant workers and the committee proposed an
Amended Resolution No. 37, as follows:
AMENDED RESOLUTION NO. 37
Health Insurance for Migrant Workers
WHEREAS, seasonal migrant workers are imported into the
State of Ohio,
WHEREAS, these workers and their families often need
medical and hospital care, and
WHEREAS, a majority of these workers do not carry health
insurance, and
WHEREAS, many communities are left with sizable unpaid
hospital and medical bills as the migrant workers leave
the communities in which they were temporarily em-
ployed, THEREFORE, BE IT
RESOLVED, that the House of Delegates of the Ohio
State Medical Association instruct the officers and staff
of the Association to meet with insurance carriers and an
appropriate agency for the State of Ohio, to attempt to
resolve the problem of adequate health insurance for these
migrant workers.”
"The committee recommends the adoption of this
amended resolution and, Mr. President, I so move.”
By official action, the recommendation of the
committee, namely, that Amended Resolution No.
37 be adopted, was approved.
(For text of Resolution No. 37 see pages 489-490,
May, 1966 issue OSMJ.)
RESOLUTION NO. 40
Condemning Actions Taken by Many Blue Cross Plans
"This resolution was presented by the Huron
County Medical Society. The committee felt this to
be somewhat confusing and testimony did not reveal
a clear cause for a new action.
"Therefore, this committee recommends this res-
olution not be adopted and, Mr. President, I so
move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 40 NOT
be adopted, was approved.
(For text of Resolution No. 40 see page 490, May,
1966 issue OSMJ.)
RESOLUTION NO. 15
Hospital Admission
"This resolution was submitted by the Mahoning
County Medical Society. Testimony was convincing
and to the point. The committee feels that, although
this is present American Medical Association policy,
the principle is of sufficient importance to justify
reaffirmation by the Ohio State Medical Association.
It was felt that the resolution could be clarified by
omitting the fourth 'Whereas’ and by amending the
'Resolved’ portion with the amended resolution read-
ing as follows:
AMENDED RESOLUTION NO. 15
Hospital Admission
WHEREAS, Public Law 89-97 (Medicare) may require
federal forms for physician certification of hospital ad-
mission, and
WHEREAS, the American Medical Association during its
October 2-3, 1965 meeting, adopted the policy that "cur-
rent practices and customary procedures with respect to
certification for hospital admission and care shall be con-
tinued under Public Law 89-97” and
WHEREAS, the current admissions practice in most Ohio
hospitals is an oral request for bed facilities, followed
by the signing of the patient’s hospital chart after the
patient’s admission, THEREFORE, BE IT
RESOLVED, that the Ohio State Medical Association af-
firms the principle that the certification of patients for
hospital admission and care be the same for all patients:
i.e., a physician may ethically continue to use the current
practice for hospital admissions without discrimination
as to age.
"The committee recommends the adoption of
Amended Resolution No. 15, and Mr. President, I so
move.”
710
The Ohio State Medical Journal
Checks representing Ohio Schools' proportion of AMA-ERF funds uere presented to representatives of the schools.
From left are Dr. John A. Prior, associate dean, Ohio State University College of Medicine ; Dr. Robert M. Woolford,
representing the University of Cincinnati College of Medicine; and Dr. Robert F. Parker, assistant dean, W estern Reserve
University School of Medicine.
A number of panels contributed to the extensive scientific program. Here is the panel on " Marriage Problems.” At the
rostrum is Miss Myra F. Thomas, of the Family Service Association. At the table, from left, are Dr. Leonard L.
Lovshin, Dr. George T. Harding, Dr. Frances K. Harding, and the Very Reverend David Loegler, Dean of Trinity
Cathedral in Cleveland.
for July, 1966
711
By official action, the recommendation of the
committee, namely, that Amended Resolution No.
15 be adopted, was approved.
(For text of Resolution No. 15 see page 484, May,
1966 issue of OSMJ.)
RESOLUTION NO. 3 4
Industrial Commission-Physician Ethical Relationship
Concerning Prescriptions
"Resolution No. 34 was introduced by the Lorain
County Medical Society but provoked little discus-
sion at the committee hearing. It is the opinion of
your committee that no real problem lies in this area
at the present time. The committee recommends that
this resolution be not adopted and, Mr. President, I
so move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 34 be
NOT adopted, was approved.
(For text of Resolution No. 34 see page 489, May,
1966 issue OSMJ.)
RESOLUTION NO. 23
Endorsement of the "Open Staff”
"Resolution No. 23 was submitted by the delegates
of the Summit County Medical Society. There was
much discussion concerning the reason for submission
of this resolution. The committee felt that there was
adequate justification for a statement concerning this
problem and submits the following substitute resolu-
tion:
SUBSTITUTE RESOLUTION NO. 23
Endorsement of the "Open Staff”
WHEREAS, the policy of "open staff in hospitals is be-
lieved to provide and encourage the best quality of medi-
cal care, and
WHEREAS, there is no conflict between medical educa-
tion programs and "open staff” hospitals, THEREFORE,
BE IT
RESOLVED, that the Ohio State Medical Association, rep-
resentative of most physicians, exert its influence so as
to assist all hospital staffs in providing excellent train-
ing programs and, at the same time, continuing its efforts
to maintain the principle of "open staff” hospitals, and
BE IT FURTHER
RESOLVED, that the House of Delegates of the Ohio State
Medical Association instruct their delegates to the Ameri-
can Medical Association to present a similar resolution to
a future meeting of the House of Delegates.
"The committee recommends that Substitute Res-
olution No. 23 be adopted and, Mr. President, I so
move.”
By official action, the recommendation of the
committee, namely, that Substitute Resolution No.
23 be adopted, was approved.
(For text of Resolution No. 23 see page 486, May,
1966 issue OSMJ.)
RESOLUTIONS NO. 16 AND 18
Reimbursement for Services of Hospital-Based Physicians
"These resolutions concerning reimbursement for
services of hospital-based physicians were considered
jointly. The discussion was lively and showed pro-
gress in the continuing struggle to give hospital-based
physicians their proper recognition as practicing
physicians. It was felt by the committee that both
resolutions had merit and could be better expressed
in a combined resolution which the committee sub-
mits as Substitute Resolution No. 16.
SUBSTITUTE RESOLUTION NO. 16
Reimbursement for Services of Hospital-Based Physicians
WHEREAS, the MEDICARE LAW (P. L. 89-97) estab-
lishes separate provisions for hospital care and for cov-
erage of physicians’ services, and
WHEREAS, Section 1701.03 of the Revised Code of Ohio
prohibits the practice of a profession by a lay corporation
and Opinion 1751 of the Attorney General of Ohio
states specifically that a corporation, whether or not or-
ganized for profit, cannot lawfully engage in the practice
of medicine in Ohio, and
WHEREAS, the national governing bodies of the concerned
physician specialists and the American Medical Associa-
tion have issued policy statements recommending fee for
service arrangements and direct billing of individual pa-
tients, NOW, THEREFORE, BE IT
RESOLVED, that the Ohio State Medical Association en-
dorse and actively support the position of all physicians
in altering whatever hospital contracts as are necessary,
to establish a normal and ethical relationship, and BE
IT FURTHER
RESOLVED, that the House of Delegates of the Ohio State
Medical Association instruct The Council of the Ohio
State Medical Association to petition the Director of
Insurance of the State of Ohio to require removal from
all prepaid hospital insurance plans provisions for bene-
fits covering physicians’ services.
"The committee unanimously recommends that
Substitute Resolution No. 16 be adopted and, Mr.
President, I so move.”
By official action, the recommendation of the
committee, namely, that Substitute Resolution No.
16, which combines Resolution No. 16 and Resolu-
tion No. 18, was approved. The word "all” was
substituted for the words "hospital-based” in the
second line of the first Resolved paragraph of the
substitute resolution by floor amendment.
(For text of Resolution No. 16 and Resolution No.
18 see pages 484 and 485, May, 1966 issue of
OSMJ.)
RESOLUTION NO. 17
Physicians, Ethics and the Corporate Practice of Medicine
"This resolution was introduced by the Stark
County Medical Society. After hearing testimony
concerning this resolution, the committee feels that
this resolution should be augmented by the addition
of another 'Whereas’ and, on advice of the legal
counsel of the Ohio State Medical Association, the
'Resolved’ be amended, and we now submit Amend-
ed Resolution No. 17.
AMENDED RESOLUTION NO. 17
Physicians, Ethics and the Corporate Practice of Medicine
WHEREAS, the Ohio State Medical Association legal
counsel has provided an excellent presentation of the
ethical and legal aspects of the corporate practice of
medicine, this presentation having been sent to all mem-
712
The Ohio State Medical Journal
bers of this Association February 8, 1966, under the
heading of "Special Medicare Newsletter No. 2,” and
WHEREAS, Section 4, Principles of Medical Ethics, states,
"The medical profession should safeguard the public and
itself against physicians deficient in moral character or
professional competence. Physicians should observe all
laws, uphold the dignity and honor of the profession, and
accept its self-imposed disciplines. They should expose,
without hesitation, illegal or unethical conduct of fellow
members of the profession,” and
WHEREAS, Section 6 of the Principles of Medical Ethics
reads as follows:
"A physician should not dispose of his services under
terms or conditions which tend to interfere with or
impair the free and complete exercise of his medical
judgment and skill or tend to cause a deterioration of
the quality of medical care,” and
WHEREAS, the Judicial Council of the American Medical
Association states (1966 Opinions and Reports, Page 16,
Section 4, Article 9):
"OBLIGATIONS OF COUNTY MEDICAL SOCIETIES
"The Council has emphasized the autonomy of the
county society and the fact that such autonomy imposes
responsibilities. If medical societies fail to accept and
discharge their obligations in matters of ethics, others
will assume these obligations by default. The Judicial
Council urges county and state societies to adopt critical
attitudes toward their programs to 'uphold the honor
and dignity’ of the profession of medicine. These pro-
grams must be based on a sound knowledge and under-
standing of ethical principles. As long as ethical prin-
ciples are widely and sedulously observed, the reputa-
tion of the medical profession will be upheld. The re-
ward will be commensurate with the services rendered
in the observation of these ideals. On the other hand,
if there is flagrant or even careless disregard of ethical
principles, the reputation of the profession of medicine
will suffer and its responsibilities and obligations will
be usurped by others, (AM A House of Delegates,
1958).” NOW, THEREFORE, BE IT
RESOLVED, that this House of Delegates urges each Com-
ponent Medical Society of this Association to be con-
stantly on the alert for violations of the Principles of
Medical Ethics, and for the appropriate committee of the
Component Medical Society to investigate all situations,
including contracts, where there are reasonable grounds
for believing that unethical practices exist.
"The committee unanimously recommends that
Amended Resolution No. 17 be adopted and, Mr.
President, I so move.”
By official action, the recommendation of the
committee, namely, that Amended Resolution No.
17 be adopted, was approved with the substitution
of the words "there are reasonable grounds for
believing that unethical practices exist” for the
words "suspicion of unethical practice exists” at
the end of the final resolve paragraph. This fur-
ther modification was suggested by the committee
and accepted by the House.
(For text of Resolution No. 17 see pages 486 and
487, May, 1966 issue OSMJ.)
RESOLUTION NO. 30
Licensing Foreign Graduates
"The last resolution discussed by Resolutions Com-
mittee No. 3 was Resolution No. 30, submitted by
the delegates of the Summit County Medical Society.
The testimony heard by the committee brought out
the fact that this was a small part of a major prob-
lem concerning the rules of the State Medical Board
and foreign medical graduates. Although the com-
Dr. David Fishman, President of the Academy of
Medicine of Cleveland, officially opened the House
of Delegates and welcomed members and guests of
the Association to Cleveland.
Principal speaker for the OMPAC-AMPAC luncheon
meeting was Dr. Hoyt D. Gardner, metnber of the
AMP AC Board of Directors, who is shown here dis-
cussing the topic, "Success Can Be Ours.’’
mittee understands that this is a problem in some
areas, it is felt that a resolution at this time is not
appropriate. The committee recommends that this
resolution be referred to The Council to be assigned
to an appropriate committee of the Ohio State Medi-
cal Association for further study, and an appropriate
resolution be introduced at a future meeting of the
House of Delegates if deemed advisable. Mr. Presi-
dent, I so move.”
By official action, the recommendation of the
committee, namely, that Resolution No. 30 be
for July, 1966
713
referred to The Council of the Ohio State Medical
Association to be assigned to an appropriate com-
mittee for further study, was approved.
(For text of Resolution No. 30 see page 488, May,
1966 issue OSMJ.)
'Mr. President, I move the adoption of the Report
of Resolutions Committee No. 3 as a whole, as
amended.”
The House of Delegates approved the motion
by official action.
"The committee is appreciative of the testimony
that was received by it and the courtesy shown the
committee by all who appeared. As Chairman, I
v/ish to express my appreciation to the members of
the committee for their consideration, wisdom and
vision and to acknowledge the excellent secretarial
staff of the Association.”
The members of the committee are: Thomas E.
Fox, Warren County; Maurice M. Kane, Darke
County; Walter A. Daniel, Seneca County; William
J. Neal, Fulton County; William F. Boukalik, Cuya-
hoga County; James W. Parks, Summit County;
James F. Sutherland, Belmont County; Carl E.
Spragg, Muskingum County; Roger P. Daniels, Meigs
County; Ben V. Myers, Lorain County; James C.
McLarnan, Knox County, Chairman.
Resolutions Committees Thanked
On motion by Dr. Charles W. Pavey, Franklin
County, and seconded by many, it was voted that this
House of Delegates record its appreciation to all
members of the Resolutions Committees for their
outstanding performance in organizing and condens-
ing an unwieldy amount of material into an under-
standable and useful set of resolutions.
Election of President-Elect
Dr. Crawford called for nominations for the of-
fice of President-Elect. Dr. Robert E. Rinderknecht,
Tuscarawas County, placed in nomination the name
of Dr. Benjamin C. Diefenbach, Martins Ferry,
Councilor of the Seventh District. The nomination
was seconded by Dr. Robert C. Beardsley, Zanesville,
Eighth District Councilor.
Dr. Edmond K. Yantes, Clinton County, placed in
nomination the name of Dr. Robert E. Howard, Cin-
cinnati, First District Councilor. The nomination
was seconded by Dr. Paul N. Ivins, Butler County.
There being no further nominations, the balloting
was conducted and Dr. Howard was declared
elected President-Elect. Dr. Howard was escorted
to the rostrum and he addressed the House of Dele-
gates.
Election of Councilors
Dr. Edwin C. Winzeler, Henry County, as chair-
man, presented the report of the Nominating Com-
mittee. The report was as follows:
First District
As Councilor of the First District to succeed Dr.
Robert E. Howard, Cincinnati, who was elected Presi-
dent-Elect, the committee placed in nomination the
name of Dr. Frank P. Cleveland, Cincinnati. Dr.
Cleveland asked that his name be withdrawn. Dr.
Paul N. Ivins, Butler County was nominated from the
floor. There being no further nominations, by of-
ficial action the nominations were closed and Dr.
Ivins was declared elected Councilor of the First
District for a term of two years, 1966-1967 and
1967-1968.
Third District
As Councilor of the Third District to succeed
himself, the committee placed in nomination the name
of Dr. Frederick T. Merchant, Marion. The nomi-
nation being duly seconded, and there being no fur-
ther nominations from the floor, by official action the
nominations were closed and Dr. Merchant was de-
clared re-elected Councilor of the Third District
for a term of two years, 1966-1967 and 1967-1968.
Fifth District
As Councilor of the Fifth District to succeed him-
self, the committee placed in nomination the name of
Dr. P. John Robechek, Cleveland. The nomination
being duly seconded, and there being no further
nominations from the floor, by official action the
nominations were closed and Dr. Robechek was de-
clared re-elected Councilor of the Fifth District
for a term of two years, 1966-1967 and 1967-1968.
Seventh District
As Councilor of the Seventh District to succeed
Dr. Benjamin C. Diefenbach, Martins Ferry, who had
served the maximum number of terms under the
Constitution and Bylaws, the committee placed in
nomination the name of Dr. Sanford Press, Steuben-
ville. The nomination being duly seconded, and
there being no further nominations from the floor,
by official action the nominations were closed and Dr.
Press was declared elected Councilor of the Sev-
enth District for a term of two years, 1966-1967
and 1967-1968.
Ninth District
As Councilor of the Ninth District to succeed him-
self, the committee placed in nomination the name of
Dr. George N. Spears, Ironton. The nomination
being duly seconded, and there being no further
nominations from the floor, by official action the
nominations were closed and Dr. Spears was de-
clared re-elected Councilor of the Ninth District
for a term of two years, 1966-1967 and 1967-1968.
Eleventh District
As Councilor of the Eleventh District to succeed
himself, the committee placed in nomination the
name of Dr. William R. Schultz, Wooster. The
nomination being duly seconded, and there being no
further nominations from the floor, by official action
the nominations were closed and Dr. Schultz was
714
The Ohio State Medical Journal
The Association was honored to have among its distinguished speakers the Incoming President and a Vast President of
the American Medical Association. Ohio’s Dr. Charles L. Hudson, (left) Incoming President of the AMA, discussed
the effect of Medicare on the practie of medicine. Dr. Edward R. Annis, Miami, Florida, Past-President of the AMA
and outstanding spokesman in behalf of maintaining the physician-patient relationship in medicine, spoke on "Care of
the Patient — 1966.”
declared re-elected Councilor of the Eleventh Dis-
trict for a term of two years, 1966-1967 and 1967-
1968.
AMA Delegates and Alternates
The Nominating Committee then placed in nomi-
nation the following for the office of delegate and
alternate to the American Medical Association for a
term of two years beginning January 1, 1966:
Dr. Theodore L. Light, Dayton, delegate, and Dr.
Kenneth D. Arn, Dayton, alternate.
Dr. Carl A. Lincke, Carrollton, delegate, and Dr.
Robert S. Martin, Zanesville, alternate.
Dr. George W. Petznick, Cleveland, delegate, and
Dr. Horatio T. Pease, Wadsworth, alternate.
Dr. Edmond K. Yantes, Wilmington, delegate,
and Dr. Harry K. Hines, Cincinnati, alternate.
Due to increased AMA membership during 1965,
the committee then proposed two candidates for the
tenth delegate, namely, Dr. Robert E. Tschantz, Can-
ton, and Dr. P. John Robechek, Cleveland. These
candidates were proposed for election to a term of
office for two years beginning January 1, 1967 and
ending December 31, 1968, as well as a term ending
December 31, 1966. The nominations being duly
seconded and there being no additional nominations,
official balloting was conducted and Dr. Tschantz
was declared elected delegate to the AMA for a
term of two years beginning January 1, 1967 and
a term ending December 31, 1966.
As tenth alternate delegate for the two-year term
and a term ending December 31, 1966, the commit-
tee placed in nomination Dr. Henry A. Crawford,
Cleveland. The nomination being seconded and
there being no additional nominations, Dr. Craw-
ford was declared elected alternate-delegate to the
AMA for a two-year term beginning January 1,
1967 and a term ending December 31, 1966.
The committee on Nominations presented two
names for a candidate to succeed Dr. Robert Tschantz,
whose term as alternate delegate expires December
31, 1967, namely, Dr. Frank F. A. Rawling, Toledo,
and Dr. Robert C. Beardsley, Zanesville. The nomi-
nations being duly seconded and there being no fur-
ther nominations, official balloting was conducted and
Dr. Frank F. A. Rawling, Toledo, was declared
elected alternate-delegate to the AMA for a term
expiring December 31, 1967.
Inaugural Ceremoney
Dr. Crawford asked all the newly elected officers,
councilors, delegates and alternates to come to the
front of the room where they were officially installed
into office.
Dr. Crawford then presented the official gavel of
the Association to Dr. Meredith, the incoming Presi-
dent, and wished him every success for his year in
office.
Dr. Tschantz, as immediate Past President, invited
Mrs. Crawford to the rostrum and presented Dr. and
Mrs. Crawford with a silver engraved tray as the
Association’s token of appreciation for his year
of service as President of the Ohio State Medical
Association. Also, a special certificate of honor was
presented to Dr. Crawford for his service to the
Association.
After he took office, Dr. Meredith presented Dr.
Crawford with the official Past President’s button.
for July, 1966
715
Dr. Meredith then addressed the House of Delegates.
(See pages 723-724 for text of the inaugural ad-
dress.)
Committees Named
Dr. Meredith made the following committee ap-
pointments which were officially approved by the
House of Delegates:
Committee on Education — Dr. Thomas E. Rar-
din, Columbus, reappointed chairman for the ensuing
year and reappointed for a five year term, 1966-1971.
Judicial and Professional Relations Committee
— Dr. Frank F. A. Rawling, Toledo, reappointed
chairman; Dr. Henry A. Crawford, Cleveland, ap-
pointed for a five-year term, 1966-1971.
Committee on Public Relations and Economics
— Dr. Frederick P. Osgood, Toledo, reappointed
chairman; Dr. Horace B. Davidson, Columbus, reap-
pointed for a five-year term, 1966-1971.
Committee on Scientific Work — Dr. Samuel
Saslaw, Toledo, reappointed chairman; Dr. Jerry
Hammon, West Milton, appointed for a five-year
term, 1966-1971. Dr. Robert E. Zipf, Dayton, ap-
pointed for a five-year term, 1966-1971.
Dr. Saslaw and OSMA Staff Commended
Dr. Samuel Saslaw, chairman of the Committee on
Scientific Work, and all members of the OSMA staff
were commended by the House of Delegates for the
success of the meeting.
Decree Approved
Under new business Dr. Theodore L. Light, Sec-
ond District Councilor, presented the following state-
ment:
"In all functions of the House of Delegates of
the Ohio State Medical Association Annual Meeting,
May 24-28, discussion was frank, sincere and un-
abridged. Where differences of opinion became
evident, they were debated temperately, astutely and
concisely, with conspicuous concern for the welfare
of our patients, and for the preservation of highest
quality medical care.”
By official action of the House of Delegates the
decree was adopted as presented.
Emergency Resolution
A request from Dr. Jack Kraker, Fairfield County,
to introduce an emergency resolution failed to receive
the required two-thirds vote of those present, ruled
necessary by the President for suspension of the rules.
Vote of Thanks
The House of Delegates expressed appreciation
to the committees and staff of the Academy of Medi-
cine of Cleveland and Cuyahoga County, to the Aux-
iliary, members of the news media, managements of
the Cleveland hotels, and to all others who con-
tributed to the success of the 1966 Annual Meeting.
Dr. Meredith announced that the 1967 Annual
Meeting will be held in Columbus the week of
May 14.
The House of Delegates then adjourned sine die.
Attest: Hart F. Page
Executive Secretary
ROLL CALL OF HOUSE OF DELEGATES
1966 ANNUAL MEETING
County
Delegate
First
Session
Second
Session
ADAMS
FIRST DISTRICT
Francis Stevens
Present
Present
BROWN
John R. Donohoo
Present
Present
BUTLER
Paul N. Ivins
Present
Present
John H. Varney
Present
Present
CLERMONT
Carl A. Minning
Present
Present
CLINTON
Edmond K. Yantes
Present
Present
HAMILTON
William C. Ahlering
Present
Present
Frederick Brockmeier
Present
Frank P. Cleveland
Present
Present
John J. Cranley, Jr.
Present
Present
Joseph G. Crotty
Present
Present
Ralph S. Grace
Present
Present
Robert S. Heidt
Present
Harry K. Hines
Present
Present
Daniel V. Jones
Present
Present
Warner A. Peck
Glenn W. Pfister, Jr.
Present
Present
Clyde S. Roof
Present
R. M. Woolford
Present
Present
HIGHLAND
Clifford G. Foor
Present
Present
WARREN
Thomas E. Fox
Present
Present
CHAMPAIGN
SECOND DISTRICT
Isador Miller
Present
Pi-esent
CLARK
David D. Smith
Present
Present
Ernest H. Winterhoff
Present
Present
716
County
Delegate
First
Session
Second
Session
DARKE
Maurice M. Kane
Present
Present
GREENE
Roger C. Henderson
Present
Present
MIAMI
Dale A. Hudson
Present
Present
MONTGOMERY
Kenneth D. Arn
Present
Present
PREBLE
Robert A. Bruce
C. E. O’Brien
William M. Porter
J. Richard Strawsburg
James G. Tye
Sylvan L. Weinberg
C. J. Brian
Present
Present
Present
Present
Present
Present
Present
Present
Present
Present
SHELBY
George J. Schroer
Present
Present
THIRD DISTRICT
ALLEN
Dwight L. Becker
Present
Present
Fred P. Berlin
Present
Present
AUGLAIZE
Robert S. Oyer
Present
Elizabeth Y. Kuffner
Present
CRAWFORD
Darrel D. Bibler
HANCOCK
Donald R. Brumley
Present
Present
HARDIN
Clarence L. Johnson
Present
Present
LOGAN
Charles A. Browning
Present
Present
MARION
Albert M. Mogg
Present
Present
MERCER
Donald R. Fox
Present
SENECA
Walter A. Daniel
Present
Present
The Ohio
State Medical Journal
County
Delegate
VAN WERT
Edwin W. Burnes
WYANDOT
Donald P. Smith
FOURTH DISTRICT
DEFIANCE
Charles E. Jaeckle
FULTON
Vernon L. Cotterman
William J. Neal
HENRY
Edwin C. Winzeler
LUCAS
George Bates
William G. Henry
Frederick P. Osgood
Frank F. A. Rawling
Merl B. Smith
Randolph P. Whitehead
OTTAWA
V. William Wagner
PAULDING
D. E. Farling
PUTNAM
Milo B. Rice
SANDUSKY
John G. Bushman
WILLIAMS
Allen G. Jackson
WOOD
Clarence Nyce
FIFTH DISTRICT
ASHTABULA
Shepard A. Burroughs
CUYAHOGA
Joseph C. Avellone
James 0. Barr
Joseph L. Bilton
William F. Boukalik
John H. Budd
E. Peter Coppedge, Jr.
Eduard Eichner
David Fishman
William E. Forsythe
John J. Grady
Harry A. Haller
Chester R. Jablonoski
Fred R. Kelly
Vincent T. LaMaida
M. H. Lambright
Richard P. Levy
Frederick V. Light
Lawrence J. McCormack
Paul A. Mielcarek
George W. Petznick
Russell P. Rizzo
John H. Sanders
A. B. Schneider, Jr.
Frederick T. Suppes
William V. Trowbridge
Elden C. Weckesser
GEAUGA
Bruce F. Andreas
Simon Ohanessian
LAKE
Joseph W. Koelliker, Jr.
Robert A. Irvin
SIXTH DISTRICT
COLUMBIANA
William S. Banfield
MAHONING
Joseph V. Newsome
Jack Schreiber
Charles W. Stertzbach
Joseph W. Tandatnick
PORTAGE
Edward A. Webb
STARK
Aubrey R. Furnas, Jr.
Mark G. Herbst
Maurice F. Lieber
William A. White, Jr.
SUMMIT
William Dorner, Jr.
Thomas W. Jackson
James W. Parks
Leonard V. Phillips
F. J. Waickman
Robert E. Yeakley
TRUMBULL
Steven A. Pollis
Rex K. Whiteman
SEVENTH DISTRICT
BELMONT
James F. Sutherland
CARROLL
Glenn C. Dowell
COSHOCTON
N. L. Wright
HARRISON
Elias Freeman
JEFFERSON
Sanford Press
Crist G. Strovilas
MONROE
Byron Gillespie
TUSCARAWAS
R. E. Rinderknecht
First
Second
Session
Session
County
Present
"
—
ATHENS
FAIRFIELD
GUERNSEY
LICKING
Present
Present
MORGAN
Present
MUSKINGUM
Present
NOBLE
Present
Present
PERRY
Present
Present
WASHINGTON
Present
Present
Present
Present
Present
Present
Present
Present
GALLIA
Present
Present
HOCKING
Present
Present
JACKSON
Present
—
LAWRENCE
Present
Present
MEIGS
—
—
PIKE
—
Present
SCIOTO
Present
Present
VINTON
Present
Present
DELAWARE
Present
Present
FAYETTE
Present
Present
FRANKLIN
Present
Pi-esent
Pi*esent
Present
Present
Present
Present
Present
Present
Present
Present
Present
Present
Present
Present
Present
Present
Present
Present
KNOX
Present
Present
MADISON
Present
Present
MORROW
Present
Present
PICKAWAY
Present
Present
Present
Present
ROSS
Present
Present
Present
UNION
Pi-esent
Present
Present
Present
Pi-esent
Pi-esent
Present
Present
ASHLAND
Present
Present
ERIE
Present
Present
—
HOLMES
Pi-esent
Present
HURON
Present
Present
LORAIN
MEDINA
Present
Present
RICHLAND
Present
Pi-esent
Pi-esent
Present
Present
Present
WAYNE
Present
Present
Present
Present
Present
Present
President
Present
Present
President-Elect
Present
Present
Present
Pi-esent
Past President
Present
Present
Treasurer
Present
Present
Present
Pi-esent
Present
Present
District
Present
Present
FIRST
Pi-esent
Present
Present
Present
SECOND
Pi-esent
Present
THIRD
FOURTH
FIFTH
Present
Pi-esent
SIXTH
Pi-esent
Present
SEVENTH
Present
Present
EIGHTH
Present
Present
NINTH
Present
TENTH
Present
ELEVENTH
Present
Present
First
Second
Delegate
Session
Session
EIGHTH DISTRICT
Don R. Johnson
Present
Present
Jack L. Kraker
Present
Present
James A. L. Toland
Present
Present
Jay R. Wells
Present
Present
Henry Bachman
Present
Carl E. Spragg
Present
Present
Edward G. Ditch
Charles E. Bope
Kenneth E. Bennett
Present
Present
NINTH DISTRICT
Thomas W. Morgan
Present
Present
L. W. Starr
Present
—
Clarence C. Fitzpatrick
Present
Present
Thomas E. Miller
—
Roger P. Daniels
Present
Present
Mack E. Moore
—
William M. Singleton
Present
Present
Richard E. Bullock
—
TENTH DISTRICT
Adelbert R. Callander
Present
__
Robert A. Heiny
Homer A. Anderson
Present
Present
Norman H. Baker
Present
Present
Joseph A. Bonta
Present
Present
James C. Good
Present
Present
Thomas M. Hughes
Present
Present
William E. Hunt
Present
Present
John R. Huston
Present
Present
Charles W. Pavey
Present
Present
D. W. Traphagen
Present
James C. McLarnan
Present
Present
Sol Maggied
Present
Present
Joseph P. Ingmire
Present
Present
Carlos Alvarez
Present
Jasper M. Hedges
Present
—
Lewis W. Coppel
Present
Present
E. J. Marsh
Present
Present
ELEVENTH DISTRICT
Charles H. McMullen
Present
Present
Emil J. Meckstroth
Present
Present
Adam J. Earney
Present
Present
William R. Graham
Present
Present
Ben V. Myers
Present
Present
James T. Stephens
Present
Present
Richard W. Avery
Present
Present
H. F. Mills
Present
Carl M. Quick
Present
Present
C. Shamess
Present
Albert B. Huff
Present
Present
OFFICERS
Henry A. Crawford
Present
Present
Lawrence C. Meredith
Present
Present
Robert E. Tschantz
Present
Present
Phillip B. Hardymon
Present
Present
COUNCILORS
Robert E. Howard
Present
Present
Theodore L. Light
Present
Present
Frederick T. Merchant
Present
Present
Robert N. Smith
Present
Present
P. John Robechek
Present
Present
Edwin R. Westbrook
Present
Present
Benjamin C. Diefenbach
Present
Present
Robert C. Beardsley
Present
Present
George N. Spears
Richard L. Fulton
Present
Present
William R. Schultz
Present
Present
Totals
1B7
151
for July, 1966
717
President’s Address . . .
Presented Before the OSMA House of Delegates at
The 1966 Annual Meeting in Cleveland on May 24
By HENRY A. CRAWFORD, M.D., Cleveland
MEMBERS of this House of Delegates; Fellow
Physicians: In my inaugural remarks one
■ year ago, I declared that, as President of
the Ohio State Medical Association, I had no inten-
tion of presiding over a wake for organized medicine.
This remark was prompted by the impending pas-
sage of Medicare, and the ensuing government med-
ical program it provides.
I am proud to stand before you this evening and
report that, rather than a wake, your OSMA and its
10,000 members have had a rejuvenation.
To the hand-wringing prophets of gloom and
doom, I can say:
Never has our Association been stronger.
Never has our Association been more active.
Never has our State Association displayed more
leadership ... on both a state and a national level.
Never has the interest of our members been higher.
Never has their expression of support and coopera-
tion been greater.
Never have so many of our Officers, Councilors,
Committees, AMA Delegates and Alternates, and our
County Medical Society officers worked so hard.
These superlatives do not reflect only my personal
opinion. They are based on the scores of comments,
remarks, letters, and phone calls I have received from
enthusiastic members.
Before I go further, I want to pay tribute and give
my own vote of appreciation to the executive staff of
this Association, Hart Page, Chuck Edgar, Mike
Traphagan, Herb Gillen, Gordon Moore, and Dr.
Perry Ayres, the Editor of our Journal, along with
the headquarters clerical staff of efficient secretaries
and other workers. Without their loyalty and devo-
tion to this organization, nothing could have been
accomplished. Some of you may be aware that the
executive staff is one man short and I surely hope a
suitable addition can be made soon, so that our leg-
islative program can go forward at an accelerated
rate when the State Legislature meets this next year.
I would like to take this opportunity to thank my
office associate, Dr. George Tischler, my secretary,
Note: For the report of the Committee on the President’s Ad-
dress, see page 698 in the official proceedings of the House of
Delegates.
Jocie Schweitzer, and my industrial nurse, Helen Sido,
for covering my practice during the many days I have
been away to meetings. Thanks should also be ex-
tended to my fellow staff members at Lutheran and
St. Vincents Charity Hospitals for cutting my staff
assignments and paper load during this rather busy
year.
Now, I would like to touch briefly the high points
of the past year, comment on the present and dwell
on the future.
The Year in Review
In the past twelve months, your Council has held
what surely must be a record number of meetings.
Usually, Council meets about five times a year. In
the past year, Council has met almost monthly, thus
reflecting the large volume of matters to be transacted.
Here again, I would like to digress a minute and
extend thanks from myself and the association to the
members of The Council, committee chairmen, and
committee members for attendance at many many
meetings this past year. Here is where the interim
policies are made and examined and passed on to
The Council for implementation if they so desire.
On very few occasions this year, if at all, has The
Council failed to adopt the recommendations of these
committees.
We have taken a number of sound, positive steps
during the past year.
First, there was the adoption of the "usual custom-
ary and reasonable’’ fee program which we con-
vinced the Bureau of Workmen’s Compensation to
be both feasible and fair.
This was a tremendous breakthrough. It represents
a program where no government agency is dictating
to physicians the value of their professional services.
In a majority of cases, this program is working
smoothly. I regret to report that we have encountered
some "bugs,’’ but we are working to eliminate them.
Also, it is our hope that this usual and customary fee
plan can be expanded — regardless of how long it
takes — to include all government medical care
programs.
We are convinced that it can be expanded if all
our members follow the guidelines recommended by
Council and by this House of Delegates.
718
The Ohio State Medical Journal
Statement of Policy
I call to your specific attention the policy regard-
ing government medical care programs adopted by
Council. This policy calls on all members to preserve
the physician-patient relationship and the quality of
medical care by billing the patients they accept under
all such programs.
This statement received wide national publicity. It
was prominently featured in The AMA News. It was
distributed to all the other state associations. It has
been adopted, word for word, by at least one other
state association, and it has served as a guide for
similar statements by several other state societies.
The statement was sent to all OSMA members,
along with an article on hospital utilization commit-
Dr. Henry A. Crawford is shown here presenting
"The President’s Address” during the first session of
the House of Delegates.
tees and a Bureau of Workmen’s Compensation legal
opinion, as Medicare Newsletter No. 3.
The legal opinion also represents a landmark. It
stated that the Bureau could not legally "make pay-
ments to a hospital where it is known that there is a
fee-splitting arrangement between the hospital and
a roentgenologist.’’
Ohioan Honored
OSMA was honored this past year by the election
of one of our Past Presidents, Charles L. Hudson,
to the office of AMA President-Elect. Dr. Hudson
will be installed in medicine’s highest office next
month at the AMA Annual Convention.
You would have been pleased and proud of the
leadership and dedication of your OSMA delegation
to the AMA at the 1965 Clinical Convention in Phil-
adelphia. Under the chairmanship of Dr. John Budd,
your delegates fought for and won adherence to prin-
ciples and positions that best reflect the policies es-
tablished by this OSMA House of Delegates.
Your Council has directed your AMA delegation
to nominate Dr. Budd, at next month’s annual con-
vention, for the important office of Vice-Speaker of
the AMA House of Delegates. The respect and stat-
ure Dr. Budd holds in the AMA House has prompted
many other states to recommend that we make him
a candidate. We are proud to do so, and we are
certain of victory.
On the housekeeping side, we have relocated our
headquarters facilities. While we do not occupy a
great deal more office space, we do have a more effi-
icent, more functional and more attractive headquar-
ters. This move was long overdue, and I am pleased
to report that it has been accomplished.
Your OSMA has assisted, and supported at every
opportunity, the efforts of certain medical specialty
groups to rid themselves of the threatened domina-
tion of their practice by hospitals. I can assure you
that we will continue this mission, just as we will
assist and support with every ounce of our energy
any threat to dominate and control any segment of
the medical profession.
We were highly pleased and impressed by the out-
standing attendance at, and participation in, our Dis-
trict Conferences last fall for County Medical So-
ciety officers and key committee chairmen. We en-
joyed the same attendance and participation in our
1966 County Medical Society Officers Conference in
Columbus.
We are pleased to announce the organization of the
Ohio Association of County Medical Society Exec-
utives. These persons, by sharing knowledge, experi-
ences and ideas, can reinforce their efforts to assist
the County Societies they so capably represent. Seven-
teen County Societies in Ohio now have executive
secretaries.
I suggest that some of the nonmetropolitan County
Societies consider the idea of sharing an executive
secretary with two or three other counties, or perhaps
on a Councilor District basis. The increasing num-
ber of Medical Society programs, projects, interest
and demands make this well worth your serious con-
sideration.
A Look at the Present
Enough of the past. Now, let me touch on the
present before I look to the future.
Another concrete example of our members’ strong
interest in OSMA, in what we say and what we do
as a medical organization, is found in the delegate’s
packet which you have before you. I refer specifically
to what I believe is the record number of resolutions
which the County Societies have indicated they will
present here tonight for your consideration and action.
You are honored to be here, for I feel that it is
an honor for any man when his fellow physicians
select and elect him to represent them in deciding
what is best for medicine and best for the patients
medicine serves.
I know that, in this spirit, you will consider these
resolutions before the Reference Committees tomor-
for July, 1966
719
row and act on them Friday morning. In this same
spirit, you will elect your Officers, Councilors, Dele-
gates and Alternates.
Distinguished Leaders
Before turning to the future, I want to point out
that we are honored by having three distinguished
medical leaders participating in our 1966 Annual
Meeting.
One is my fellow Clevelander who will be installed
as President of the AMA just five weeks from this
date — Dr. Charles L. Hudson.
Another is an outstanding Past President of the
AMA who will address our meeting Friday morning
— Dr. Edward R. Annis, of Miami, Florida.
The third is a man who has done more for Ohio
medicine than any physician I know ... a man whose
life has been given to upholding and preserving the
ideals, principles and ethics of our profession . . .
the man to whom we humbly dedicate this 1966
Annual Meeting, Dr. Herbert M. Platter.
The New Look in Medicine
The theme of this meeting is The New Look in
Medicine. In turning now to the future, I must, in
all sincerity, not only ask, but warn that we must
take on a "New Look.”
The atmosphere in which we practice is taking on
a new look. We must adjust ... we must adapt . . .
and we must dedicate ourselves to the task of meeting
this new look . . . these new conditions and respon-
sibilities that confront us.
Instead of asking, "What do we face?” I am going
to state . . . emphatically and unequivocally . . . what
we must face.
We must face up to the fact that the privileges of
our profession . . . privileges we have earned . . .
carry equal responsibilities. We must shoulder these
responsibilities.
These are medical responsibilities. If they are not
shouldered by medical men, then we immediately will
find them being taken over by nonmedical interests
. . . interests that do not look on our patients as peo-
ple ... as human beings . . . but, rather, look on them
as collective numbers.
As individual physicians, we cannot delegate our
responsibilities to our County Medical Society . . .
our Ohio State Medical Association ... or the Amer-
ican Medical Association. We cannot legislate in con-
vention this week, then go home and forget about
it for another year. We are mnning out of years . . .
out of months . . . even out of days.
We are approaching medicine’s moment of truth.
It is entirely within our hands to determine whether
this becomes a period of darkness or becomes medi-
cine’s finest hour.
Importance of Committees
One responsibility is that of our Medical Society
review or mediation committees. A good example
is the usual and customary fee program of the Bureau
of Workmen’s Compensation.
I am happy to report that most committees are
doing an excellent, effective job in reviewing cases
which the Bureau has questioned. Unfortunately, I
regret to say that some committees are failing to meet
their responsibilities. The proof is found in files in
our OSMA headquarters.
These committees must realize that they cannot
bow to the whims of one person. They must consider
the whole picture . . . the whole spectrum of medicine.
I think it is ridiculous . . . downright short-sighted
. . . to oppose effective review committees. I would
much rather be judged by my fellow physicians in
medical matters than be judged by some lay claims
clerk who doesn’t know a hypodermic from a
hydrocele.
Review committees of all kinds function with con-
viction . . . with impartiality . . . regardless of what
parties may be involved. They must base their rec-
ommendations on fact . . . not fear or fancy. They
must not only know and understand the Principles
of Medical Ethics, but they must uphold these
principles.
This applies to all matters brought before such
committees, and not just workmen’s compensation
cases. However, I must dwell on these industrial
cases because of the current situation.
The burden of proof is on us. The burden of
proof is on the OSMA, the County Society and the
individual physician ... to prove that this program
can work . . . can succeed . . . and can best serve all
interests involved.
Your OSMA fought hard to achieve what was said
to be impossible. Your OSMA convinced the Bureau
of Workmen’s Compensation that this program could
succeed, just as the Ohio Medical Indemnity usual
and customary fee plan is succeeding. Now, it’s up
to you. If you want to preserve it, fight for it.
Improved Medical Practice Act
Another responsibility we must face in the near
future is the strengthening and improvement of the
Ohio Medical Practice Act. Your OSMA intends to
seek badly needed . . . and too long delayed . . .
legislation to improve this Act.
The present Act has too many weaknesses. It does
not give the Medical Board the authority to give to
the citizens of Ohio the protection they need. The
legislation we will seek must protect . . . effectively
. . . our citizens against the medical charlatan, the
quack, the incompetent.
I charge you members of this House to return to
your communities and immediately enlist the support
of your fellow physicians, your fellow citizens and
your State Representatives and Senators to assure
passage of this vital measure.
720
The Ohio State Medical Journal
A Policy — A Stand
One of the responsibilities we shirk so miserably
is that of informing ourselves and supporting the
actions, statements, and policies of this Association.
I refer, as an outstanding example, to the Policy
Statement of The Council of the Ohio State Medical
Association Regarding Government Medical Care
Programs,” adopted by Council, March 20, 1966.
For months, members had been saying to your state
officers and your Councilors, "What is OSMA going
to do about Medicare?” "What can it do?” "How
will Medicare change my practice?”
Council’s statement was sent, in Medicare News-
letter No. 3, to all OSMA members. Also, it was sent
to the AMA, to all other State Associations and to
all specialty societies.
I am pleased to report that this statement was
adopted verbatim by at least one other State Associa-
tion, and has been used as a guide by other State
Associations in developing their own statements.
We have received, from coast to coast, numerous
requests from medical organizations for additional
copies of this statement . . . asking for 25 copies
to 1,000.
But most of our own members couldn’t be
bothered to take the time to read it. If most of our
County Medical Society officers read it, they appar-
ently failed to recognize its significance.
These are harsh words. They are true words. Proof
is found in reports I have had from Councilors after
they attended County Society meetings. These meet-
ings were to discuss Medicare. "What to do? How
will we bill? How will we be paid?” . . . Those were
some of the questions doctors asked at these meetings.
Why a Policy?
This policy statement of The Council was de-
veloped for three purposes:
First ... to put this Association officially on record.
Second ... to recommend policy to the County
Societies.
Third ... to give the individual members of this
Association guidelines for conducting medical prac-
tice under all government programs.
Gentlemen, this statement of policy was Ohio
Medicine’s 1966 Declaration of Independence. If our
County Societies and our individual members do not
support it . . . and support it forcefully ... it becomes
empty words on paper.
We will include this statement in the next OSMA-
gram. I urge you, in meetings of your County So-
cieties, to study this statement, to support it, and
to urge your members to adhere to it in the personal
conduct of their practice.
Another area of concern is the field of post-
graduate education. We physicians are finding it more
and more difficult to find time to keep abreast of
medical progress. We are finding it more and more
difficult to find postgraduate courses that are prac-
tical rather than theoretical.
We must improve the availability, the content and
the quality of these courses. We must establish a
closer working relationship with our medical schools
and other medical centers to accomplish this task.
To accomplish it, we must continually impress on
our medical schools and our medical educators the
cold, hard fact that their primary mission . . . their
first obligation to the profession and to the public . . .
is medical education . . . not research.
Where Responsibility Lies
Too many physicians are forgetting personal service
to patients. Too many are allowing third parties to
handle responsibilities that should be handled by the
physician and the patient.
We must combat the public’s false impression that
we are more interested in organs and diseases than
we are in people.
We must combat the public’s erroneous attitude
that we are more interested in recreation and travel
than we are in patients.
We must re-establish in the mind of the public,
awareness of the hard fact that ... as physicians
. . . we devote the major portion of our time . . .
our energies . . . our lives ... to meeting ... to the
best of our abilities and our efforts . . . the solemn
responsibility of caring for the health and well-being
of our patients.
After a year in the office I will soon relinquish
. . . after traveling 75,000 miles . . . after a thou-
sand meetings . . . and with hundreds of new friend-
ships ... I want to thank this House of Delegates
. . . humbly and sincerely . . . for the privilege of
sharing in so many rich and rewarding experiences.
Only those who have preceded me in this office
can understand and appreciate my deep, personal
feelings on this occasion.
Points to Remember
In summary and as a conclusion let us:
1. Keep the "pot” boiling, keep up the steam. I
am sure that Larry Meredith and his officers and staff
can keep the lid on, letting off the pressure here and
there.
2. Keep up the communicating to the County So-
cieties and to individual members, and never quit
applying the pressure on the AMA to heed the voices
and warnings from the grass roots.
3. Record and document all the inefficiencies, the
mistakes and the boondoggling under governmental
and other such programs, that deteriorate the quality
of medical care given our patients; and then let us
cry out in loud and distinct tones to the people about
such practices and participate in correcting or abolish-
ing them.
4. Handle our own "dirty linen,” and work dili-
for July, 1966
721
gently for laws and other measures to eliminate un-
ethical and incompetent practice.
5. Make every effort to establish a practical means
of postgraduate education so as to maintain eacn
doctor’s fund of knowledge current that our patients
may benefit from the latest treatment and medications.
6. Organize a study group or a committee or "what
not” to keep our associations abreast of the latest
socio-economic thinking of the welfare agencies, "do
gooders,” labor unions and others so that we can
counter these before politicians can take control of
all medicine.
7. Actively participate in community activities, pol-
itics at all levels, and campaigns such as water and
air pollution.
There are many more activities we could think of,
so add as many as you want so long as you work at
their correction.
One last thought. I remember reading this state-
ment on the Warner and Swasey billboard at East
55th and Carnegie several years ago.
"Only the strong remain free.” I repeat, "Only
the strong remain free.”
Let us heed this warning.
Outstanding Scientific Exhibits
At Annual Meeting Awarded
A JUDGING committee designated seven Sci-
entific Exhibits at the 1966 OSMA Annual
Meeting in Cleveland to receive special recog-
nition and their sponsors were presented awards.
They were among 27 Scientific Exhibits presented in
the area where Health Education Exhibits and Tech-
nical Exhibits were on display.
Annual Meeting planners have authorized a mone-
tary award as well as a permanent type, mounted
metal plaque and certificate for each exhibit judged as
outstanding. Following are the authorized awards
with the names of selected exhibits and their sponsors:
Gold Award in Teaching: The exhibit, "Con-
trol of Hemorrhage by G-Suit,” sponsored by Drs.
John Storer and James Gardner, of Huron Road
Hospital, Cleveland.
Gold Award in Original Investigation : The
exhibit, "Stereoscopic Microangiography : Observa-
tions on the Microcirculation in Bone Repair,” spon-
sored by Drs. F. W. Rhinelander, R. S. Phillips, and
W. M. Steel, Western Reserve University School of
Medicine and Cleveland Metropolitan General Hos-
pital, Cleveland.
Silver Award in Teaching: The exhibit, "Sim-
plified Treatment of Breast Cancer,” sponsored by
Drs. George Crile, Jr., and C. B. Esselstyn, of the
Cleveland Clinic.
Silver Award in Original Investigation : The
exhibit, "Bilateral Transabdominal, Transperitoneal
Omentoureterostomy,” sponsored by Dr. Arthur A.
Roth, Cleveland.
Bronze Award in Teaching: The exhibit, "Of-
fice Evaluation of a Geriatric Patient,” sponsored by
the following team from the Ohio Department of
Health, in cooperation with the USPHS Gerentology
Branch, Columbus: Dr. Emmett W. Arnold, Ohio
director of health; Dr. Aileen L. MacKenzie; Fran-
ces Williamson, Richard W. Orzechowski, and Den-
nis Webb.
Series on Outstanding Exhibits
To Be Published in Journal
Because of the obvious educational value of
the Scientific Exhibits, and for the further pur-
pose of bringing to its readers additional in-
formation on the material presented, The Jour-
nal will publish a series of special articles on
the seven exhibits judged as outstanding. This
tribute is in keeping with a policy established
by the Committee on Scientific Work, and ap-
proved by The Council.
Watch for the coming issues of The Journal
and illustrated features about exhibits listed on
this page. Through this means, The Journal
not only will salute the outstanding exhibits,
but will attempt to acknowledge the many
hours of research and preparation all of the
sponsors have put behind their presentations.
illllllllliil!
Bronze Award in Original Investigation: The
exhibit, "Let’s Control Rubella in Ohio,” sponsored
by Dr. Gilbert M. Schiff, University of Cincinnati
College of Medicine.
Special Award: The exhibit, "Motorbike Safety,”
sponsored by the following team of the Committee
on Trauma of the Academy of Medicine of Cleve-
land: Drs. R. C. Waltz, Karl Alfred, Vernon Hacker,
J. D. Osmond, and George Phalen.
722
The Ohio State Medical Journal
Inaugural Address . . .
More Challenging Role for the Medical Profession’s
Potential Strength Is Urged by Incoming President
By LAWRENCE C. MEREDITH, M. D., Elyria
IN THIS 1966 session of the House of Delegates,
we have been privileged to be the participants
simultaneously in the end of two eras. We have
justly acclaimed the long career, and have expressed
our sincere admiration for Doctor Herb Platter’s
contributions to medicine in Ohio. In a grave sense
of privilege as members of this House of Delegates,
we find ourselves, against our will, participants in the
end of another era . . . this being the final session
of the House before Medicare.
No one here today is vested with power to predict
accurately the impact of Public Law 89-97 upon the
profession or upon society. We can anticipate that
there will be abundant evidence of the effect of this
law upon the spirit with which we will reassemble
in May, 1967.
The end of an era is but the beginning of another.
The medical profession has faced many eras. It has
created change, and it has led change.
As a leader, the medical profession has evolved
statements of principle, of purpose, of rule and ethics
which today insure the highest quality of professional
relationship. I am confident that, through medicine’s
voluntary "self-policing, self-determination, and self-
evaluation,” Ohio physicians ensure the best of medi-
cal care for the patients of Ohio.
A year from now, if our spirit and dedication for
leadership are to match and continue that of our
medical predecessors, we must at that time assess our
weaknesses, our strengths and plan realistically for
future action.
Are We 10,000 Strong?
OSMA membership is now 10,000. But are we
10,000 strong?
I have observed many attitudes which lead me to
wonder, at this turning point, if Ohio physicians have
faith in, or recognize the strength of our organization.
Many physicians have said: "We are lost! There
is no future in the voluntary practice of medicine!”
In the doctors’ dressing room at the hospital, many
are quick to criticize medicine’s shortcomings. But
these men will not speak out in a County Society
Presented before the House of Delegates at the OSMA Annual
Meeting in Cleveland, May 27, 1966.
meeting; others will not participate in County Society
activities because they are "too busy” with patients,
or are too busy with hospital staff commitments.
Are we 10,000 strong, if, in some County Society
meetings, announcements of state or national prob-
lems or policy are ignored in favor of long-winded
guest speakers?
Strength — or Weakness?
What of the strength of our principles if 4,000
physicians signed the exculpatory Civil Rights oath?
And what strength have we if only 2,900 in Ohio
joined OMPAC and AMPAC?
Here we stand at the beginning of an era with
the federal "foot in the door.” We are strong in
number, but through fatalism, perhaps indifference,
and hampered by faulty communication, we have
some glaring weaknesses.
At this turning point, we cannot blame the past
for that "foot.” The call for physicians to stand in
support of their traditions and ethics is clear! We
must answer this call in growing unity, sophistica-
tion, and, above all, courage.
Unity can only evolve if individual members rec-
ognize their common heritage as doctors of medicine.
All physicians must realize that, despite the increas-
ing fragmentation into specialties, each, contributing
of himself in a dual role of physician and citizen,
strengthens the organization. In this coming year we
must explore mandatory indoctrination of new physi-
cians as a requirement for active membership in
County Society and State Association.
Matters of Ethics
Section Four of the Principles of Medical Ethics
stales: "The medical profession should safeguard the
public and itself against physicians deficient in moral
character or professional competence. Physicians
should observe all laws, uphold the dignity of the
profession, and accept its self-imposed disciplines.
They should expose without hesitation, illegal or un-
ethical conduct of fellow members of the profes-
sion.” We must in this coming year explore methods
of educating our component societies in the legal me-
chanics of the self-regulatory and self-disciplinary
procedures as outlined in our Bylaws.
for July, 1966
723
Organizational unity cannot be increased without
a more equitable representation from our component
societies. Council and the House of Delegates last
acted upon this problem in 1939, with the establish-
ment of the Eleventh District. District lines may have
to be changed. Perhaps another district must be
evolved.
We must also, in our effort to gain greater unity,
acknowledge the growth and participation of Spe-
cialty Sections. I believe, that acting in accordance
with our Bylaws, delegate representation from Spe-
cialty Sections could be evolved.
A Call for Knowledgeability
The call for unity without knowledgeability of
variation of usual, customary, and reasonable fees, or
without knowledge of hospital utilization patterns
throughout the state, is pointless. From a political
point of view, Congress, in establishing P. L. 89-97,
has placed reliance on existing mechanisms and pro-
cedures established by the state and local societies for
determining reasonable charge. We may place our
organization in joepardy if we are not so knowledge-
able. From an educational as well as a political point
of view, the Association must have current and reli-
able facts concerning utilization or face the strong
possibility of external regulation which truly may
lead to the deterioration of the voluntary practice of
medicine.
It is a paradox that we daily contribute such data
to hospitals and third parties, but are too penurious
or naive to assemble these facts for our own educa-
tion or protection.
We must, then, explore in this coming year so-
phisticated methods of collecting, analyzing, and
using such data if we are to support the principles
we have enunciated in the past, or to support the
actions we have taken in this House of Delegates.
Positive Leadership
Unity and sophistication, however, cannot turn the
tide of battle. If the medical profession is dedicated
to leadership, we must have the courage to lead ! The
most biting criticism of our profession has been that
we are "against” and never "for.” We have in this
session shown that we are for improvement in mental
health, for betterment of air and traffic safety, for
betterment of the health of the migrant worker and
the hard of hearing. But, in none of the 47 resolu-
tions have we been for a courageous stand in opposi-
tion to the one element in P. L. 89-97 which in my
mind places, through economic threat of that law,
the possibility of seeing not only the "foot” but the
"whole leg” through the door. That element is the
granting of "want” not "need” in this legislation.
Therefore I charge myself, and Council, and this
House of Delegates, and every member of OSMA, to
be courageous in this coming year, to study actively
and attempt to formulate recommendations that will
Dr. Lawrence C. Meredith is shown here addressing
the second session of the House of Delegates immedi-
ately after being installed as President for the coining
year.
provide continuing protection to the relationship of
patient and physician.
Finally, essential to the spirit with which we face
this new era must be the recognition that no one
physician, no one medical staff, no one society, no
one school of medicine can speak for the profession.
The voice that speaks must be the composite of all.
It whispers if we fail to communicate with each
other.
We of this House of Delegates will reassemble in
1967 with the deep conviction that only the Ohio
physician intimately knowledgeable of his community
provides, and will in growing unity, sophistication,
and courage, continue to fight for the high quality of
medical care long enjoyed by the Ohio patient!
Drug Firm Foundation Promotes
Career Selection Program
Twenty-nine students from 24 colleges and univer-
sities in Ohio and Pennsylvania have been chosen
by their schools to participate in a summer program
designed to help them decide on medical careers.
The college men and women are taking part in
the Medical Careers Program of the Smith Kline &
French Foundation, scientific and educational trust
of the Philadelphia-based prescription drug firm. Each
student will work for eight to 12 weeks at one of the
medical schools on research projects along side
medical students and with supervision of physicians.
Six students of Ohio colleges are assigned to West-
ern Reserve University School of Medicine. They are
Lawrence Barnthouse, Kenyon College Sophomore;
Wayne Beveridge, Kenyon College junior; John M.
Moorhead, Ohio Wesleyan University sophomore;
Julia Pfile, Oberlin College sophomore; Gregory
Prazar, Wooster College junior; and James Whipple,
Baldwin Wallace College sophomore.
724
The Ohio State Medical Journal
Annual Meeting Attendance
REGISTRATION records for the 1966 Annual
Meeting in Cleveland, May 24-28, show that
- both members of the Association and guests
attended excellent numbers. Total registration was
3035, with the following breakdown: Members,
1484; guest physicians, 309; medical students, 22;
Woman’s Auxiliary, nurses, dentists, technicians, and
miscellaneous guests, 865; scientific and technical ex-
hibitors, 355.
Following are registration figures for members of
the Association by counties and a comparison of An-
nual Meeting attendance figures from 1919 through
1966:
Registration by Counties, 1966 Annual Meeting,
and Membership Data
County
Adams
Allen . ...
Ashland _.
Ashtabula
Athens
Auglaize „
Belmont _.
Brown
Butler
Carroll
Champaign
Clark
Clermont
Clinton
Columbiana
Coshocton
Crawford
Cuyahoga
Darke
Defiance
Delaware
Erie
Fairfield
Fayette
Franklin
Fulton
Gallia
Geauga
Greene
Guernsey
Hamilton
Hancock
Hardin
Harrison
Henry
Highland
Hocking
Holmes
Huron
Jackson
Jefferson
Knox
Lake
Lawrence
Licking
Logan
Lorain
Lucas
Total Membership
Dec. 31, May 18,
1965
14
124
25
59
37
16
55
15
174
10
17
1966
13
124
26
59
37
16
54
14
175
10
17
Ann. Meet.
Registra-
tion
2
14
7
9
4
3
8
1
9
2
1
Members
and
Guests Who
e Figures
for
Other Years
Total Membership
County
Dec. 31,
May 18
1965
1966
Perry
10
9
Pickaway
17
19
Pike
11
10
Portage _
55
56
Preble ... .
11
9
Putnam
12
11
Richland
119
118
Ross ....
39
39
Sandusky
46
46
Scioto
68
67
Seneca
45
44
Shelby .
22
22
Stark
354
346
Summit
572
556
Trumbull
134
132
Tuscarawas
51
52
Union
18
18
Van Wert ... ...
20
21
Vinton
1
Warren
16
14
Washington
30
30
Wayne
60
59
Williams
18
18
Wood .. .. . .
42
38
Wyandot
11
11
Total _ _
10,042
9713
Ann. Meet.
Registra-
tion
1
3
0
9
1
2
21
7
4
13
8
2
44
55
15
18
4
2
0
2
6
9
3
3
2
1484
ANNUAL MEETING REGISTRATION FOR
1919 - 1966 INCLUSIVE
a) m
H S
'V.t?
c x>
Madison
Mahoning
Marion
Medina
Meigs
Mercer
Miami
Monroe
Montgomery
Morgan
Morrow
Muskingum
Noble
Ottawa
Paulding
22
21
1
£
P*
§
3J3
OPP
§02
6 x
MW
O
H
67
68
11
25
24
5
1919
Columbus .
1173
264
92
1539
39
40
6
1920
Toledo . ..
860
105
80
1062
2315
2219
630
1921
Columbus .
1275
104
96
1503
24
24
6
1922
Cincinnati
1066
184
70
1341
21
20
3
1923
Dayton .....
1117
202
76
1414
27
26
5
1924
Cleveland .
1301
180
109
1603
67
64
10
1925
Columbus .
1204
361
107
1689
53
50
8
1926
Toledo
.. 903
120
83
1125
16
16
0
1927
Columbus .
1320
286
82
1705
928
868
127
1928
Cincinnati
916
92
80
1115
17
16
1
1929
Cleveland _
1231
249
124
1619
33
33
3
1930
Columbus .
1241
435
86
1775
24
26
7
1931
Toledo
826
198
50
1087
49
52
7
1932
Dayton
978
201
45
1226
29
25
7
1933
Akron
858
160
25
1049
1243
1223
66
1934
Columbus .
1069
410
51
1539
47
48
6
1935
Cincinnati
973
197
84
1271
26
26
1
1936
Cleveland _
1099
563
137
1813
7
7
2
1937
Dayton
1103
366
64
1551
15
16
2
1938
Columbus .
1330
619
104
2068
19
18
2
1939
Toledo
1056
271
84
1426
9
8
3
1940
Cincinnati
1126
323
114
1589
10
10
5
1941
Cleveland —
-Joint Meeting with AMA
28
26
5
1942
Columbus .
1221
527
119
1880
16
15
2
1943
Columbus .
544
160
717
63
39
5
1944
Columbus .
830
441
130
1421
36
37
5
1945
No Meeting
108
107
31
1946
Columbus _
1262
130
65
507
157
2121
22
22
1
1947
Cleveland _
1502
158
15
411
328
2414
69
67
6
1948
Cincinnati
1362
293
27
491
214
2387
18
15
1
1949
Columbus .
1533
162
221
462
230
2608
193
194
35
1950
Cleveland _
1587
260
102
707
376
3032
613
584
48
1951
Cincinnati
1208
162
185
647
352
2554
14
14
5
1952
Cleveland .
1366
204
49
687
395
2701
336
337
31
1953
Cincinnati
1155
180
224
578
298
2435
66
66
5
1954
Columbus .
1222
197
173
701
252
2545
57
56
9
1955
Cincinnati
1360
211
185
738
317
2810
6
6
1
1956
Cleveland .
1601
338
120
1029
489
3577
21
18
4
1957
Columbus .
1164
149
320
689
368
2690
62
66
5
1958
Cincinnati
1327
164
45
674
325
2535
3
3
0
1959
Columbus .
1359
293
445
721
364
3182
579
539
36
1960
Cleveland .
1642
489
48
1026
447
3652
3
2
2
1961
Cincinnati
1256
231
24
751
301
2563
8
8
2
1962
Columbus .
1304
265
343
736
371
3019
73
72
10
1963
Cleveland _
1502
336
19
893
441
3191
2
2
0
1964
Columbus .
1428
332
297
1002
376
3435
23
23
3
1965
Columbus .
1330
275
335
968
394
3302
7
7
1
1966
Cleveland .
1484
309
22
865
355
3035
for July, 1966
725
The Annual Meeting in Review . . .
Here Are Some Highlights and Sidelights on Events
That Combined To Make Another Successful Session
T
"^HIS review is an attempt to pinpoint only a
few of the many events and functions that are
typical of the 1966 Annual Meeting and that
helped make it another successful meeting for mem-
bers and guests. Obviously only a few of the high-
lights and sidelights can be touched upon with a
hint of special meetings, luncheons, dinners, social
hours, hospitality groups, reunions, and a host of
other get-togethers.
Elsewhere in this issue are a presentation of the
newly elected Officers and Councilors, official pro-
ceedings of the House of Delegates, the President’s
Address, and the Inaugural Address of the Incoming
President, an official tabulation of the attendance rec-
ord, report from the Woman’s Auxiliary, etc.
Official Hosts
Dr. David Fishman, Cleveland, president of the
Academy of Medicine of Cleveland and Cuyahoga
County, officially opened the House of Delegates 1966
sessions and welcomed Association members and
guests to Cleveland.
A great deal of the success of the meeting and the
comfort of guests was due to efforts on the part of
numerous members of local committees who worked
primarily behind the scenes in preparations for events.
Guests from Other States
Among distinguished guests from neighboring states
were Dr. Seigle W. Parks, Charleston, president of the
West Virginia State Medical Association; Dr. James
S. Klumpp, Huntington, past president of the West
Virginia State Medical Association; Dr. William B.
West, Huntingdon, Pa., president of the Pennsylvania
Medical Society; Dr. Donald K. Dudderar, Newport,
Ky., vice-president of the Kentucky Medical Asso-
ciation; Dr. Luther R. Leader, Royal Oak, Mich.,
president of the Michigan State Medical Society;
Dr. Kenneth O. Neumann, Lafayette, Ind., president
of the Indiana State Medical Association.
Another guest was Dr. Thomas L. Dwyer, Mexico,
Missouri, president of the American Association of
Physicians and Surgeons. In addition, a number of
out-of-state guest physicians participated in the pro-
Typical of the General Sessions is this audience in the Cleveland Room photographed on W ednesday afternoon during
the program on "Marriage Problems.”
726
The Ohio State Medical Journal
Camera Highlights of the Meeting
In the receiving line
at the President’s Reception,
from left:
Dr. Robert E. Howard,
New President-Elect,
Mrs. Howard,
Dr. Lawrence C. Meredith,
Incoming President.
In background
Charles W. Edgar, OSMA
Public Relations Director
Mrs. Meredith
Dr. Henry A. Crawford,
1965-1966 President,
Mrs. Crawford
Dr. Philip B. Hardymon,
Treasurer, Mrs. Hardymon,
Dr. Robert E. Tschantz,
Immediate Past President,
Mrs. Tschantz
for July. 1966
727
grams indicated by names and portraits printed in the
official program.
OMPAC - AMPAC Luncheon
Highly successful event held during the Annual
Meeting was the luncheon sponsored by the Ohio
Medical Political Action Committee and the Ameri-
can Medical Political Action Committee on Wednes-
day.
Principal speaker for the occasion was Dr. Hoyt
D. Gardner, Louisville, Ky., a member of the Board
of Directors of AMPAC, who inspired his audience
with the topic, "Success Can Be Ours.”
Dr. Platter Honored
By official action of the House of Delegates, the
entire 1966 OSMA Annual Meeting was dedicated
to Dr. Herbert M. Platter, Past President of the State
Association, and Secretary of the State Medical Board
of Ohio from 1917 through 1965. See Resolution
No. 1, page 696 of this issue.
A standing ovation was accorded Dr. Platter at the
first session of the House of Delegates and President
Crawford presented him with a copy of the resolution
inscribed in bronze expressing the admiration and
gratitude of the physicians of Ohio for his outstand-
ing leadership, guidance and counsel. He also was
presented a color television set as a token of ap-
preciation from the Association.
Dr. Platter acknowledged the honor with brief
remarks to the House. Now making his home at the
Lutheran Senior City in Columbus, Dr. Platter cele-
brated his 97th birthday on June 18. He was ac-
companied to the Cleveland meeting by his son and
and daughter-in-law, Mr. and Mrs. Harold O. Platter,
of Columbus.
Lieutenant Governor Brown
Representing the State of Ohio in honors to Dr.
Platter was Lieutenant Governor John W. Brown
who brought greetings and a special message from
Governor Rhodes. He also paid personal tribute
to Dr. Platter for the many services he has rendered
to the people of Ohio.
Past Presidents Honored
A reception and dinner was given by The Council
on Wednesday evening of the Annual Meeting week
honoring Past Presidents of the Association. Each
Past President was presented a plaque as a token of
appreciation for his services to the Association. See
photograph of Past Presidents elsewhere in this issue.
News Media Coverage
News media coverage of the meeting reached what
many believed to be an all-time high. Press, radio,
and television reporting of the meeting was extensive,
and several presentations were reported on TV net-
work newscasts.
In addition, several national medical journals had
writers covering the meeting.
The Woman’s Auxiliary
The Woman’s Auxiliary to OSMA again held its
annual meeting concurrently with that of the Asso-
ciation. The numerous projects and functions of
this organization, and the dedication of the ladies in
positions of responsibility, are an inspiration to all
persons interested in good medicine and health in
Ohio. Refer to the report made before the House
of Delegates by the Auxiliary president, beginning
on page 729, and the account of the Auxiliary meet-
ing written by the Auxiliary’s correspondent begining
on page 739.
Committeemen Named
Within the organization of the OSMA are numer-
ous committees whose members work primarily be-
hind the scenes on numerous projects, both scientific
and organizational. Some of these committees are
appointed by the House of Delegates and others are
named by the President with the approval of The
Council. Turn to the back of this issue and see the
roster of committeemen beginning on page 746.
This is part of the large group of people who attended the OMPAC- AMP AC luncheon held in the spacious Gold Room.
728
The Ohio State Medical Journal
The Woman’s Auxiliary Report . . .
Auxiliary’s President Gives Account of Year’s Activities
Before the OSMA House of Delegates Session, May 24, 1966
By MRS. HERBERT F. VAN EPPS, Dover
IT IS A PRIVILEGE to be granted a little time to
tell you what our County Auxiliaries have been
doing this past year when I know there are very
important problems you are anxious to solve. It is
not necessarily true that I am long winded, but our
members have worked so hard all year in so many
activities, there is much for me to report.
We greatly appreciate the cooperation and encour-
agement given by Dr. Crawford, our advisors and the
staff at the Ohio State Medical Association office.
Dr. Diefenbach, Dr. Beardsley and Dr. Light were
never too busy to give advice or to listen to our
problems. While our work on Medicare has lessened
this year, we have had other important projects.
The Auxiliaries were asked to study the health
needs of their counties, analyzing the strong and
weak points. In planning their year’s projects and
programs, they were to work on their county needs.
A poem from the Virginia Health Bulletin Preven-
tion and Cure describes what happened.
’Twas a dangerous cliff, as they freely confessed,
Tho’ the walk near its crest was so pleasant;
But over its terrible edge had slipped
A duke and full many a peasant.
So the people said, " Something would have to be done.”
But their projects did not all tally.
Some said, "Put a fence around the edge of the cliff.”
Some: "An ambulance in the valley.”
AMA-ERF
Forty-eight of our 5 6 organized counties sent con-
tributions into the AMA-ERF. These donations varied
from $10 to $5325, for a total of $33,115.49. This
is less than the total of $36,000 given at the end
of last year. We are hoping this gap will be closed
by our deadline. This money came from doctors’
donations to their medical schools through the Aux-
iliary; sale of Christmas cards, donations sent to
AMA-ERF instead of sending cards to doctors’ fam-
ilies. One card was sent with the names of all the
contributors. Other funds were raised by auction
sales, some auctioning articles made by doctors, their
families and friends. We are not aware of the talents
in our midst until we see their art on display. There
were bridge parties, the sale of sympathy and con-
gratulation cards, and other articles — you name it,
one of our auxiliaries sold it.
Our Legislation Chairman, Frankie Fry, in Cincin-
nati, has been a ball of fire all year — no let down
because of Medicare. She sent bulletins out to all
counties explaining legislation in the making, telling
what should be done and what resulted. She is assist-
ing counties in organizing nonpartisan Political Ac-
tion Workshops, having supervised a couple of very
successful ones in her own city. You will hear more
of this work during the coming year, in both large
and small counties.
Emphasis on Local Needs
Reports show that the county auxiliaries are work-
ing on the needs of their localities. Cincinnati with
its project "The Apple Tree,’’ a non-profit child day
care center for children of key hospital personnel,
has resulted in supplying over 8000 nursing and
health work hours to nine hospitals. Stark County
received the Golden Key Award from United Fund
for the work of three women.
Cuyahoga County received the 1965 Second Place
in the Mayor’s Award Program for work in Traffic
Hazard Elimination. The "Operation Know How’’ —
disaster control — carried on in Cleveland had the
assistance of that auxiliary. Members in most coun-
ties have sponsored Health Career days and Future
Health Career Clubs. A total of $32,606 was given
by the counties for Scholarships and Loans for Health
Careers. This is money earned by Auxiliary members
above the AMA-ERF funds. The counties have co-
operated with Safety Councils. Safety attention was
directed toward poison control, tetanus immuniza-
tions, seat belts, home, water and bicycle safety,
mouth-to-mouth resuscitation, and traffic problems.
Other auxiliary energies were directed toward: S.S.
Hope, packing supplies and drugs from your office
samples, bandages, and eye glasses for international
needs; volunteer hours to the mentally ill, and
measles inoculations.
Have you been reading Ruth Meltzer’s pages in
your Journal on our events? If you haven’t read them,
look for them when you go home, for Ruth is a
talented writer. The Auxiliary News, edited by Ludel
Sauvageot, is also well worth taking your time to
read. The $1500 received from the Ohio State Medi-
cal Association has been used to help publish this.
The magazine is second to no other of the 50 state
publications.
These are some of the contributions your wives
are making to the medical profession. It shows our
for July, 1966
729
wholehearted interest and our pride in the work you
are doing for the betterment of humanity.
During our coming meetings we are asking our
delegates to grant a raise in our State dues from $1.25
to $3.00 a year per member. We shall soon know the
results.
Along with all the accomplishments of which we
are so proud, there always has to be a little irritation.
The OSMA has 10,042 membership, the Auxiliary
5,56l. Where are those thousands of potential auxil-
iary members? We have 56 organized counties; 32
counties with no auxiliary. We have only 67 mem-
bers-at-large from these counties. You will agree
with me, I am sure, there is no woman’s organiza-
tion doing more worthwhile work than we are. I
know all of your wives are members but you must
know of other doctors’ wives who should join. We
are counting on your assistance.
A quote from the Bible expresses our situation so
completely. "The harvest is plenteous, but the la-
borers are few.”
Inasmuch as you have married us, you are stuck
with us. Whether it is good or bad is not the point.
The point is for you to make the best of what you
have. Invite your auxiliaries to assist you on your
projects, show them you are interested in them, and
you will be amazed at the results. Your "better-
halves” will never be happier than when they are
feeling needed.
In a few days our very capable president-elect,
Ruth Wychgel, of Cleveland, will take over the presi-
dency of the State Auxiliary. She is planning a very
active year and will appreciate your assistance and
cooperation.
Thank you for allowing me to tell you of our ac-
complishments this year. May the coming year bring
a closer relationship between our two organizations
as we work together for Better Medicine.
Department Chairman Named
At Western Reserve
Dr. John Robert Carter, professor and chairman of
the Department of Pathology and Oncology at the
University of Kansas Medical Center, will come to
Cleveland some time before September 1. He has
been named director of the Institute of Pathology and
professor and director of the Department of Path-
ology in the Schools of Medicine and Dentistry at
Western Reserve University. The posts were for-
merly held by Dr. Alan R. Moritz who became pro-
vost of WRU last September.
CHOICE MEDICAL
OPPORTUNITIES
with a growing
INTERNATIONAL
PHARMACEUTICAL
ORGANIZATION
Immediate opportunities
for AID’s now exist in
the following areas
■ MEDICAL
SERVICE
Involves liaison with
pharmacology-clinical re-
search, government
agencies and the ad-
vertising-marketing de-
partments involved in
the preparation of medi-
cal literature and re-
view of advertising
material. (Travel) limit-
ed to U. S. 30% of the
time.
In addition to liberal company
benefits these positions offer sub-
urban living at its best in conven-
ient North Jersey, just 30 miles
from N. Y. C. served by fine
schools and close to all recrea-
tional and educational facilities.
Send resume and salan
requirements in confident to
BOX 1
c/o Ohio State Medical Journal
17 So. High St., Suite 500
Columbus, Ohio 43215
■ CLINICAL
RESEARCH
Position of responsibility
involves establishing
and supervising the clin-
cal trials of new drugs,
analysis of results and
preparation of reports.
(Travel) within the U. S.
20% of the time.
Protect Your Family — Now — With the OSMA - PLAN
of comprehensive group major medical insurance sponsored by the
Ohio State Medical Association for its members and their families
NEW —
up to $100,000
ACCIDENTAL
DEATH AND
DISABILITY
INSURANCE
Also available to Ohio Physicians:
DISABILITY
and INCOME and
PROTECTION
(All three at low group rates)
PRACTICE
OVERHEAD
EXPENSE
INSURANCE
Call or write : DANIELS-HEAD & ASSOCIATES, Inc.
Daniels-Head Building, Portsmouth, Ohio 45662 TeL 353-3124
730
The Ohio State Medical Journal
The OSMA Section for Directors
Of Medical Education
By WARREN G. HARDING II, M. D., Administrator
Grant Hospital, Columbus, Ohio
I
^HE establishment of an Ohio State Medical
Association Section for Directors of Medical
Education is recognition of the changing fac-
tors in the concept of medical education. The di-
ploma, internship, licensure and practice are valid
accomplishments and essential, but the quality of
medical care offered to the people of Ohio can be
maintained only if the profession supports a con-
tinuing program of learning, extending throughout
the physicians professional life. The environment
of the learning situation changes from the school-
room to the active direction of patient care, but the
need for knowledge and research remains critical,
if the doctor does not wish to become obsolete.
The emerging position of Hospital Director of
Medical Education seeks to fill this need. The ac-
tivities of the medical profession are focusing on the
hospital to a greater degree each year. Many of the
new technics require the controlled environment of
the hospital with its medical and paramedical per-
sonnel in order to be effective. The Director of
Medical Education is responsible to coordinate an
additional program within the hospital so that prac-
ticing physicians can keep current without expending
an excessive amount of energy and time to maintain
their competence.
Why a New Section?
The question arises, "Why a new section in organ-
ized medicine?” What type of program is suitable
for this group? What is the need? The answer
to these questions could fill a volume. The present
effort is to give a succinct outline of the direction of
development which can be anticipated. The adjec-
tive flexibility is perhaps the most appropriate des-
criptive term. The involvement in the entire future
of medicine requires an open course associated with
creative ideas and a willingness to experiment.
This new section will be a forum for the discussion
of organized medicine as it relates to the individual
physician. The recent graduates need guidance in
the aims, methods and structure of medicine, which
in most cases, has not been made a vital part of their
formal training. How can the medical association
help them and they, in turn, add strength to their
representative? The Director of Medical Education
is closest to them in the early hospital experience. He
must be informed and dedicated to medicine in its
broadest aspect. His position lends itself to the
continuing promotion of organized medicine for all
physicians. The need is obvious for a statewide
voice in the discussion and interpretation of the multi-
tude of regulations, rules, opinions and edicts that
the federal government, state and local government
are continuously promulgating, which affect the prac-
tice of medicine.
Scope of Program
The program is limitless. Authentic information
on staff relations, hospital administration, efficient
methods of teaching, socio-economic problems as
related to practice, community needs at both state
and local levels, medico legal problems, information
storage and retrieval, research methods applicable to
clinical problems, cultural knowledge as seen in the
humanities and detailed expertise required in trans-
mitting these concepts to house staff and the prac-
ticing profession, provide an abundance of topics for
the new section. In addition, the section should be-
come a repository where authentic material may be
found to facilitate the successful presentation of the
many programs in the hospital for which the Director
of Medical Education is held responsible. It is im-
possible for each one to complete individually the
necessary research for these teaching efforts but
through sharing with the others, the quality of the
training effort can be greatly improved.
Encompassing Broad Field
The objectives of the new section encompass the
entire field of medicine. The difference from the
other sections is the emphasis placed upon teaching.
The organization of appropriate knowledge and the
method of transmitting it most efficiently to the prac-
ticing profession, as well as, the house staff, is the
primary responsibility.
The definition of the responsibility of the Direc-
tor of Medical Education as a new position in the
hospital needs to be clarified. Many staff members
consider it to be for recruiting and scheduling of
house staff. Others attempt to place the entire edu-
cational program on the shoulders of the Director of
Medical Education. The necessity of staff involve-
ment on an active, cooperative basis for the success of
these programs needs to be emphasized. The Direc-
tor of Medical Education is not a super resident at
the beck and call of the attending staff, but a fellow
professional man with whom a two-way exchange of
effort for the common good is due. The technical
details are unknown due to a neglect of serious studies
of these problems. The Ohio State Medical Asso-
ciation is to be complimented for its recognition of
the need and its willingness to pioneer in this excit-
ing field of medicine.
for July, 1966
731
Obituaries
Ad Astra
Emerson Victor Arnold, M. D., Delaware; Ohio
State University College of Medicine, 1928; aged
69; died May 23; member of the Ohio State Medical
Association and the American Medical Association.
A practicing physician for some 35 years in Delaware,
Dr. Arnold also was on the staffs of two Columbus
hospitals. A veteran of World War I, he was a
member of the American Legion. Other affiliations
included memberships in the Rotary Club, Elks
Lodge, Masonic Lodge and the Episcopal Church.
Among survivors are his widow, a son and a daughter.
Bernard L. Brofman, M. D., Cleveland; Western
Reserve University School of Medicine, 1944; aged
47; died May 29; member of the Ohio State Medi-
cal Association, the American Medical Association,
American College of Cardiology, and the American
College of Chest Physicians; diplomate of the Ameri-
can Board of Internal Medicine. Long associated
with a well-known cardiovascular research team in
Cleveland, Dr. Brofman was former director of
cardiovascular research at Mount Sinai Hospital. Re-
cently, he was engaged in private practice and part-
time research. A high point in his career was a
trip to Israel as member of a team demonstrating
new techniques in treatment of heart disease. A
former Army Medical Corps officer, he was a mem-
ber of the Temple and the Masonic Lodge. Survi-
vors include his widow, two sons, a daughter, his
parents, and a sister.
John Redman Claypool, M. D., Mount Vernon;
University of Michigan Medical School, 1909; aged
79; died May 9; member of the Ohio State Medical
Association and the American Medical Association;
past president of the Knox County Medical Society.
A native of Mount Vernon, Dr. Claypool began his
practice at nearby Gambrier and moved to Mount
Vernon two years later. His professional career in
the area extended over about 45 years before his
retirement. He was a veteran of World War I and
a member of the American Legion; also a member
of the Masonic Lodge and the Episcopal Church.
Among survivors are his widow, a son and a daughter.
Robert P. Hagerman, M. D., Waverly; University
of Maryland Medical School, 1923; aged 69; died
May 5; member of the American Psychiatric Associa-
tion. Dr. Hagerman was for about three years medi-
cal director at the Chillicothe Federal Reformatory, and
formerly associated with the medical services of other
federal penal institutions as well as the U. S. Pub-
lic Health Service. His widow survives.
Morris Hyman, M. D., Cincinnati; Eclectic Medi-
cal College, Cincinnati, 1927; aged 63; died May 19;
member of the Ohio State Medical Association, the
American Medical Association, and the American
Academy of Ophthalmology and Otolaryngology;
diplomate of the American Board of Otolaryngology.
A native of Cincinnati, Dr. Hyman began practice
there after postgraduate studies abroad, specializing
in otolaryngology. A member of the Temple, he
was a leader in numerous groups such as the Zionist
Organization, Jewish Community Relations Commit-
tee, B’nai B’rith, Bonds for Israel, and the Jewish
National Funds Campaigns. Among survivors are
his widow, three daughters, two brothers and two
sisters.
Harris Durkee Iler, M. D., Cleveland; Western
Reserve University School of Medicine, 1927; aged
68; died May 18; member of the Ohio State Medical
Association and the American Medical Association.
Before his retirement, Dr. Iler practiced for about
20 years in the Lakewood area.
Joseph Thomas Nakayama, M. D., Cincinnati;
University of Cincinnati College of Medicine, 1924;
aged 70; died March 7; former member of the Ohio
State Medical Association; member of the American
Academy of General Practice. Dr. Nakayama prac-
ticed for many years in the Cincinnati area.
George Augustus Pierret, M. D., Cincinnati; Uni-
versity of Cincinnati College of Medicine, 1901;
aged 89; died January 31; former member of the
Ohio State Medical Association. Dr. Pierret had
not been in practice for many years.
Ursus Victor Portmann, M. D., Tucson, Arizona;
Western Reserve University School of Medicine,
1913; aged 79; died May 21; former member of the
Ohio State Medical Association; member of the
Roentgen Ray Society and the Radiological Society
of North America; diplomate of the American Board
of Radiology. Dr. Portmann was director of ther-
apeutic radiology at the Cleveland Clinic for 30
years before he moved to Arizona about 1952. He
is survived by his widow, a son, and two brothers.
Harry Prushing, M. D., Columbus; Ohio Medical
University, Columbus, 1902; aged 90; died May 27;
former member of the Ohio State Medical Associa-
tion. A practicing physician for many years in Co-
lumbus, Dr. Prushing retired in 1956. Survivors
include a son, a daughter, two brothers and a sister.
J. Edwin Purdy, M. D., Canton; University of
Pennsylvania School of Medicine, 1918; aged 74;
died May 1 6; member of the Ohio State Medical
Association and the American Medical Association;
diplomate of the American Board of Surgery. A
732
The Ohio State Medical Journal
practicing physician and surgeon in Canton for many
years, Dr. Purdy was a past president of the Stark
County Medical Society'. He was a member of the
Masonic Lodge, the Presbyterian Church, and was a
veteran of World War I. Survivors include his
widow, a daughter, and two sisters.
Harry Clifford Rosenberger, M. D., Cleveland;
Western Reserve University School of Medicine,
1919; aged 74; died May 1 6; member of the Ohio
State Medical Association, the American Medical
Association, American Academy of Ophthalmology
and Otolaryngology, American Otological Society;
Fellow of the American College of Surgeons; diplo-
mate of the American Board of Otolaryngology. A
physician and surgeon in Cleveland for many years,
Dr. Rosenberger retired about a year ago. He was
a member of the Masonic Lodge, the American Tri-
ological Society and the Pasteur Club. Survivors
incude his widow, two daughters, a stepdaughter,
and two sons.
George Wallace Ryall, M. D., Cleveland; Uni-
versity of Cincinnati College of Medicine, 1919; aged
72; died May 7; member of the Ohio State Medical
Association, the American Medical Association,
American Academy of Ophthalmology and Otolar-
yngology, and the American Society of Ophthal-
mologic and Otolaryngologic Allergy. An eye, ear,
nose, and throat allergy specialist, Dr. Ryall practiced
for years in Cleveland. He moved there after sev-
eral years of practice in Wooster, his native city.
Survivors include his widow, three sons, and a sister.
Samuel Bernard Sonkin, M. D., West Union;
Eclectic Medical College, Cincinnati, 1938; aged 55;
died May 12; member of the Ohio State Medical
Association and the American Medical Association.
A resident of Columbus during his early life, Dr.
Sonkin received his early education there before go-
ing to medical school. His practice in the West
Union area extended over about 25 years. Survivors
include his widow, three daughters, two brothers, and
three sisters.
Alexander Wylie, M. D., Ripley; Medical College
of Ohio, Cincinnati, 1895; aged 92; died May 8. A
native of Ripley, Dr. Wylie was the son of a physi-
cian, and served all of his professional career in
the Brown County area. He was a member of the
Methodist Church and was active in public education
work in the community. A daughter and two sons
survive.
Edward Zimmer, M. D., Trotwood; Medical Fac-
ulty of the University of Vienna, 1925; aged 65;
died May 1 5 ; member of the American Medical
Association. Dr. Zimmer was chief of the geriatrics
sendee at the Veterans Administration center in Day-
ton. He moved to Dayton after practicing in James-
town, N. Y. A member of the Temple, he is sur-
vived by his widow.
Heart Group Offers Handbook
On Low-Sodium Diets
The Franklin County Heart Association, 3416 N.
High Street, Columbus, has announced the forthcom-
ing Low-Sodium Handbook, sponsored in cooperation
with the Columbus Dietetic Association. Geared to
the locale of the sponsoring groups, the illustrated
booklet is of general nature.
It is a handbook to be used in conjunction with a
prescribed low-sodium diet and is intended to help
the patient follow the restricted diet prescribed by his
physician. It explains sodium in relation to food
needs and offers suggestions for buying and prepar-
ing low-sodium meals. Available from the above
organization in mid-summer at 50 cents per copy.
Dr. William S. Jasper, Sr., Lancaster, was elected
president of the Central Ohio Urological Society at
the group’s meeting in Columbus.
Accredited by The Joint Commission on Accreditation of Hospitals.
WINDSOR HOSPITAL
A NONPROFIT CORPORATION
— ESTABLISHED 1 8 9 8 —
Chagrin Falls, Ohio 44022
247-5300 (Area Code 216)
A hospital for the treatment
of Psychiatric Disorders
Booklet available on request.
JOHN H. NICHOLS, M. D., Medical Director G. PAULINE WELLS, R. N., Admin. Director HERBERT A. SIHLER, Jr., Pres.
MEMBER: American Hospital Association — National Association of Private Psychiatric Hospitals — Ohio Hospital Association
for July, 1966
733
HAWAIIAN
CARNIVAL
via Overseas National Airways * Read and Compare! Includes all this:
(A Certificated Supplemental Carrier)
Sfl
three days, three nights in
LAS VEGAS!
• Jet flight to Las Vegas
• 3 nights in the incredible
Sands Hotel, entertainment
capital of the world
• Reserved tables for big name dinner
shows (such as Sammy Davis, Jr.,
Sinatra, Dean Martin)
%
Plus — there will be absolutely
no charge for all the food and all
the beverages (hard and soft)
you want from the time you arrive
till the time you leave The Sands Hotel!
♦
three days, three nights in
SAN FRANCISCO!
• Jet flight Las Vegas to
San Francisco
• 3nights in beautiful, San Francisco
Hilton or Jack Tar Hotel
• Breakfasts at hotel
• Luxurious dinners nightly at
restaurants of your choice
from list of top restaurants
to be supplied
• Cocktail Parties
(Unlimited beverages)
#
3%'
4
*
seven days, seven nights in
HONOLULU!
*
Flower lei greeting on arrival
7 nights at world-famous Hiltd
Hawaiian Village or llikai Hot
Breakfasts daily at hotel
Exotic dinners nightly at top
restaurants of your choice
from list to be supplied
Cocktail Parties (Unlimited
beverages)
Jet flight home
In addition to all this — Transportation to and from each airport in Las
Vegas, San Francisco and Honolulu along with all luggage is included.
Depart November 27, From Hopkins Municipal Airport, Cleveland
And Columbus Airport (if necessary), Return December 11
Dr. John J. McCarthy c/o Academy of Medicine of Cleveland, 15000 Madison Avenue, Lakewood, Ohio 44107
Gentlemen: or: Reid Travel, Inc., 400 Buckley Bldg., Cleveland 1 5, 0 )
Enclosed please find $ as deposit as full payment. Make check or money order payable to
Academy of Medicine of Cleveland- Hawaiian Carnival. $100 minimum deposit per person — final payment e
30 days Defore departure.
NAME SI
ADDRESS
PHONE
NAME
ADDRESS
PHONE
Return this reservation promptly to insure space
(Reservations limited. Rates based on double occupancy. Single rates $100 additional).
-
Now available to members of
THE OHIO STATE
MEDICAL ASSOCIATION
and their immediate families
Depart November 27, Return December 11
(sponsored by the Academy of Medicine of Cleveland )
In conjunction with American Medical Assn. Meeting in Las Vegas
be t the flight — You get VIP treatment all the way!
orfortable, silken-smooth jet flying. Luxury meals
noeverages. Just ask the stewardess!
be
net
DL
m
t meals — We have very carefully selected the
restaurants in San Francisco and Honolulu for
evening meals. You may eat at any of them any
with your own friends.
t beverages — In San Francisco and Hawaii
tail party get-togethers are included. In Las
s cocktails are unlimited 24 hours daily at
heSands Hotel.
Academy of Medicine of Cleveland
'■tear .'lember:
C8rnivartr^?7SuJmi[ttMnh!8tae?Urtfirat Hawallar>
accommodate all m,r C*® has 8®lected another dat»
E.»ul:u:ij0r1vSv%* ssss," “» :v
.. cat lon^ package ^whlch aimplv*ca'1etfIia on * 8 Facial
trip la available to all iilLC8nn?t be match«d. Thla
to8lnfatl°n and th*lr lmm«<3lSeSf^inea°hiW Stat* Medlcal
to inform you that your committee has hfi *,,re Pleased
MeertL°g.t0 ** in La3 V**aa « the ttae^tfi1^0^"**
Sf 5^t1«?9'oS"’lSu';rKi 8 13-a*y lexer,
are Sunday. November 27 departure «<*->!bUlOUS autumn vacation
on Sunday. December 11. R^d th* return to Cleveland
lif^tJeVe y°U wU1 a<?ra« that hire il°^eti0n carafuHy and
lifetime and a vacation of a lifetlmf fh opportunity of a
"nd your fellow members. *tlm* for you. your family
“ ""*•* iSeTffTkSisr11
but weather — Delightful is the word for it in
la\aii. Temperatures in the low 80's in the daytime,
i te evening, it's a cool, comfortable 10 degrees
bit clothing — In Las Vegas and San Francisco,
?s|urants require suits for men, cocktail dresses
)r idies.
i lawaii, however, the keynote is informality.
1e usually wear sports shirts or Aloha shirts both
ayjnd evening. Sports attire is acceptable in
ealy all restaurants, with very few requiring tie
ncacket. Colorful mumus or shifts are popular
'it women, and can be worn both day and night.
hot luggage — “Unlimited Weight" — two pieces per person will be transported to and from your hotel rooms
Tdairports without charge! No waiting! No tipping!
bCt golf — Golf privileges are available at many leading courses. Green fees are not included,
d* ailed itinerary, with day-by-day activities, available on request.
bet Insurance — As on all regularly scheduled flights
stance may be purchased at any airline counter at time
' eparture.
fieerRectl
ytt^/fKZM-iZfcL
John 1. McCarthy, k.D, J
Chalmfian, Travel Committee
Academy of Medicine of Cleveland
Ohio Academy of General Practice . . .
16th Annual Scientific Assembly Scheduled in Columbus,
Tuesday-Thursday, August 2-4; Program Events Announced
THE Ohio Academy of General Practice has an-
nounced its 16th Annual Scientific Assembly to
be held at the Sheraton-Columbus Hotel in
downtown Columbus, on Tuesday, Wednesday, and
Thursday, August 2, 3, and 4.
Registration begins at noon on Tuesday, August 2,
and the program continues to noon on Thursday. Fol-
lowing are program highlights.
Tuesday, August 2
Registration opens at 12:00 noon.
Introductions
What Is a Neonatalogist? — Doris A. Howell,
M. D., Philadelphia.
Malignancy in Childhood — Robert D. Mercer,
M. D., Cleveland.
The GP as the Prime Iatrogenologist — Walter W.
Sackett, M. D., Miami, Fla.
Common Sense Management of Acne Vulgaris - —
William E. Pace, M. D., London, Ontario.
Wednesday, August 3
Breakfast Session (7:30 - 8:45 a. m.)
1. Current Trend in Erythroblastosis Fetalis —
Dr. Howell.
2. Culprit in Diabetes — Fat or Sugar? — Dr.
Sackett.
3. Chromosomes of Man — Dr. Mercer.
4. Mechanism and Action of the Anti-Infective
Drugs — John C. Krantz, Jr., M. D., Baltimore.
5. How to Differentiate Injury-Prone Individ-
uals— James A. Nicholas, M. D., New York
City.
Modern Drug Incompatability — Dr. Krantz.
Common Athletic Injuries; Pitfalls in Diagnosis
and Treatment — Dr. Nicholas.
Diagnosis and Differential Diagnosis and Treat-
ment of Migraine — Arnold P. Friedman, M. D.,
Bronx, N. Y.
Diagnosis and Treatment of Common Pulmonary
Diseases — Murray Sachs, M. D., Pittsburgh, Pa.
Luncheon Sesison (12:30 - 1:45 p.m.)
1. Sex Education — M. Edward Davis, M. D.
2. Diagnosis and Treatment of Atypical Pneu-
monia — Dr. Sachs.
3. Metabolic Bone Disease: Difficulties of De-
finition and Diagnosis — E. D. Pellegrino,
M. D., Lexington, Ky.
4. Local Ear Medication — Ralph J. Caparosa,
M. D., Pittsburgh.
5. Heart Disease, Cancer and Stroke Regional
Programs — Michael DeBakey, M. D., Hous-
ton, Texas.
Wednesday Afternoon
Office Otology-Dizziness — Dr. Caparosa.
Surgery of Arteriosclerosis — Dr. DeBakey.
A New Look at Inguinal Anomalies — H. William
Clatworthy, M. D., Columbus.
Hyperparathyroidism : Diagnostic Difficulties —
Dr. Pellegrino.
Evening: Marion Laboratories Party and Officers Re-
ception.
Thursday, August 4
Management of Essential Hypertension and Hy-
pertensive Emergencies — Ray W. Gifford, M. D.,
Cleveland.
Gynecologic Problems in Adolescence — Robert W.
Kistner, M. D., Brookline, Mass.
Dysfunctional Uterine Bleeding — Robert B.
Greenblatt, M. D., Augusta, Ga.
Estrogen and the Retardation of Aging in Women
— M. Edward Davis, M. D., Chicago.
Adjournment at 12:15 p.m.
AMA Medical and Health Films
Being Shown at Record Rate
A total of 11,635 medical and health films were
lent to physicians, hospitals, medical schools or other
professional groups by the American Medical Asso-
ciation Film Library during 1965.
Most of the films were employed as educational
material for physicians, medical students and nurses.
The library now consists of 2,130 copies of 458
films. The total includes 119 health films which
can be used by physicians who are invited to address
lay groups. A current list of these films is now
available.
736
The Ohio State Medical Journal
Activities of County Societies . . .
CLINTON
Dr. Foster J. Boyd spoke on the subject of the
American Cancer Society at the meeting of the Clin-
ton County Medical Society on May 24 in the Clinton
Memorial Hospital dining room.
To indicate the importance of this organization, he
gave some statistics on volume of cancer patients
seen at the local hospital since its opening in 1951.
He also contrasted the voluntary health organization
way of doing things as opposed to the "let Uncle
Sam do it" philosophy.
CUYAHOGA
Dr. David Fishman took office as president of the
Academy of Medicine of Cleveland at its annual
meeting at the Mid-Day Club on May 13. He suc-
ceeds Dr. William F. Boukalik.
Dr. Elden C. Weckesser was named president-
elect in the mail vote, to take office as president in
1967. Dr. John J. Grady was named vice-president;
and Dr. Fred R. Kelly was re-elected secretary-
treasurer.
Distinguished memberships in the Academy were
awarded to Dr. Harr)7 Goldblatt, director of research
at Mount Sinai Hospital; Dr. Alan R. Moritz, provost
of Western Reserve University; and Dr. Irvine H.
Page, who recently retired as director of research at
the Cleveland Clinic.
Dr. John H. Budd was given a citation for his
contributions to medicine through his sendees to the
Academy, the Ohio State Medical Association, and
the American Medical Association.
FRANKLIN
Members and guests of the Academy of Medicine
of Columbus and Franklin County had a choice of
two programs at the May meeting in the Neil House,
downtown Columbus hotel.
Following a social hour and dinner, Dr. Frank
Moya, anesthesiologist at the University of Miami
(Florida) School of Medicine, spoke in one session
on "Transmission of Drugs Across the Placenta.”
In the other session, Dr. Vol K. Philips moderated
a panel on Medicare. Included among panel speak-
ers were Dr. Russell B. Roth, chairman of the AMA
Medical Sendee Committee; Fred B. Wolf, regional
representative of the Social Security Administra-
tion; Hugh F. Hughes, Medicare manager in Ohio
for the Nationwide Insurance Company; and Fred-
erick J. Zuber, chief of the Ohio Division of Health
and Rehabilitation Sendees.
HAMILTON
Results of the annual elections of the Academy
of Medicine of Cincinnati were announced at the
May meeting. At the September 20 annual meeting,
Dr. Elmer R. Maurer, who was named president-
elect a year ago, will succeed Dr. Robert M. Wool-
ford as president.
Dr. Stanley D. Simon was named president-elect,
and will take office as president in September, 1967.
Other officers elected are Dr. John J. Will, secretary;
Dr. Robert S. Heidt, treasurer; Dr. William R. Cul-
bertson, trustee for a three-year term; and Dr. Warner
A. Peck, councilman-at-large for a three-year term.
The Academy of Medicine of Cincinnati with the
Auxiliary held the "President’s Dinner” meeting on
May 17 in the Daniel Drake Auditorium at the head-
quarters building. A social hour and dinner were
part of the evening’s events.
JEFFERSON
In March, 1966, the Jefferson County Medical So-
ciety began its program of regular monthly meetings
at the Steubenville Country Club under the direction
of the following officers: Jack R. Cohen, M. D., presi-
dent; Lee A. Rosenblum, M. D., president-elect;
Irving Dreyer, M. D., secretary-treasurer; Sanford
Press, M. D., delegate; Crist G. Strovilas, M. D., alter-
nate delegate; Aniceto Carneiro, M. D., censor; John
P. Smarrella, M. D., censor; Warren G. Snyder,
M. D., censor.
The Society actively participates in such community
health activities as the Jefferson County Association
of Health and Welfare Agencies, the Jefferson County
Mental Health Association, the Jefferson County
Head Start Program, the Steubenville Care of the
Aged Program, and confers with representatives of
local industry on health insurance programs.
Society officers participated in the Annual Confer-
ence of County Medical Society Officers in February
and at the Annual Meeting of the Ohio State Medi-
cal Association at Cleveland in May.
Dr. Sanford Press of this Society was elected Coun-
cilor for the Seventh District, O. S. M. A.
Guest speakers at dinner-meetings have been: Ste-
phen H. Hart, M. P. H., Steubenville Health Com-
missioner; "Health Planning for the Aged in Steuben-
ville, and, the Head Start Program in Jefferson
County”; J. Philip Ambuel, M. D., Professor of
Pediatrics, O. S. U. College of Medicine and direc-
tor of out - patient department of The Children’s
for July, 1966
737
Hospital, Columbus: "The Birth Defects Program.”
— Irving Dreyer, M. D., Chairman, Committee on PR.
LUCAS
The Inter-Hospital Postgraduate Lecture Series
was presented on May 12 and 13 with Dr. Robert
D. Johnson, associate professor at the University of
Michigan, as guest speaker. Theme for the series
was, "Some Recent Advances in Medicine.”
During the Specialty Section meeting on May 19, the
subject, "Iron Metabolism and Anemia in Pregnancy,”
was discussed by Dr. Curtis Lund, professor of ob-
stetrics and gynecology, University of Rochester. The
program was jointly sponsored by the Toledo OB-
GYN Society.
The Academy of Medicine of Toledo and Lucas
County has scheduled its annual Academy Golf
Tournament on Thursday, July 14, at the Sunning-
dale Gold Course, 2162 W. Alexis Road. Tee off
time is 11:30 a. m. to 2:00 p. m. A refreshment
period will be followed by a steak dinner at 6:30 p. m.
MAHONING
The Mahoning County Medical Society held two
meetings for the purpose of enlightening members
on the coming Medicare regulations. The first meet-
ing, held on April 19, consisted of a panel to discuss
Medicare rules. Panel members were: Dr. Jack
Schreiber, Dr. Robert E. Tschantz, and Dr. Carroll
L. Witten. Dr. Witten is a member of the 1 6-man
Health Insurance Benefits Advisory Commission, ap-
pointed by President Johnson. Dr. Harold J. Reese,
president-elect, presided at the meeting.
The second meeting, held on May 17, was for the
purpose of general discussion and questions and an-
swers. Dr. Jack Schreiber, program chairman, an-
swered questions on Medicare. At that meeting, the
Mahoning County Medical Society endorsed a resolu-
tion approving an Individual Responsibility Plan.
Dr. F. A. Resch, president, presided.
OTTAWA
Members of the Ottawa County Medical Society
and the Auxiliary attended a dinner meeting on May
12 at the Catawba Cliffs Beach Club.
SENECA
Members of the Seneca County Medical Society
were hosts to members of the Seneca County Bar
Association at a ladies’ night dinner meeting on
May 10 in Tiffin. Guest speaker was Bernard
O’Kelly, Ph. D., professor of English at Ohio State
University, whose topic was "Language — A Key to
Identity.”
SUMMIT
The Summit County Medical Society held its
monthly meeting on May 3 in the Children’s Hospital
auditorium. Speaker was Dr. J. L. Ankeney, profes-
sor of surgery at Western Reserve University School
of Medicine, whose topic was "Current Status of
Surgery in Cardiovascular Disease.”
Dinner preceded the meeting at the Akron City
Club.
Director Is Named at Ohio State
For Allied Medical Services
Dr. Robert J. Atwell, former chief of medical serv-
ice at the Ohio Tuberculosis Hospital, has been named
director of the new School of Allied Medical Services
in the Ohio State University College of Medicine.
In his new position, Dr. Atwell will direct the
educational programs for paramedical services at Ohio
State. Under his jurisdiction will be the medical
dietetic program, physical therapy, occupational ther-
apy, x-ray technology, medical technology, medical
illustration, nurse anesthesiology, and orthoptics.
Ohio State’s Board of Trustees in April approved
establishment of the School of Allied Medical Serv-
ices effective July 1.
SUCCESSOR TO
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References on request
Chloral — the “old reliable” — for more than 100 years
is dramatically improved in DriClor (5 grains chloral
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toxic . . . more stable . . . non-irritating to the stomach
. . . and more effective grain for grain.
The effective sedative, hypnotic and anti-convulsant
form of Chloral Hydrate.
Also Chlorasec for quick, even sleep. DriClor inner core
(equivalent to 3.75 Grs. of Chloral Hydrate). Seco-
barbital acid outer coat (.75 Grs.)
738
The Ohio State Medical Journal
Auxiliary Annual Meeting Report . . .
Auxiliary Convenes in Cleveland in Conjunction with
OSMA Annual Meeting; Sessions in Sheraton-Cleveland
By MRS. S. L. MELTZER, Portsmouth
Chairman, Publicity Committee
/\T hands make light work.” One John
/ AMl Heywood (who had much to say about many
things) wrote that back in the 16th century
and to a point he was right. I would dare to para-
phrase that quotation by saying "many hands make
inspired and more effective work” and, of course, I
have in mind the 150 Cuyahoga County women who
served on the year’s convention committee under the
forceful leadership of Mrs. Burdett Wylie, chairman,
and Mrs. Roscoe J. Kennedy, cochairman. According
to no less an authority than Mrs. Herbert F. Van
Epps, 1965-66 President of the Woman’s Auxiliary
to the Ohio State Medical Association, "everybody
worked hard, but the wonderful thing is that each
committee member gave strong evidence of enjoying
herself and having a ball.”
This twenty-sixth annual meeting at the Sheraton-
Cleveland, Tuesday, May 24 through Friday, May 27,
was informative, interesting and full of accomplish-
ment. It highlighted that cherished "first” — the
invitation from OSMA to attend each of its three
General Sessions. And believe me, the Auxiliary
DID turn out! Thank you, gentlemen, for this
very great privilege.
Approximately 300 doctors’ wives registered for
this 1966 meeting presided over by Mrs. Van Epps,
Tuscarawas County. Mrs. Karl F. Ritter, Allen
County, served as parliamentarian. The first session
on Wednesday morning, May 25, began with the
invocation by the Rev. Allen Blackman of First Meth-
odist Church, Dover. This was followed by the
House of Delegates’ pledge of allegiance and pledge
of loyalty as led by Mrs. A. L. Kefauver, first vice-
president, Franklin County. A cordial note of wel-
come was sounded by Mrs. Elden C. Weckesser,
president, Cuyahoga County, to which Mrs. James
Zeller, president, Tuscarawas County, was privileged
to give the response. Mrs. J. Kenneth Potter, Cuya-
hoga County, introduced these out-of-state guests:
Mrs. Lucian Fronduti, president, and Mrs. Manuel
Bergnes, president-elect, Pennsylvania Auxiliary; Mrs.
Wilson Smith, president, Mrs. Hu Myers, president-
elect and Mrs. Bruce Martin, state AMA-ERF chair-
man, West Virginia Auxiliary; Mrs. Raymond Jones,
president-elect, Kentucky Auxiliary. Mrs. Van Epps
then introduced her convention chairman and co-
chairman. Mrs. Wylie expressed deep gratitude to
her committee members and made special mention
of the fine work done by Mrs. Kennedy and Mrs.
Vincent T. Kaval on the printed program. Also in-
troduced to the House of Delegates were Mrs. Henry
Crawford, wife of the President of OSMA, and Mrs.
William H. Evans, immediate Past National President.
Several pertinent announcements and adoption of
the Rules of Convention preceded the report on Roll
Call. It was moved that the minutes of the 1965
convention not be read since they had already been
published in the Auxiliary News. Motion approved.
Mrs. R. L. Wiessinger, Allen County, presented her
treasurer’s report. The motion to accept that report
as audited was duly approved. First reading of the
report of the Resolutions Committee was presented
by Mrs. John Toepfer, Hamilton County. Three such
resolutions were submitted.
Nominations
On the agenda under new business came the re-
port of the Nominating Committee by its chairman,
Mrs. John D. Dickie, Lucas County. Following this
reading, the President asked for nominations from
the floor for each office on the first nominative slate
for officers, district directors and directors-at-large.
Since there were no nominations from the floor, Mrs.
Van Epps declared the nominative slate the elected
slate. (See page 749 for names of new officers.)
The President then asked for nominations from the
floor for members of the 1966-67 Nominating Com-
mittee: From the Board, four to be nominated, two
elected; from the membership, ten to be nominated,
five elected. There being no nominations from the
floor, it was moved that nominations as presented
by the Nominating Committee be closed, subject to
election Thursday afternoon between 3:00 and 5:30
p. m. in the Mezzanine Lobby East. Motion carried.
Thirty-six names were placed in nomination from
the floor for delegates and alternates to the National
Auxiliary convention to be held in Chicago from
June 26 through June 30. These names were also
for July, 1966
739
to be voted on Thursday afternoon. It was moved
that the chairman of delegates be empowered to
move any alternate to delegate if necessary and that
the President be empowered to appoint any member in
good standing who is present in Chicago as an alter-
nate, should that be necessary. Motion approved.
Mrs. George T. Harding III, Franklin County,
chairman of the Reference and Revisions Committee,
presented the two proposed changes in the bylaws
which had already been approved by the State Board
and by the Advisory Committee of OSMA, and
which had been printed in the Auxiliary Netos and
sent by letter to all county presidents for consideration
and instruction of delegates. The first proposed
amendment had to do with Section 5-C-2, under
duties of President-Elect, and recommended the dele-
tion of "membership chairman’’ under those duties.
Motion was made that this amendment be accepted.
Motion carried.
The second proposed amendment had to do with
Article VII, Section 7, on Resolutions : As it originally
read — "all resolutions from component auxiliaries
. . . shall be referred to the Committee on Resolu-
tions no later than 30 days before the annual meet-
ing . . .” The amendment would change the "30
days” to "90 days” and insert after the first sentence
these additional words: "Not less than 60 days before
the annual meeting all resolutions approved by the
Advisory Committee and the Resolutions Committee
shall be sent to each component auxiliary.” It was
moved that this second amendment be accepted. Mo-
tion carried.
Board Recommendations
Mrs. James N. Wychgel, Cuyahoga County, State
President-Elect, moved the acceptance of this recom-
mendation as it was presented in a letter to the county
presidents: "We asked for and received permission
from our State Advisors to allow two or more of our
unorganized counties with very few members to unite
and form one organization as is done in other states.
This is to apply largely to unorganized counties and
must have the approval of the Medical Societies of
these counties as well as approval of the State Board.”
There was considerable discussion on this recom-
mendation, revolving largely around the limitation
imposed by the term "unorganized” and the fact
that that word had been omitted from the statement
appearing in Auxiliary News. The parliamentarian
was asked for clarification of the motion. The vote
then taken on the original recommendation was de-
feated.
Mrs. Wychgel then presented a new motion for
acceptance of the same statement but with the omis-
sion of the word "unorganized” in the phrase "al-
low two or more unorganized counties to unite.”
Motion passed. However, further discussion re-
vealed that this is a recommendation only and that
necessary steps will have to be taken to amend the
bylaws.
Mrs. Calvin Warner, Hamilton County, Finance
Committee chairman, moved the adoption of a recom-
mendation to raise the State dues from $1.25 to
$3.00 annually. Considerable discussion also fol-
lowed this recommendation. A deferral amendment
was defeated and the original motion for adoption
of the dues increase was then voted upon and carried.
The first business session of this twenty-sixth meet-
ing was adjourned at 11:30 a. m. to permit Auxiliary
delegates to attend the OMPAC luncheon at noon.
Dr. Hoyt D. Gardner of Louisville, Kentucky, a
member of AMPAC’s Board of Directors, was the
luncheon’s dynamic speaker who, later, was described
by many as a "spellbinder.” His stirring words on
"Success Can Be Ours” brought him a standing ova-
tion. The first of OSMA’s three General Sessions
was held at 1:30 p. m. and featured "Problems in
Marriage” with a star-studded panel.
It was at 3:00 p. m. that Auxiliary members recon-
vened in the Cleveland Room to hear the two-minute
reports of Ohio’s county presidents. It amazes this
reporter how much vital, helpful data can be en-
compassed into a two-minute presentation. There
was a wealth of Auxiliary activity paraded in those
reports. They spelled out clearly the dedication to the
medical profession that underlies every Auxiliary
project. The "extracurricular” part of Wednesday’s
program was the between 5:30 and 7:30 p. m.
escorted trips to Hixon’s Barn — a fascinating and
relaxing jaunt (also available on Thursday). Nor
will anyone who was there be likely to forget the
mammoth, tempting ice cream cone which looked
like a prop out of Disneyland.
Thursday Session
The second business session convened in the
Cleveland Room on May 26 at 9:15 a. m. Mrs. Van
Epps welcomed the delegates, alternates, and guests
and introduced Mrs. Richard A. Sutter, National
Auxiliary President. Dr. Henry A. Crawford, President
of OSMA, was on hand to greet the Auxiliary mem-
bers and to express his gratitude for the outstanding
job the Auxiliary is doing. He cautioned that the
medical profession heed these words: "Stop fighting
among yourselves, but fight the politicians.”
Additional out-of-state guests were introduced:
Mrs. Frank Gastineau, Past President, National Aux-
iliary; Mrs. John Deever, president-elect, Indiana;
Mrs. W. G. Gamble, first vice-president, and Mrs.
Earl Weston, second vice-president, Michigan. The
motion was made that the reading of the previous
day’s minutes be dispensed with (they will appear
in the Auxiliary News). Motion carried.
Mrs. John Toepfer, chairman of the Resolutions
Committee, gave the Second Reading of the three
proposed resolutions. The first resolution regard-
ing Mental Health facilities called for reorganization
of these facilities. This resolution is similar to one
740
The Ohio State Medical Journal
passed by OSMA. Mrs. Toepfer moved the adop-
tion of this resolution. Motion carried.
Following careful study, the Resolutions Commit-
tee and Dr. Benjamin C. Diefenbach, chairman of
advisors, recommended that Resolution No. 2 not be
adopted (it had to do with traffic safety and included
recommendations for periodic driver physical exami-
nations and an increase in the minimum driver age
to 18). Mrs. Harry Fry, legislation chairman,
stated that the preamble of this resolution is politi-
cally controversial. There was considerable discus-
sion (raising the minimum age of drivers had been
defeated in the State Legislature). The carrying
out of periodic physical examinations was, according
to those carefully studying the question, completely
unrealistic and impractical since it would involve an
increase of some 300 patients a month per doctor.
Mrs. Toepfer moved the resolution not be adopted.
Motion carried.
The third resolution recommended that the name
of Mrs. C. A. Colombi, Cuyahoga County, past state
president and past National community service chair-
man, be submitted to the 1966-67 National Nominat-
ing Committee for National office. Mrs. Toepfer
moved adoption of this resolution. Motion carried.
Mrs. Toepfer read a courtesy resolution expressing
gratitude to the many individuals and groups who
contributed to the success of the convention. Mrs.
Calvin Warner, Hamilton County, Finance Commit-
tee chairman, stated that copies of the budget for
1966-67, as approved by the Board, had been dis-
tributed to the House of Delegates. She moved the
adoption of the budget. Motion carried.
President’s Report
It was with obvious pride that Mrs. Van Epps high-
lighted the accomplishments of Ohio’s Auxiliaries
and their 5,599 members (to date). There are 67
members-at-large — more than for some time. She
remarked on the variety of community service projects
and reviewed the activities of the various commit-
tees. She spoke of her "fringe benefits” as President
— the cooperation and fellowship she enjoyed and
the privilege of visiting the many counties over the
state. Her parting words were particularly meaning-
ful: "It’s not what you have, but what you do with
what you have that matters.” Mary Louise Van Epps
was accorded an enthusiastic standing ovation.
Next introduced to the House of Delegates was
Dr. Lawrence C. Meredith, of Elyria, Incoming Presi-
dent of OSMA. Dr. Meredith spoke forcefully on
the need for creative thinking in working out present-
day problems. He stressed the importance of work-
ing before election to change the complexion of Con-
gress. "See to it that the dove that flies into the
kitchen,” he counseled, "turns into a screaming eagle
of tremendous activity.” He also pointed out that an
AMPAC button and a winning smile could be an un-
beatable combination.
Mrs. Van Epps then recognized Mrs. R. L. Wies-
singer, Allen County, who read a resolution from the
Board recommending the name of Mrs. Karl F.
Ritter for Honorary Membership in the Ohio State
Auxiliary. Mrs. Ritter, named on this year’s Na-
tional nominative slate for the office of President-
Elect, is a past state president, a present National
director and chairman of Organizational Reports.
She has, in addition, served three years as National
AMA-ERF chairman, four years as National finance
secretary and one year as National treasurer — an
impressive record. Mrs. Calvin Warner read the
honorary membership certificate recommended for
Mrs. Ritter and moved that such honorary member-
ship in the state organization be accorded Mrs. Ritter.
Motion was carried by unanimous vote.
Credits and Awards
This was the "big” moment — that moment when
county auxiliaries are honored for their year’s en-
deavors. Mrs. C. L. Johnson, Hardin County, Cre-
dits and Award chairman, made the presentations.
There are seven membership categories and three
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types of awards — ■ the Certificate, the Certificate with
Gold Seal, and the top honor, the Certificate with
Gold Seal and Blue Ribbon. Here’s how those
awards shaped up: In the 1-17 category: Lawrence,
Morrow and Union, the Certificate; Clermont, Certi-
ficate with Seal and Ribbon. 18-30: Logan, Certifi-
cate; Coshocton, Delaware, Geauga, Greene, Hardin,
Medina, Ottawa, Van Wert and Washington, Certi-
ficate with Seal; Huron, Seal and Ribbon. 31-50:
Fairfield, Hancock, Jefferson and Sandusky, Certifi-
cate; Belmont and Knox, with Seal; Tuscarawas, with
Seal and Ribbon. 51-75: Marion, Certificate; Colum-
biana, Lake, Licking, Muskingum and Scioto, with
Seal; Erie, with Seal and Ribbon. 76-150: Butler,
Clark and Lorain, Certificate; Richmond and Trum-
bull, with Seal; Allen, with Seal and Ribbon. 151-
300: Stark and Mahoning, Certificate with Seal. 301
and up: Lucas and Summit, with Seal; Cuyahoga,
Hamilton and Montgomery, with Seal and Ribbon.
Another high spot of the morning was the presen-
tation of awards for AMA-ERF by Mrs. R. K. Ram-
sayer, Stark County, chairman. She announced first
that total contributions to date were $37,702.52. The
largest contribution — $5,325 — came from Summit
County. The greatest per capita contribution —
$55.20 per member — came from Tuscarawas County.
Honors for the greatest increase over last year went
to Hamilton County.
This year there was no Memorial Service in the
traditional sense. In accordance with a Board de-
cision, the name and record of Auxiliary service of
deceased members will be published in the Auxiliary
News. Names of deceased members of this past
year were included in the Convention program. Fur-
ther, the Board voted an In Memoriam gift to AMA-
ERF of $100. Mrs. Van Epps called for a moment of
silence Thursday morning to honor the memory of
those who had died. The second business session
was adjourned at 11:00 a. m.
Tuscarawas County (Mary Louise’s "home base”)
served as hostess for a social hour at 11:30 a. m. in
the Whitehall Room. Luncheon followed at noon,
honoring past state president, county presidents,
presidents-elect, out-of-state guests and presidents
of WA - SAMA. Special honored guests included
Mrs. Richard A. Sutter, National President; Mrs.
William H. Evans, immediate Past National Presi-
dent and Ohio’s state officers. Luncheon arrange-
ments were handled by the Lake County group.
Mrs. John Dickie, past state president, gave the in-
vocation. An exquisite gold pendant watch was
presented to Mrs. Van Epps by Dr. Robert Kuba on
behalf of the Tuscarawas County Medical Society, as
a gesture of appreciation and gratitude for the part
so well played by Mary Louise as State President.
Again, at 1:30 p. m., Auxiliary delegates and
guests attended another General Session — this one
a vitally informative talk by Ohio’s prominent Dr.
Charles L. Hudson, President-Elect, AM A on 'Medi-
care’s Rules and Regulations and Their Effect on the
Practice of Medicine.” Dr. Hudson received a
standing ovation.
And at 3:00 p. m., Mrs. James Wychgel, President-
Elect, presided at the Auxiliary’s School of Instruc-
tion for 1966-67. Especially emphasized were Legis-
lation and AMA-ERF. Some of the state chairmen
outlined the year’s program in the different categories.
Mrs. Wychgel announced that she, her officers and
her committee chairmen stand ready at all times to
help local groups.
Doctors’ Breakfast
That’s how Friday, May 27, began — with a
"Doctors’ Breakfast” — at 7:30 a. m. ! The early
hour seemed to deter no one. Certainly "a goodly
crowd was there” (to quote somebody . . .). Mrs.
Joseph F. Corsaro, chairman, and her two cochair-
men, Mrs. Leonard A. Backiel and Mrs. Thomas L.
Manning, wore the traditional chefs’ hats (and most
becomingly) . Special guests were Dr. Charles L. Hud-
son, Dr. Henry A. Crawford, Dr. Lawrence C. Mere-
dith and Mrs. Richard Sutter. Mrs. M. W. Sloan II,
2nd vice-president, gave the invocation.
Mrs. Van Epps started the ball rolling with the
introduction of Ruth Wychgel, President-Elect. The
"piece de resistance” of the Breakfast Hour was
Higbee’s Fashion Show for Men. The models, be-
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T he Ohio State Medical Journal
lieve it or not, were eight courageous, wonderful
Cuyahoga County doctors as well as a doctor’s teen-
age son. They did a beautiful job of preening, pos-
ing, walking, exhibiting — the latest in men’s fash-
ions. There were colors and fabrics to slenderize the
figure (for calorie-conscious M. D.’s); white trousers
and sports jackets have sneaked in out of the past;
men do wear hats and topcoats and carry umbrellas
and wear ties (Higbee’s should know!). There was
the casual look, the golfer look, the evening look —
the look for yachting, tennis, and what have you.
Dark slacks and stripes of all kinds are "in,” and
there was a maroon shirt with ascot no less. And
how handsome the men looked in the tuxedo with
shawl collar and the after- five Teal blue dinner jacket
and the "softer” shirts for evening wear! All in all,
it was quite a show. The models did themselves —
and their wives — proud. A boutonniere — at least
— to these good sports: Dr. James Coviello, Dr.
Eugene Gessler, Dr. Edward Kieger, Dr. Ralph
Kovach, Dr. Jerome Litt, Dr. Chester Lulenski, Dr.
J. Kenneth Potter, Dr. Paul Sindelar and Larry Ken-
nedy, son of Dr. and Mrs. Roscoe Kennedy.
The third business session convened at 9:45 a. m.,
May 27 in the Cleveland Room. Mrs. Burdett
Wylie, convention chairman, presented the AMA-
ERF chairman with a $125 contribution from the Con-
vention Committee. This contribution was made
possible through the extra efforts of the committee
in making paper money corsages, centerpieces and
French beading favors. Mrs. Karl F. Ritter intro-
duced the National Auxiliary President, Mrs. Richard
A. Sutter. In a stimulating talk, Mrs. Sutter dis-
cussed three important areas : that of health education,
of public health and of the role of community organ-
izations. "There is inadequacy of health education,”
Mrs. Sutter told her audience, "and a great need for
improving it . . . there is lack of health education
in the schools . . . and what is being done to raise
the level of uneducated adults to help themselves?”
She stressed that public health should be nonpartisan
and that public health officials must have the support
of organizations and professional groups in creating
public awareness of the many problems. She re-
marked that in community action there is a conflict
between a liberal concern for humanity and a con-
servative concern for freedom. She emphasized that
Auxiliary’ members must work together on local, state
and national levels.
The report of the Election and Tellers Committee
revealed these results of the previous day’s voting for
members of the 1966-67 Nominating Committee:
Elected to that committee from the Board: Mrs. Herb-
ert F. Van Epps and Mrs. A. L. Kefauver; from the
membership: Mrs. John Toepfer, Mrs. E. P. Greena-
walt, Mrs. Jack Weiland, Mrs. Joseph Moran, Jr., and
Mrs. Paul Woodward, Jr. Also announced were the
results of the previous day’s voting on the 18 dele-
gates and 18 alternates to the National Convention
in June.
Installation
Mrs. Richard Sutter, National President, installed
the new officers headed by Mrs. James N. Wychgel
as president, and Mrs. Paul Sauvageot as president-
elect. "This is more than merely a great honor con-
ferred upon you,” Mrs. Sutter said, "it is a real
responsibility and challenge.” And she went on
to remind the Auxiliary membership that "these are
your officers and you assume responsibility to them
equal to theirs to you.”
Mrs. C. A. Colombi, president of the Gavel Club
(made up of past state presidents), presented the
past president’s pin to Mrs. Van Epps. "No one is
ever honored for what she reecived, but rather for
what she gave,” Mrs. Colombi said, "and you have
given much this past year.” In telling Mrs. Van
Epps that she was now eligible for membership in
the Gavel Club, she played upon the letters in the
word "gavel” to liken Mrs. Van Epps’ endeavors in
this fashion: Graciousness in a Presidential manner;
Ability to administer wisely; Valiant in the upholding
of our laws; Enthusiasm for all projects and plans;
and Loyalty to all and to all things at all times.
Mrs. James Wychgel, newly installed president,
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for July, 1966
743
said in her inaugural address "work together and you
will be surprised at what comes out of it.” She
traced medicine’s incredible historical background,
comparing the past with the present. She spoke of
the founding of the American Medical Association in
1847 when 250 physicians met in Philadelphia. She
went on to emphasize the needs in many health
related fields, especially in legislation and AMA-ERF.
She announced a new state chairman — that of Health
Education under Community Service. She suggested
that Auxiliary members use as a guideline ten im-
portant two-letter words: "If it is to be, it is up to
me.” And she closed her remarks with this signifi-
cant comment: "To work is to triumph — and tri-
umph is just a little 'umph’ added to 'try’.” Mrs.
Wychgel then asked for a rising vote of thanks for
Mrs. Van Epps, the outgoing President. And at
1 1 :45 a. m., Mrs. Van Epps declared the Twenty-
Sixth Annual Convention of the House of Delegates
adjourned.
"Happy Time,” courtesy of the Cuyahoga Aux-
iliary, preceded the novel "Lunch-on-a-Cart” honor-
ing the new officers, guests and members. Mrs.
Edward L. Doerman, Lucas County, third vice-presi-
dent, gave the invocation. The luncheon committee
members were attired as perky French maids who
helped create a distinctive atmosphere. To add to
the gala occasion, Ruth Wychgel wore a beautiful
crown of red carnations, presented by her county
auxiliary. (She looked every inch the queen!) At
1:30 p. m., the Auxiliary attended OSMA’s third
General Session to hear another dynamic, enthusi-
astically received speaker, Dr. Edward R. Annis, Past
President of the AMA, discuss "Care of the Patient:
1966.”
One last orchid: To those many counties who made
the Auxiliary’s exhibit (in the OSMA Exhibit Hall)
so completely outstanding, unusual and clever. It
would be very easy to heap all sorts of superlatives
on this "showing” without exaggerating in the least!
1966-67
This new Auxiliary year offers as many possibilities
for outstanding activity as we have the interest, deter-
mination and capacity to "do.” I said it last month,
and I say it again: "Let’s give it everything we’ve got.”
When a Fellow Needs a Friend!
An accident victim in need — a phy-
sician— and a newspaper photogra-
pher on the spot: These are elements
that combined to produce this photo-
graph published in the May 12 issue
of the Columbus Dispatch. Favorable
readership response was tremendous,
according to reports received by The
Journal.
Dr. Perry R. Ayres, Columbus phy-
sician and Editor of The Journal, gives
first aid and reassurance to Daniel
Hollis, 8, after the boy ran into the
path of a car on West Town Street.
Dr. Ayres was passing in his own car
and witnessed the accident.
Columbus Dispatch Photographer
Bill Foley happened on the scene be-
fore the emergency squad arrived, and
snapped this photo with the boy lying
on the hood of a car. Hollis was
taken to Mount Carmel Hospital and
released after treatment.
f|l§p
Photo Courtesy Columbus Dispatch
The Ohio State Medical Journal
744
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This is a typical "case history” of one new drug — or,
rather, a proposed new drug — assembled for submis-
sion to the U. S. Federal Food and Drug Administration.
These volumes are the result of several years’ work by
thousands of professional and skilled personnel in
just one pharmaceutical company's research labora-
tories, and by hundreds of physicians in medical
schools, hospitals, and private practice. They cover
every aspect of experience with this proposed new
agent from chemical laboratory to clinic, from mouse
to man. Each volume could conceivably represent
hundreds of thousands of dollars of financial invest-
ment, countless hours of human effort. This veritable
mountain of data stands behind every new agent
offered to you by pharmaceutical manufacturers — a
reassuring testimonial to the efficacy, safety and
purity of the drugs you will prescribe today to lower
the cost of disease to your patients.
Pharmaceutical
Manufacturers Association
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1155 Fifteenth St., N. W„ Washington, D.C. 20005
State Association Officers and Committeemen
Headquarters Office : 17 S. High St. — Suite 500, Columbus 43215. Telephone: (611^) 228-6971
OFFICERS and COUNCILORS
Lawrence C. Meredith, M. D., President
205 Elyria Block, Elyria 44035
Robert E. Howard, M. D., President-Elect
2600 Union Central Bldg., Cincinnati 45202
Henry A. Crawford, M. D., Past President
1058 Hanna Bldg., Cleveland 44115
Philip B. Hardymon, M. D., Treasurer
350 East Broad St., Columbus 43215
Paul N. Ivins, M. D., First District
306 High Street, Hamilton 45011
Theodore L. Light, M. D., Second District
2670 Salem, Avenue, Dayton 45406
Frederick T. Merchant, M. D., Third District
1051 Harding Memorial Parkway,
Marion 43305
Robert N. Smith, M. D., Fourth District
3939 Monroe Street, Toledo 43606
P. John Robechek, M. D., Fifth District
10525 Carnegie Avenue, Cleveland 44106
Edwin R. Westbrook, M. D., Sixth District
438 North Park Avenue, Warren 44481
Sanford Press, M. D., Seventh District
525 N. Fourth Street, Steubenville 43952
Robert C. Beardsley, M. D., Eighth District
2236 Maple Avenue, Zanesville 43705
George N. Spears, M. D., Ninth District
2213 South Ninth Street, Ironton 45638
Richard L. Fulton, M. D., Tenth District
1211 Dublin Road, Columbus 43212
William R. Schultz, M. D., Eleventh District
1749 Cleveland Road, Wooster 44691
THE EXECUTIVE STAFF
Hart F. Page, Executive Secretary Charles W. Edgar, Director of Public Relations
Herbert E. Gillen, Administrative Assistant and Assistore< Executive Secretary
W. Michael Traphagan, Administrative Assistant R. Gordon Moore, Executive Editor
THE EDITOR: Perry R. Ayres, M. D.
COMMITTEES
Committee on Education — Thomas E. Rardin, Columbus, Chair-
man (1971) ; Clyde W. Muter, Warren (1970) ; Thomas S.
Brownell, Akron (1969) ; John G. Sholl, Cleveland (1968) ;
Elmer R. Maurer, Cincinnati (1967).
Judicial and Professional Relations Committee — Frank F. A.
Rawling, Toledo, Chairman (1968) ; Henry A. Crawford, Cleve-
land (1971) ; Homer A. Anderson, Columbus (1970) ; Chester H.
Allen, Portsmouth (1969) ; David Fishman, Cleveland (1967).
Committee on Public Relations and Economics — Frederick P.
Osgood, Toledo, Chairman (1969) ; Horace B. Davidson, Colum-
bus (1971) ; Luther W. High, Millersburg (1970) ; John H.
Budd, Cleveland (1968) ; John J. Cranley, Jr., Cincinnati
(1967).
Committee on Scientific Work — Samuel Saslaw, Columbus,
Chairman (1968) ; Jerry Hammon, West Milton (1971) ; Robert
E. Zipf, Dayton (1971) ; Jack Schreiber, Canfield (1970) ;
Walter J. Zeiter, Cleveland (1970) ; John D. Battle, Jr., Cleve-
land (1969) ; Harold J. Schneider, Cincinnati (1969) ; Isador
Miller, Urbana (1968) ; William Hamelberg, Columbus (1967) ;
F. A. Simeone, Cleveland (1967).
Committee on AMA-ERF — Robert S. Martin, Zanesville,
Chairman.
Committee on Auditing and Appropriations — William R.
Schultz, Wooster, Chairman ; Edwin R. Westbrook, Warren ;
George Newton Spears, Ironton.
Committee on Cancer — Arthur G. James, Columbus, Chair-
man ; Thomas D. Allison, Lima ; Andrew M. Barone, Lima ;
William F. Boukalik, Cleveland; William J. Flynn, Youngs-
town ; Douglas P. Graf, Cincinnati ; Stanley O. Hoerr, Cleve-
land ; William A. Newton, Jr., Columbus ; W. D. Nusbaum,
Lancaster ; Arthur E. Rappoport, Youngstown ; Carl A. Wilz-
bach, Cincinnati.
Committee on Disaster Medical Care — Thomas D. Allison,
Lima, Chairman ; Thomas P. Bowlus, Toledo ; Nino M. Camardese,
Norwalk ; Drew L. Davies, Columbus ; John H. Davis, Cleveland ;
Gregory G. Floridis, Dayton ; Robert D. Gillette, Huron ; Robert
S. Heidt, Cincinnati ; Robert E. Holmberg, Cleveland ; N. J. M.
Klotz, Wadsworth ; Thomas W. Morgan, Gallipolis ; Sterling
W. Obenour, Jr., Zanesville; Vol K. Philips, Columbus; Liaison
with the American Medical Association : Wendell A. Butcher,
Columbus.
Committee on Environmental Health — Rex H. Wilson, Akron,
Chairman ; William W. Davis, Columbus ; Larry L. Hipp, Gran-
ville; Robert C. Markey, Bowling Green; B. C. Myers, Lorain;
Tuathal P. O’Maille, Marietta ; Thomas N. Quilter, Marion ; I. C.
Riggin, Lorain ; Robert E. Schulz, Wooster ; Victor A. Simiele,
Lancaster; John P. Storaasli, Cleveland; Robert Vogel, Dayton;
Robert C. Waltz, Cleveland ; Tennyson Williams, Delaware ;
John L. Zimmerman, Fremont.
Committee on Eye Care — Arthur D. Collins, Cleveland, Chair-
man ; Martin J. Cook, Springfield ; Thomas L. Edwards, Lima ;
Robert H. Magnuson, Columbus ; Russell J. Nicholl, Cleveland ;
Claude S. Perry, Columbus ; Norman W. Pinschmidt, Gallipolis ;
Barnet R. Sakler, Cincinnati ; Robert L. Willard, Toledo.
Committee on Government Medical Care Programs — H. Wil-
liam Porterfield, Columbus, Chairman ; James O. Barr, Chagrin
Falls ; Dwight L. Becker, Lima ; Robert A. Borden, Fremont ;
Edwin W. Burnes, Van Wert ; Philip T. Doughten, New Phila-
delphia ; Robert B. Elliott, Ada ; George T. Harding, Sr.,
Worthington ; Roger E. Heering, Columbus ; M. Robert Huston,
Millersburg ; Francis M. Lenhart, Defiance ; Harold E. Mc-
Donald, Elyria ; Elliott W. Schilke, Springfield ; Bernard A.
Schwartz, Cincinnati ; Clarence V. Smith, Canton ; Joseph B.
Stocklen, Cleveland; Don P. Van Dyke, Kent; William M.
Wells, Newark.
Committee on Hospital Relations — Robert M. Craig, Dayton,
Chairman ; L. Fred Bissell, Aurora ; L. A. Black, Kenton ;
Wendell T. Bucher, Akron ; Oscar W. Clarke, Gallipolis ; Henry
A. Crawford, Cleveland; John V. Emery, Willard; Harvey C.
Gunderson, Toledo ; Henry L. Hartman, Toledo ; E. R. Haynes,
Zanesville ; Middleton H. Lambright, Cleveland ; Lloyd E. Lar-
rick, Cincinnati ; James C. McLarnan, Mt. Vernon ; Ben V.
Mvers, Elyria ; E. W. Schilke, Springfield ; Robert A. Tennant,
Middletown ; V. William Wagner, Port Clinton ; William A.
White, Canton.
Committee on Insurance — David A. Chambers, Cleveland,
Chairman ; William F. Bradley, Columbus ; Walter A. Daniel,
Tiffin; Chester R. Jablonoski, Cleveland; William A. Knapp,
Zanesville ; Marvin R. McClellan, Cincinnati ; William Neal,
Archbold; Oliver E. Todd, Toledo; Robert E. Tschantz, Canton;
Allan L. Wasserman, Dayton ; John W. Wherry, Elyria ; Wil-
liam A. White, Canton.
Committee on Laboratory Medicine — Horace B. Davidson,
Columbus, Chairman ; William H. Benham, Columbus ; John B.
Hazard, Cleveland ; Melvin Oosting, Dayton ; Arthur E. Rappo-
port, Youngstown; William Sinclair, Cleveland; Gilbert B.
Stansell, Toledo ; Philip B. Wasserman, Cincinnati.
746
The Ohio State Medical Journal
State Association Officers and Committeemen (Continued)
Committee on Legislation — James T. Stephens, Oberlin, Chair-
man ; Chester H. Allen, Portsmouth ; Donald R. Brumley, Find-
lay; Jonathan G. Busby, Columbus; George D. J. Griffin, Cin-
cinnati; Jack L. Kraker, Lancaster; William J. Lewis, Dayton;
Maurice F. Lieber, Canton ; James C. McLarnan, Mt. Vernon ;
Wesley J. Pignolet, Willoughby; Marvin J. Rassell, Hamilton;
Theodore E. Richards, Urbana ; Robert E. Rinderknecht, Dover ;
John H. Sanders, Cleveland; William W. Trostel, Piqua.
Committee on Maternal Health — Anthony Ruppersberg, Colum-
bus, Chairman ; Otis G. Austin, Medina ; Raymond E. Barker,
Columbus ; William D. Beasley, Springfield ; Keith R. Brande-
berry, Gallipolis ; Thomas E. Byrne, Mentor ; Mel A. Davis,
Columbus; Marion F. Detrick, Jr., Findlay; John P. Garvin,
Columbus ; Richard P. Glove, Cleveland ; Robert A. Heilman,
Columbus; John F. Hillabrand, Toledo; Robert E. Johnstone,
Cincinnati; Albert A. Kunnen, Dayton; James F. Morton,
Zanesville ; Ralph K. Ramsayer, Canton ; Robert E. Swank,
Chillicothe; Densmore Thomas, Warren; Robert S. VanDervort,
Elyria.
Committee on Medicine and Religion — Charles A. Sebastian,
Cincinnati, Chairman ; John D. Albertson, Lima ; Eugene F.
Damstra, Dayton ; Francis M. Lenhart, Defiance ; Ralph W.
Lewis, Portsmouth ; George W. Petznick, Cleveland ; J. Kenneth
Potter, Cleveland; John R. Seesholtz, Canton; William B.
Smith, Zanesville; James T. Stephens, Oberlin; Donald J.
Vincent, Columbus ; Don G. Warren, West Lafayette.
Committee on Mental Health — -Wendell A. Butcher, Columbus,
Chairman ; Homer A. Anderson, Columbus ; Robert D. Eppley,
Elyria ; Max D. Graves, Springfield ; Richard G. Griffin, Worth-
ington ; Warren G. Harding, Columbus ; Edward 0. Harper,
Cleveland ; Henry L. Hartman, Toledo ; William H. Holloway,
Akron ; C. Eric Johnston, Columbus ; Robert E. Reiheld, Orr-
ville ; Philip C. Rond, Columbus ; W. Donald Ross, Cincinnati ;
Viola V. Startzman, Wooster; Victor M. Victoroff, Cleveland.
Military Advisory Committee — Drew L. Davies, Columbus,
Chairman ; Ralph G. Carothers, Cincinnati ; Homer D. Cassel,
Dayton; Henry A. Crawford, Cleveland; Walter L. Cruise,
Zanesville ; Charles R. Keller, Mansfield ; Ralph W. Lewis,
Portsmouth ; Edward L. Montgomery, Circleville ; Frank T.
Moore, Akron ; Frederick P. Osgood, Toledo ; Earl Rosenblum,
Steubenville ; Richard G. Weber, Marion.
Committee on Rural Health — Robert E. Reiheld, Orrville,
Chairman ; Chester J. Brian, Eaton ; Robert R. C. Buchan,
Troy; J. Martin Byers, Greenfield; Walter A. Campbell, Co-
shocton ; E. Joel Davis, East Canton ; Victor R. Frederick,
Urbana ; Benjamin W. Gilliotte, Zanesville ; Jerry L. Hammon,
West Milton ; Jasper M. Hedges, Circleville ; Luther W. High,
Millersburg ; E. D. Mattmiller, Athens ; John R. Polsley, North
Lewisburg ; Leonard S. Pritchard, Columbiana ; Harold C.
Smith, Van Wert; Kenneth W. Taylor, Pickerington.
OSMA Advisory Committee to the Ohio State Society of
Medical Assistants — Richard L. Fulton, Columbus, Chairman ;
George Newton Spears, Ironton.
Committee on School Health — Charles H. McMullen, Loudon-
ville. Chairman; Walter Felson, Greenfield; Howard H. Hop-
wood, Cleveland ; Dale A. Hudson, Piqua ; Howard J. Ickes,
Canton ; Charles L. Kagay, Dayton ; Thomas E. Wilson, Warren ;
Robert C. Markey, Bowling Green ; Robert J. Murphy, Colum-
bus ; Carey B. Paul, Jr., Columbus ; Carl L. Petersilge, Newark ;
William H. Rower, Ashland ; Thomas E. Shaffer, Columbus ;
Aubrey L. Sparks, Warren ; Homer B. Thomas, Gallipolis.
OSMA Members of the Joint Committee on School Bus Driver
Examinations — Carey B. Paul, Jr., Columbus; Thomas N.
Quilter, Marion ; Drew L. Davies, Columbus.
OSMA Members of the Joint Advisory Committee on Athletic
Injuries — Walter A. Hoyt, Jr., Akron; John R. Jones, Toledo;
Don A. Kelly, Cleveland ; Sol Maggied, West Jefferson ; Marvin
R. McClellan, Cincinnati ; Robert P. McFarland, Oberlin ;
Charles H. McMullen, Loudonville ; Robert J. Murphy, Colum-
bus ; Carey B. Paul, Jr., Columbus ; Thomas E. Shaffer,
Columbus.
Committee on Workmen’s Compensation — H. P. Worstell,
Columbus, Chairman ; A. L. Berndt, Portsmouth ; Thomas H.
Brown, Jr., Toledo; Charles A. Browning, Jr., Bellefontaine ;
Oscar W. Clarke, Gallipolis ; Frederick A. Flory, Columbus ;
Lawrence T. Hadbavny, Cleveland ; Clyde O. Hurst, Ports-
mouth; Edmund F. Ley, Tiffin; Joseph Lindner, Sr., Cincinnati;
John D. Osmond, Jr., Cleveland ; James G. Roberts, Akron ;
George L. Sackett, Sr., Painesville; William V. Trowbridge,
Cleveland; Rex H. Wilson, Akron; James N. Wychgel, Cleve-
land ; Joseph H. Shepard, Columbus ; Frederick A. Wolf,
Cincinnati.
Woman’s Auxiliary Advisory Committee — Robert C. Beard-
sley, Zanesville, Chairman ; Theodore L. Light, Dayton ; Fred-
erick T. Merchant, Marion.
Ohio Medical Indemnity Liaison Committee — Robert E.
Tschantz, Canton, Chairman ; Henry A. Crawford, Cleveland ;
Lawrence C. Meredith, Elyria ; Mr. Hart F. Page, Executive
Secretary, OSMA, Columbus.
DELEGATES AND ALTERNATES
Delegates and Alternates to the American Medical Association
— George W. Petznick, Cleveland ; H. T. Pease, Wadsworth, alter-
nate ; Carl A. Lincke, Carrollton ; Robert S. Martin, Zanesville,
alternate ; Theodore L. Light, Dayton ; Kenneth D. Arn, Dayton,
alternate ; Edmond K. Yantes, Wilmington ; Harry K. Hines,
Cincinnati, alternate; John H. Budd, Cleveland; P. John Robe-
chek, Cleveland, alternate ; Richard L. Meiling, Columbus ;
Frank F. A. Rawling, Toledo, alternate ; Frederick P. Osgood,
Toledo ; Robert N. Smith, Toledo, alternate ; Charles A. Sebas-
tian, Cincinnati ; J. Robert Hudson, Cincinnati, alternate ; Ed-
win H. Artman, Chillicothe ; Philip B. Hardymon, Columbus,
alternate ; Robert E. Tschantz, Canton ; Henry A. Crawford,
Cleveland, alternate.
County Societies’ Officers and Meeting Dates
First District
Councilor: Paul N. Ivins, Hamilton 45011
306 High Street
ADAMS — Gary J. Greenlee, President, Manchester 45144 ; Stan-
ley H. Title, Secretary, Manchester 45144.
BROWN — Charles H. Maly, President, Sardinia 45171 ; Charles
W. Hannah, Secretary, Sardinia 45171. 1st Monday monthly.
BUTLER — Robert Johnson, President, 500 S. Breiel Boulevard,
Middletown 45042 ; Mr. Charles G. Greig, Executive Secretary,
110 North Third Street, Hamilton 45011. 4th Wednesday
monthly.
CLERMONT — Cecil F. Barber, President, State Route 133, Feli-
city 45120 ; Phillips F. Greene, Secretary, Route 1, Box 509,
New Richmond 45157. 3rd Wednesday monthly, except July
and August.
CLINTON — Richard R. Buchanan, President, 115 West Main,
Wilmington 45177 ; Mary Ranz Boyd, Secretary, Box 629,
Wilmington 45177. 4th Tuesday monthly.
HAMILTON — Robert M. Woolford, President, 320 Broadway,
Cincinnati 45202 ; Mr. Edward F. Willenborg, Executive
Secretary, 320 Broadway, Cincinnati 45202. Monthly meet-
ing dates, 1st Tuesday; Academy, 3rd Tuesday, except June,
July and August.
HIGHLAND — Thomas L. Jones, President, 528 South St., Green-
field 45123 ; Walter Felson, Secretary, 357 South St., Greenfield
45123. 3rd Tuesday bimonthly.
WARREN — O. Williard Hoffman, President, 20 East Fourth
Street, Franklin 45005 ; Ray E. Simendinger, Secretary, 901
North Broadway Street, Lebanon 45036. 2nd Tuesday monthly.
Second District
Councilor: Theodore L. Light, Dayton 45406
2670 Salem Ave.
CHAMPAIGN — Myron J. Towle, President, 848 Scioto Street,
Urbana 43078 ; Fred R. Denkewalter, Secretary, 848 Scioto
Street, Urbana 43078. 2nd Wednesday monthly.
CLARK — Henry M. Tardif, President, 2608 E. High Street,
Springfield 45505 ; Mrs. Marion L. Wilcoxson, Executive
Secretary, Hotel Shawnee, Room 207, Springfield 44501. 3rd
Monday monthly, except June, July and August.
DARKE — William A. Browne, President, 722 Sweitzer St.,
Greenville 45331 ; Delbert D. Blickenstaff, Secretary, 552 S.
West St., Versailles 45380. 3rd Tuesday monthly.
GREENE — Clement G. Austria, President, 1142 North Monroe
Drive, Xenia 45385 ; Mrs. C. K. Elliott, Executive Secretary,
225 Pleasant Street, Xenia 45385. 2nd Thursday monthly
except July and August.
MIAMI — David Brown, President, 1060 North Market Street,
Troy 45373 ; Jack P. Steinhilber, Secretary, 145 Sunset Drive,
Piqua 45356. 1st Tuesday monthly.
MONTGOMERY — Charles E. O’Brien, President, 600 Fidelity
Building, Dayton 45402 ; Mr. Robert F. Freeman, Executive
Secretary, 280 Fidelity Medical Building, Dayton 45402. 1st
Friday monthly October through May — 1st Wednesday June.
PREBLE — John D. Darrow, President, 228 N. Barron St., Eaton
45320 ; Willard C. Clark, Jr., Secretary, 228 N. Barron, Eaton
45320. Irregular meetings.
SHELBY- — George J. Schroer, President, 322 Second Ave., Sidney
45365 : Alfonsas Kisielius, Secretary, Ohio Bldg., Sidney 45365.
for July, 1966
747
County Societies’ Officers and Meeting Dates (Continued)
Third District
Council : Frederick T. Merchant, Marion 43305
1051 Harding Memorial Pky.
ALLEN — Carl H. Zinsmeister, President, 729 W. Market Street,
Lima 45801 ; Thomas D. Allison, Secretary, 401 Metropolitan
Bank Building, Lima 45801. 3rd Tuesday monthly.
AUGLAIZE — Robert Sobocinski, President, 75 Blackhoof Street,
Wapakoneta 45895 ; J. F. Bowling, Secretary, 319 West Spring
Street, St. Marys 45885. 1st Thursday monthly except July.
CRAWFORD — Don E. Ingham, President, 201 N. Market Street,
Galion 44833 ; Johnson H. Chow, Secretary, 1040 Devonwood
Drive, Galion 44833. Called meetings.
HANCOCK — Raymond J. Tille, President, 801 S. Main St., Find-
lay 45840 ; Herbert L. Queen, Secretary, 828 Woodworth Dr.,
Findlay 45840.
HARDIN — William D. Dewar, President, 405 North Main Street,
Kenton 43326 ; John J. Roget, Secretary, Belle Center 43310.
2nd Tuesday monthly.
LOGAN — Thomas Seitz, President, 223 E. Columbus Street,
Bellefontaine 43311 ; Glen Miller, Secretary, R. D. 2, West
Liberty 43357. 1st Friday monthly.
MARION — Ransome Williams, President, 1035 Harding Me-
morial Parkway, Marion 43302 ; Alice Fisher, Secretary, 1040
Delaware Avenue, Marion 43302. 1st Tuesday monthly.
MERCER — R. Duane Bradrick, President, Rockford 45882 ; R. L.
Dobbins, Secretary, 5402 State Route 29 East, Celina. 3rd
Thursday, monthly.
SENECA — Olgierd C. Garlo, President, 53 Clay Street, Tiffin
44883 ; Leonard M. Gaydos, Secretary, 233 South Monroe
Street, Tiffin 44883. 3rd Tuesday monthly.
VAN WERT — Norman L. Marxen, President, Medical Arts Bldg.,
Fox Road, Van Wert 45891 ; W. L. Iler, Secretary, Medical
Arts Bldg., Fox Road, Van Wert 45891. 4th Friday monthly.
WYANDOT — Herschel A. Rhodes, President, 777 N. Sandusky
Ave., Upper Sandusky 43351 ; J. J. Browne, Secretary, 777 N.
Sandusky Ave., Upper Sandusky 43351. 2nd Tuesday monthly.
Fourth District
Councilor: Robert N. Smith, Toledo 43606
3939 Monroe St.
DEFIANCE — L. F. Berry, Jr., President, 1400 East Second
Street, Defiance 43512 ; W. S. Busteed, Secretary, Box 218,
Defiance 43512.
FULTON — B. H. Reed, Jr., President, Delta 43515 ; R. L. Davis,
Secretary, Wauseon 43567. 2nd Tuesday quarterly March,
June, September, December.
HENRY — J. J. Harrison, President, 113 East Clinton Street,
Napoleon 43545 ; Gamble S. Hall, Secretary, 834 Strong
Street, Napoleon 43545. 1st Tuesday monthly.
LUCAS — E. L. Doermann, President, 2001 Collingwood Blvd.,
Toledo 43620 ; Mr. Robert W. Elwell, Executive Secretary, 3101
Collingwood Blvd., Toledo 43610. 3rd Tuesday monthly except
July and August.
OTTAWA — V. Wm. Wagner, President, 122 East Perry, Port
Clinton 43452 ; William Coon, Secretary, 120 East Perry, Port
Clinton 43452. 2nd Thursday monthly.
PAULDING — Roy R. Miller, President, 220 W. Perry, Paulding
45879 ; D. Paul Ward, Secretary, Box 416, Oakwood 45873.
Meetings called.
PUTNAM — Arthur P. Daniel, President, 144 N. Walnut, Ottawa
45875 ; Oliver N. Lugibihl, Secretary, Pandora 45877. 1st
Tuesday monthly.
SANDUSKY — J. L. Zimmerman, President, Memorial Hospital
of Sandusky County, Fremont 43420 ; Mrs. Patsy J. Askins.
Executive Secretary, Memorial Hospital of Sandusky County,
Fremont 43420. 3rd Wednesday monthly.
WILLIAMS — John E. Moats, President, Central Drive, Bryan
43506 ; Neil T. Levenson, Secretary, 907 Noble Drive, Bryan
43506. 2nd Tuesday monthly.
WOOD — Roger A. Peatee, President, 140 S. Prospect Street,
Bowling Green 43402 ; Douglas Hess, Secretary, 920 North
Main St., Bowling Green, Ohio 43402. 3rd Thursday monthly.
Fifth District
Councilor: P. John Robechek, Cleveland 44106
10525 Carnegie Ave.
ASHTABULA — J. R. Nolan, President, 2736 Lake Avenue, Ash-
tabula 44004 ; Richard Millberg, Secretary, 430 West 25th
Street, Ashtabula 44004. 2nd Tuesday monthly.
CUYAHOGA — David Fishman, President, Room 404, 10515 Car-
negie Avenue, Cleveland 44106 ; Mr. Robert A. Lang, Executive
Secretary, 10525 Carnegie Avenue, Cleveland 44106.
GEAUGA — Bruce F. Andreas, President, 400 Downing Drive,
Chardon 44024; Arturo J. Dimaculangan, Secretary, 8400 May-
field Road, P. O. Box 277, Chesterland 44026. 2nd Friday
monthly.
LAKE — Robert W. Colopy, President, 89 E. High Street, Paines-
ville 44077 ; Mrs. Owen A. McLaren, Executive Secretary,
7408 Cadle Avenue, Mentor 44060. 4th Wednesday evening
monthly, January, May, March, September and November
unless otherwise ordered by Council.
Sixth District
Councilor: Edwin R. Westbrook, Warren 44481
438 North Park Ave.
COLUMBIANA — Edith S. Gilmore, President, 432 W. 5th St.,
E. Liverpool 43920 ; Fraser Jackson, Secretary, 205 W. 6th
St. 3rd Tuesday monthly.
MAHONING — F. A. Resch, President, Doctors Park, Canfield
44406 ; Mr. Howard C. Rempes, Jr., Executive Secretary, 245
Bel-Park Building, 1005 Belmont Avenue, Youngstown 44504.
3rd Tuesday monthly except July and August.
PORTAGE — David Palmstrom, President, 124 North Prospect
Street, Ravenna 44266 ; William R. Brinker, Secretary, 141
East Main Street, Kent 44240. 3rd Tuesday monthly.
STARK — A. R. Furnas, Jr., President, 420 Lake Avenue, N. E.,
Massillon 44646 ; Mr. John H. Austin, Executive Secretary,
405 4th Street, N. W., Canton 44702. 2nd Thursday monthly.
SUMMIT — James G. Roberts, President, 655 West Market Street,
Akron 44303 ; Mr. Sidney H. Mountcastle, Executive Secretary,
437 Second National Building, 159 South Main Street, Akron
44308. 1st Tuesday monthly.
TRUMBULL — John F. McGreevey, President, 297 Hawthorne
Lane N. E., Warren 44484 ; Mrs. Kay Ticknor, Executive
Secretary, 280 North Park Avenue, Warren 44481. 3rd
Wednesday monthly September through May.
Seventh District
Councilor : Sanford Press, Steubenville 43952
525 North Fourth Street
BELMONT — James Sutherland, President, 9 North 4th Street,
Martins Ferry 43935 ; Bertha M. Joseph, Secretary, 100 South
4th Street, Martins Ferry 43935. 3rd Thursday of February,
March, April, June, September, October, November and
December.
CARROLL — Glen C. Dowell, President, 207 West Main, Car-
rollton 44615 ; Thomas J. Atchison, Secretary, 292 East
Main, Carrollton 44615. 1st Thursday monthly.
COSHOCTON — Don Warren, President, 600 East Main Street,
West Lafayette 43845 ; Harold Lear, Secretary, 133 South
Fourth Street, Coshocton 43812. 2nd Tuesday monthly.
HARRISON — Charles D. Evans, President, 159 South Main
Street, Cadiz 43907 ; G. E. Vorhies, Secretary, Scio 43988,
Quarterly.
JEFFERSON — Jacob R. Cohen, President, 341 Market Street,
Steubenville 43952 ; Irving Dreyer, Secretary, Ohio Valley
Hospital, Steubenville 43952. 4th Tuesday monthly except
December, January, February.
MONROE — Byron Gillespie, Secretary, Woodsfield 43793.
TUSCARAWAS — Robert J. Kuba, President, 319 Grant St., Den-
nison 44621 ; Thomas E. Ogden, Secretary, 138 E. Main St.,
Gnadenhutten. 2nd Thursday monthly.
Eighth District
Councilor: Robert C. Beardsley, Zanesville 43705
2236 Maple Ave.
ATHENS — D. R. Johnson, President, 52 West Washington
Street, Nelsonville 45764 ; L. A. Hamilton, Secretary, 400 East
State Street, Athens 45701. 2nd Tuesday monthly except July
and August.
FAIRFIELD — George W. LeSar, President, 216 Harmon Avenue,
Lancaster 43130 ; Stephen R. Hodsden, Secretary, 1423 West
Market Street, Baltimore 43105. 2nd Tuesday monthly.
GUERNSEY — A. C. Smith, President, 1115 Clark Street, Cam-
bridge 43725 ; Dayle O. Snyder, Secretary, 840 Wheeling
Avenue, Cambridge 43725. 1st Tuesday monthly.
LICKING — Carl L. Petersilge, President, 104 Hudson Avenue,
Newark 43055 : Robert P. Raker, Secretary, 317 N. Granger
Street, Granville 43023. 4th Tuesday monthly.
MORGAN — A. H. Whitacre, President, Chesterhill 43728 ; Henry
Bachman, Secretary, Box 199, Malta 43758.
MUSKINGUM — Paul A. Jones, President, 838 Market Street,
Zanesville 43701 ; Myron Powelson, Secretary, 2825 Maple
Avenue, Zanesville 43705. 2nd Tuesday monthly.
NOBLE — Frederick M. Cox, President, Caldwell 43724 ; Edward
G. Ditch, Secretary, 415 Main Street, Caldwell 43724. 1st
Tuesday monthly.
PERRY — Charles B. McDougal, President, 319 High St., New
Lexington 43764 ; Michael P. Clouse, Secretary, West Main St.,
Somerset 43783.
WASHINGTON — Mary L. Whitacre, President, Rt. 6, Marietta
45750 ; G- E. Huston, Secretary, 328 Fourth St., Marietta
45750. 2nd Wednesday monthly.
748
The Ohio State Medical Journal
County Societies’ Officers and Meeting Dates (Continued)
Ninth District
Councilor: George N. Spears, Ironton 45638
2213 S. 9th St.
GALLIA — Quentin Korfhage, President, Gallipolis Clinic, Gal-
lipolis 45631 ; John Groth, Secretary, Holzer Clinic, Gallipolis
45631. Monthly meetings at called times.
HOCKING — Jan S. Matthews, President, 9 East Second Street,
Logan 43138 ; H. M. Boocks, Secretary, Route 3, Logan 43138.
2nd Tuesday monthly.
JACKSON — John M. Cook, President, Box 316, Oak Hill 45656 ;
Earl J. Levine, Secretary, 120 N. Ohio Ave., Wellston 45692.
LAWRENCE — Frank W. Crowe, President, 2110 South 9th
Street, Ironton 45638 ; George Newton Spears, Secretary, 2213
South Ninth Street, Ironton 45638. Quarterly at called times.
MEIGS — Charles J. Mullen, President, 210% E. Main St., Pome-
roy 45769 ; Edmund Butrimas, Secretary, 204 E. Main St.,
Pomeroy 45769.
PIKE — Robert T. Leever, President, 100 East Third St., Waverly
45690 ; Albert M. Shrader, Secretary, East Water St., Waverly
45690. 1st Tuesday monthly.
SCIOTO — Chester H. Allen, President, 1405 Offnere Street,
Portsmouth 45662 ; Erich Spiro, Secretary, 1735 Waller Street,
Portsmouth 45662. 2nd Monday in February, April and Octo-
ber ; December meeting and summer meeting decided by the
Council and members notified one month in advance.
VINTON — Richard E. Bullock, President, 203 South Market St.,
McArthur 45651.
Tenth District
Councilor: Richard L. Fulton, Columbus 43212
1211 Dublin Rd.
DELAWARE — Don K. Michel, President, 98 W. William, Dela-
ware 43015 ; Tennyson Williams, Secretary, Box 265, Delaware
43015. 3rd Tuesday monthly.
FAYETTE — R. D. Woodmansee, President, 403 East Market
Street, Washington C. H. 43160 ; M. H. Roszmann, Secretary,
1005 East Temple Street, Washington C. H. 43160. 2nd
Friday monthly
FRANKLIN — Joseph A. Bonta, President, 3100 Olentangy River
Road, Columbus 43202 ; Mr. W. “Bill” Webb, Jr., Executive
Secretary, 79 East State Street, Room 601, Columbus 43215.
3rd Tuesday monthly.
KNOX — Richard L. Smythe, President, 812 Coshocton Road,
Mt. Vernon 43050 ; Robert E. Sooy, Secretary, Box 470, Mt.
Vernon 43050. 1st Wednesday evening monthly.
MADISON — Sol Maggied, President, 15 East Pearl Street, West
Jefferson 43162 ; Michael Meftah, Secretary, 11 East 2nd
Street, London 43140. 1st Wednesday monthly.
MORROW — Francis W. Kubb, President, 140 North Main, Mt.
Gilead 43338 ; William S. Deffinger, Secretary, Box 8, Marengo
43334. 1st Tuesday monthly.
PICKAWAY — V. D. Kerns, President, 143 E. Main Street,
Circleville 43113 ; Carlos Alvarez, Secretary, 147 Pinckney
Street, Circleville 43113. 1st Friday evening monthly, except
months of July and August.
ROSS — Joseph McKell, President, 174 W. Main Street, Chilli-
cothe 45601 ; Lowell O. Smith, Secretary, 217 Delano Avenue,
Chillicothe 45602. 1st Thursday evening monthly.
UNION — Malcolm Maclvor, President, 110 N. Court St., Marys-
ville 43040 ; May B. Zaugg, Secretary, 225 Stockdale Drive,
Marysville 43040. 1st Tuesday, February, April, October,
December.
Eleventh District
Councilor : William R. Schultz, Wooster 44691
1749 Cleveland Road
ASHLAND — Henry C. Chalfant, President, 309 Arthur Street,
Ashland 44805 ; H. W. Smith, Secretary, 414 Samaritan Ave-
nue, Ashland 44805. 1st Thursday monthly.
ERIE — Clinton F. Lavender, President, 1218 Cleveland Road,
Sandusky 44870; Mrs. Bertha Wolpert, Executive Secretary,
1205 Tyler Street, Sandusky 44870.
HOLMES — Charles H. Hart, President, 109 South Clay Street,
Millersburg 44654 ; William A. Powell, Secretary, 8 West
Adams Street, Millersburg 44654. 3rd Thursday monthly.
HURON — W. R. Graham, President, 15 Main Street, Wakeman
44889 ; E. R. McLoney, Secretary, 257 Benedict Avenue, Nor-
walk 44857. 2nd Wednesday of February, April, June, Au-
gust, October, and December.
LORAIN — Joseph A. Cicerrella, President, 209 6th Street, Lorain
44052 ; Mrs. Gladys Davidson, Executive Secretary, 428 West
Avenue, Elyria 44035. 2nd Tuesday monthly except June,
July and August.
MEDINA — Myrl A. Nafziger, President, Albrecht Building,
Wadsworth 44281 ; Mr. A. Dana Whipple, Executive Secretary,
320 East Liberty Street, Medina, Ohio 44256. 3rd Thursday
monthly.
RICHLAND — C. J. Shamess, President, 74 Wood Street, Mans-
field 44903 ; Harold F. Mills, Secretary, 70 Madison Road,
Mansfield 44905. 3rd Thursday monthly except June, July and
August.
WAYNE — Howard MacMillan, President, 1740 Cleveland Road,
Wooster 44691 ; R. J. Watkins, Secretary, 1736 Beall Avenue,
Wooster 44691. 2nd Wednesday monthly, January, February,
April, September, November and December.
I1IIIIIIIIIIIIIIIII1IIIII1
Dr. Washam Named Executive Secretary
Of the State Medical Board
Newly appointed executive secretary of the State
Medical Board of Ohio is Dr. William T. Was-
ham, former practicing physician at Jackson, and
more recently engaged in the practice of law in
Columbus. Dr. Washam has accepted the post on
a part-time basis and will continue to devote some
of his time to his medico-legal practice.
The announcement was made by Dr. Domenic
A. Macedonia, of Steubenville, president of the
Board, just before this issue of The Journal went
to press. Dr. H. M. Platter, retired December 31,
1965, after 48 years as secretary of the Board.
Dr. Washam graduated from Ohio State Uni-
versity College of Medicine in 1945 and practiced
in his native Jackson from 1946 to 1962. He re-
ceived his law degree from Franklin University,
Columbus, and was admitted to Ohio Bar on May
5, 1965. Dr. Washam is a member of the Ohio
State Medical Association and the American Medi-
cal Association.
THE WOMAN’S AUXILIARY TO THE OHIO STATE MEDICAL ASSOCIATION
President : Mrs. James N. Wychgel
3320 Dorchester Rd., Cleveland 44120
Vice-Presidents : 1. Mrs. Malachi W. Sloan, II
415 Towerview Rd., Dayton 45429
2. Mrs. Carl F. Goll
1001 Granard Pkwy., Steubenville 43952
3. Mrs. Edward L. Doerman
3605 Laskey Rd., Toledo 43623
Past President and Nominating Chairman :
Mrs. Herbert F. Van Epps
425 E. 15th St., Dover 44622
President-Elect : Mrs. Paul Sauvageot
2443 Ridgewood Rd., Akron 44313
Recording Secretary : Mrs. James W. Loney
15450 Hemlock Point Rd., Chagrin Falls
Corresponding Secretary : Mrs. Vincent T. Kaval
19201 VanAken Blvd., Cleveland 44122
Treasurer: Mrs. Russell L. Wiessinger
2280 West Wayne St., Lima 45805
for July, 1966
749
JOURNAL ADVERTISERS
Advertisers in The Journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The Journal,
and help make it a quality publication. In return we
place their messages on the desks of Ohio’s physicians.
Please familiarize yourself with their services and pro-
ducts, and let them know that you see their advertising
in The Journal.
In This Issue :
Abbott Laboratories 643-644-645-646
Academy of Medicine of Cleveland —
Hawaiian Carnival 734-735
Allergy Laboratories of Ohio, Inc 637
Ames Company, Inc 632
Appalachian Hall 658
Blessings, Inc 738
The Brown Pharmaceutical Co 658
Burroughs Wellcome & Co. (USA) Inc 660
Daniels-Head & Associates, Inc 730
Data Corporation Inside Back Cover
Elder, Paul B. Company 633
Geigy Pharmaceuticals, Division of
Geigy Chemical Corporation 636, 653
Glenbrook Laboratories (Bayer Aspirin) 651
Harding Hospital 647
Hewlett-Packard Company, Sanborn Division 689
Hynson, Westcott & Dunning, Inc 627
Lederle Laboratories, A Division of
American Cyanamid Company .... 634-635,
648-649, 652, 662
Lilly, Eli, and Company 664
Medical Opportunities 730
The Medical Protective Company 647
Neisler Laboratories, Inc., Subsidiary of
Union Carbide Corporation 630-631
North, The Emerson A., Hospital Inc 640
Parke, Davis & Company Inside Front Cover
Pharmaceutical Manufacturers
Association 650, 745
Philips Roxane Laboratories 655-656
Pitnam-Moore, Division of
Dow Chemical Company 743
Roche Laboratories, Division of
Hoffmann-La Roche Inc Back Cover
Sanborn Division,
Hewlett-Packard Company 689
Searle, G. D., & Company 690-691
Smith Kline & French Laboratories 659
Squibb, E. R., & Sons 641, 661
Turner & Shepard, Inc 741
Tutag, S. J., & Co 638
The Vale Chemical Company, Inc 642
Wallace Laboratories 639, 663
The Wendt-Bristol Company 742
West-ward, Inc 752
Windsor Hospital 733
Winthrop Laboratories 628
Table of Contents
(Continued From Page 629)
Page
633 Ohioans Inducted into Fellowship by American
College of Physicians
633 New Members of the Association
638 AMA Takes Responsibility for Project Vietnam
638 Director Is Named for AMA Health Care
Services
642 Environmental Health Project Authorized for
Cincinnati
648 Current Comments in the Field of the Drug
Manufacturers
660 Army Medical Department Issues Edition in
History Series
660 1966 Edition of New Drug Text Is Available
from AMA
660 OSU Alumni Honored
694 Ohio State Heart Association Elects Officers
730 Department Chairman Named at Western
Reserve
724 Drug Firm Foundation Promotes Career
Selection Program
732 Obituaries
733 Heart Group Offers Handbook on Low-Sodium
Diets
736 AMA Medical and Health Films Being Shown
at Record Rate
737 Activities of County Medical Societies
738 Director Is Named at Ohio State for Allied
Medical Services
744 'When a Fellow Needs a Friend!”
746 Roster of State Association Officers and
Committeemen
747 Roster of County Medical Society Officers and
Meeting Dates
749 Dr. Washam Named Executive Secretary of
The State Medical Board
749 Roster of Woman’s Auxiliary State Officers
750 The Journal’s Advertisers in This Issue
751 Classified Advertisements
751 Foundation Grant Furthers Study Of
Prematurity at OSU
Diabetic Detection
"Finding the Hidden Diabetic” is the title of a
new 39-minute sound film aimed at professional audi-
ences and produced as an educational sendee of the
Upjohn Company. Among four discussants pre-
sented in the film is Dr. Gerald T. Kent, Western
Reserve University School of Medicine, who also acts
as moderator of the panel. Requests for the film and
also for brochures on the subject may be addressed
to: Diabetes Detection Program, Room 914, 342
Madison Avenue, New York, N. Y. 10017.
750
The Ohio State Medical Journal
‘Oie I
OHIO STATE MEDICAL (
journal |
OSMA OFFICERS m
President H§
Lawrence C. Meredith, M. D. §j
205 Elyria Block, Elyria 41035 ^
President-Elect g
Robert E. How ard, M. D. J
2500 Central Trust Tower, II
Cincinnati 45202 g
Past President 3
Henry A. Crawford, M. D. 3
1058 Hanna Bldg., Cleveland 44115 3
Treasurer Wk
Phii.ii* B. Hardymon, M. D. 3
350 E. Broad St., Columbus 43215 g
EDITORIAL STAFF
Editor gj
Perry R. Ayres, M. D. gj
Managing Editor and g|
Easiness Manager g
Hart E. Pace g
Executive Editor and Jgj
Executive Business Manager g
R. Gordon Moore
Table of Contents
Pase Scientific Section
795 Palliation for Pelvic Carcinoma. A Study of Isolated
Pelvic Perfusion with Chemotherapeutic Agents.
Robert N. Swaney, M. D., and William G. Pace,
M. D., Columbus.
797 "Hippocrates.” [A short poem] Marie Markle, Dayton,
Ohio.
798 Brain Scanning. D. Bruce Sodee, M. D., Cleveland.
i
805 Obesity. Phenmetrazine Effect Without Dietary Restric-
tion. John R. Huston, M. D., Columbus.
808 Intussusception of Small Bowel on a Cantor Tube. Re-
port of a Case. Noel Purkin, M. D., and Samuel S.
Teitelbaum, M. D., Cleveland.
811 Pregnancy in Acute Leukemia. Report of a Case. T. D.
Stevenson, M. D., William C. Rigsby, M. D., Colum-
bus, and D. P. Smith, M. D., Sycamore.
814 A Clinicopathological Conference from The Ohio State
University Hospital, Columbus, Ohio.
782 The Historian’s Notebook: Health Officers of Cincin-
nati, Ohio, and the Problems of Their Day — 1900
to I960. (Part II.) Kenneth I. E. Macleod, M. D.,
Cincinnati.
OSMA EXECUTIVE STAFF 3
Executive Secretary j
Hart F. Pace 3
Director of Public Relations and =
Assistant Executive Secretary 3
Charles W. Edgar gj
Administrative Assistants g
W. Michael Traphagan 3
Herbert E. Gillen g
Jerry J. Campbell |g
Address All Correspondence: g
The Ohio State Medical Journal g
17 South High Street, Suite 500 M
Columbus, Ohio 43215 g
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
News and Organization Section
822 New Public Health Regulations on PKU Testing in Ohio
Text of Regulation HE-45-01
Information for Hospitals and Physicians (Page 823)
Screening Factors to Consider (Page 824)
827 New Executive Secretary Takes Office with State Medi-
cal Board
Published monthly under the direction of the
Council for and by members of The Ohio State
Medical Association, 17 South High Street, Suite
500, Columbus, Ohio 43215, a scientific society,
nonprofit organization, with a definite member-
ship for scientific and educational purposes.
Subscription, $6.00 per year to non-members;
single copy, 50 cents (outside Continental U.S.,
$7.50 and 75 cents).
Entered as second class matter July 5, 1905, at
the Postoffice at Columbus, Ohio, under the Act
of Congress of March 3, 1879; Acceptance for
mailing at special rate of postage provided for in
Section 1103, Act of Oct. 3, 1917. Authority
July 10, 1918.
The Journal does not assume responsibility for
opinions expressed by the essayists. Advertisers
must conform to policies and regulations estab-
lished by The Council of the Ohio State Medical
Association.
828 'Horse and Buggy’ Doctor Retires after 57 Years
829 State Association Scholarships Awarded to Two Medical
Students
830 Ohioan Is Named President-Elect of Woman’s Auxiliary
to the AMA; Other Woman’s Auxiliary Highlights
( Continued on Page 850)
STONEMAN PRESS, COLUMBUS. OHIO
PRINTED
H_ IN U S A
plus important supportive
benefits that help her through
those critical early months
of oral contraception
low incidence of side effects
Low incidence of BTB and spot-
ting, nausea and amenorrhea
tends to minimize side effect
problems and increases patient
cooperation.
no confusion about dosage
An unbreakable “confusionproof”
package makes it easy to adhere
to prescribed dosage schedule: in-
dividually sealed tablets numbered
from 1 through 20 plus monthly
calendar record enables patient
to double-check dosage intake by
day and corresponding tablet num-
Contraindications: Thrombophlebitis or pul-
monary embolism (current or past). Exist-
ing evidence does not support a causal
relationship between use of Norinyl and
development of thromboembolism. While
a study which was conducted does not
resolve definitively the possible etiologic
relationship between progestational agents
and intravascular clotting, it tends to con-
firm the findings of the Ad Hoc Advisory
Committee appointed by the Food and
Drug Administration to review this possi-
bility. Cardiac, renal or hepatic dysfunc-
tion. Carcinoma of the breast or genital
tract. Patients with a history of psychic
depression should be carefully studied and
the drug discontinued if depression recurs
to marked degree. Patients with a history
of cerebral vascular accident.
Warning: Discontinue medication pending
examination if there is sudden partial or
complete loss of vision, or if there is a
sudden onset of proptosis, diplopia or mi-
graine. If examination reveals papilledema
or retinal vascular lesions, medication
should be withdrawn.
Precautions: By May 1963, experience with
norethindrone 2 mg.— mestranol 0.1 mg.
had extended over 24 months. Through
miscalculation, omission or error in taking
the recommended dosage of Norinyl, preg-
nancy may result. If regular menses fail
to appear and treatment schedule has
not been adhered to, or if patient misses
two menstrual periods, possibility of preg-
nancy should be resolved before resuming
Norinyl. If pregnancy is established,
Norinyl should be discontinued during
period of gestation since virilization of the
female fetus has been reported with oral
use of progestational agents or estrogen.
When lactation is desired, withhold
Norinyl until nursing needs are established.
Existing uterine fibroids may increase in
size. In metabolic or endocrine disorders,
careful clinical preevaluation is indicated.
A few patients without evidence of hyper-
thyroidism had elevated serum protein-
bound iodine levels, which in the light of
present knowledge, does not necessarily
imply hyperthyroidism. Protein-bound
iodine increased following estrogen admin-
istration. Bromsulphalein retention has oc-
curred in up to 25% of patients without
evidence of hepatic dysfunction. Studies
from 24-hour urine collections have
shown an increase in aldosterone and 17-
ketosteroids and decrease in 17-hydroxy-
corticoid levels. Thus, Norinyl should be
discontinued prior to and during thyroid,
liver or adrenal function tests. Because
progestational agents may cause fluid re-
tention, conditions such as epilepsy,
migraine and asthma require careful obser-
vation. Thus far no deleterious effect on
pituitary, ovarian or adrenal function has
been noted; however, long-range possible
effect on these and other organs must
await more prolonged observation.
Norinyl should be used with caution in
patients with bone, renal or any disease in-
volving calcium or phosphorus metabolism.
Side Effects: Intermenstrual bleeding;
amenorrhea; symptoms resembling early
pregnancy, such as nausea, breast engorge-
ment or enlargement, chloasma and minor
degree of fluid retention (if these should
occur and patient has not strictly adhered
to medication plan, she should be tested
for pregnancy); weight gain; subjective
complaints such as headache, dizziness,
nervousness, irritability; in a few patients
libido was increased. In a total of 3,090
patients, 2.2% discontinued medication be-
cause of nausea.
NOTE: See sections on contraindications
and precautions for possible side effects
on other organ systems.
Dosage and Administration: One Norinyl
tablet orally for 20 days, commencing on
day 5 through and including day 24 of the
menstrual cycle. (Day 1 is the first day of
menstrual bleeding.)
Availability: Dispensers of 20 and 60 tab-
lets; bottles of 100.
References: 1. Council on Drugs. JAMA 187:664 (Feb.
29) 1964. 2. Brvans, F. E.: Canad Med Ass J 92:287
(Feb. 6) 1965. 3. Goldzieher, J. W.: Med Clin N Amer
48:529 (Mar.) 1964. 4. Cohen, M. R.: Paper presented
at Symposium on Low-Dosage Oral Contraception, Palo
Alto, Calif., July 15, 1965. Reported in Med Sci 16:26
(Nov.) 1965. 5. Hammond, D. 0.: Ibid. 6. Rice-Wray, E..
Goldzieher, J. W., and Aranda - Rosell, A.: Fertil Steril
14:402 (Jul.-Aug.) 1963. 7. Goldzieher, J. W., Moses,
L. E , and Ellis. L. T.: JAMA 180:359 (May 5) 1962.
8. Kempers, R. D.: GP 29:88 (Jan.) 1964. 9. Tyler, E. T.:
JAMA 187:562 (Feb. 22) 1964. 10. Rudel, H. W., Mar-
ti nez-M ana utou, J., and Maqueo-Topete, M .: Fertil Steril
16:158 (Mar. -Apr.) 1965. 11. Flowers, C. E., Jr.: N
Carolina Med J 25:139 (Apr.) 1964. 12. Goldzieher, J.
W.: Appl Ther 6:503 (June) 1964. 13. The Control of
Fertility. Report adopted by the Committee on Human
Reproduction of the American Medical Association. JAM A
194:462 (Oct. 25) 1965. 14. Flowers. C. E., Jr.: JAMA
188:1115 (June 29) 1964. 1 5. Merritt, R. I.: Appl Ther
6:427 (May) 1964. 16. Newland. D. O.: Paper presented
at Symposium on Low-Dosage Oral Contraception, Palo
Alto, Calif., July 15, 1965. Reported in Med Sci 16:26
(Nov.) 1965.
norethindrone — an original steroid from
SYNTEXE3
LABORATORIES INC. .PALO ALTO. CALIF
Norinyl
(norethindrone 2 mg c mestranol %/0 1 mg )
for multiple contraceptive action
for August, 1966
7^3
October 16-22 Is Designated as
Community Health Week
The American Medical Association has officially
designated a period in mid-October with the recom-
mendation that County Medical Societies develop
plans for Community Health Week.
F. J. L. Blasingame, Executive Vice-President of
the AM A, addressed an open letter to County Medi-
cal Society officers and certain others in regard to
this matter. The letter follows:
"The Board of Trustees has officially designated the
week of October 16-22 as Community Health Week
— 1966 and established the corresponding week for
the observance of Community Health Week in future
years.
"We urge all state and county medical societies to
develop appropriate programs marking this fourth
annual observance of Community Health Week to
encourage other members of the community health
team to join with them in planning and carrying out
activities.
"Community Health Week is a time for all local
members of health professions and health organiza-
tions— public, private and voluntary — to conduct
communitywide activities emphasizing the continuing
theme of the observance — "Teaming Up for Better
Health.”
"Primary objectives of this nationwide observance
are to stimulate greater public awareness and ap-
preciation of the wealth of health facilities and serv-
ices which are available at the community level and
to stress the health progress and medical advances
which have been made locally through the united
efforts of all members of the community health team.
"We are again advising national health organ-
izations and state and territorial health departments
of our plans and encouraging them to participate ac-
tively in the promotion. We also are notifying them
that their component local groups may be invited
to participate wherever local observances are planned.
"To assist you in planning, we shall again prepare
a kit of program suggestions and promotion mate-
rials. Promotional aids for 1966 will be concentrated
on two appropriate local themes — the expanding
career opportunities in medicine and its allied fields
and overcoming preventable disease, with special em-
phasis on measles immunization and control of VD.
"If conflicting events make it impractical for your
medical society7 to observe Community Health Week
at the regularly scheduled time, we recommend that
you schedule your local observance at another time
close to the October 16-22 date so that you can derive
maximum benefit from national publicity.”
Dr. John W. Coles, Jr., practicing physician at
Loudonville, has been named assistant dean for stu-
dent affairs at Temple University School of Medi-
cine, Philadelphia.
Bamadex® Sequels®
Contraindications: In hyperexcitability and in agi-
tated prepsychotic states. Previous allergic or
idiosyncratic reactions.
Precautions: Use with caution in patients hyper-
sensitive to sympathomimetic compounds, who
have coronary or cardiovascular disease, or are
severely hypertensive.
Dextro-amphetamine sulfate: Use by unstable in-
dividuals may result in psychological dependence.
Meprobamate: Careful supervision of dose and
amounts prescribed is advised; especially for pa-
tients with known propensity for taking excessive
quantities of drugs. Excessive and prolonged use
in susceptible persons, e.g. alcoholics, former ad-
dicts, and other severe psychoneurotics, has been
reported to result in dependence. Where excessive
dosage has continued for weeks or months, re-
duce dosage gradually. Sudden withdrawal may
precipitate recurrence of pre-existing symptoms
such as anxiety, anorexia, or insomnia; or with-
drawal reactions such as vomiting, ataxia, trem-
ors, muscle twitching and, rarely, epileptiform
seizures. Should meprobamate cause drowsiness
or visual disturbances, reduce dose — operation of
motor vehicles, machinery or other activity re-
quiring alertness should be avoided. Effects of
excessive alcohol consumption may be increased
by meprobamate. Appropriate caution is recom-
mended with patients prone to excessive drinking.
In patients prone to both petit and grand mal
epilepsy meprobamate may precipitate grand mal
attacks. Prescribe cautiously and in small quanti-
ties to patients with suicidal tendencies.
Side Effects: Overstimulation of the central nerv-
ous system, jitteriness and insomnia or drowsiness.
Dextro-amphetamine sulfate: Insomnia, excita-
bility, and increased motor activity are common
and ordinarily mild side effects. Confusion, anx-
iety, aggressiveness, increased libido, and halluci-
nations have also been observed, especially in
mentally ill patients. Rebound fatigue and de-
pression may follow central stimulation. Other
effects may include dry mouth, anorexia, nausea,
vomiting, diarrhea, and increased cardiovascular
reactivity.
Meprobamate: Drowsiness may occur and can be
associated with ataxia, the symptom can usually
be controlled by decreasing the dose, or by con-
comitant administration of central stimulants.
Allergic or idiosyncratic reactions: maculopapu-
lar rash, acute nonthrombocytopenic purpura
with petechiae, ecchymoses, peripheral edema
and fever, transient leukopenia. A case of fatal
bullous dermatitis, following administration of
meprobamate and prednisolone, has been re-
ported. Hypersensitivity has produced fever,
fainting spells, angioneurotic edema, bronchial
spasms, hypotensive crises (1 fatal case), anuria,
stomatitis, proctitis (1 case), anaphylaxis, agranu-
locytosis and thrombocytopenic purpura, and a
fatal instance of aplastic anemia, but only when
other drugs known to elicit these conditions were
given concomitantly. Fast EEG activity, usually
after excessive dosage. Impairment of visual ac-
commodation. Massive overdosage may produce
drowsiness, lethargy, stupor, ataxia, coma, shock,
vasomotor, and respiratory collapse.
764
The Ohio State Medical Journal
Diagnosis:
cystitis?
pyelonephritis?
pyelitis?
urethritis?
prostatitis?
/ case,
ram-negative!
q.i.d.
Indications: Urinary tract infections caused by gram-negative and some gram-
positive organisms.
Side effects: Mainly mild, transient gastrointestinal disturbances; in
occasional instances, drowsiness, fatigue, pruritus, rash, urticaria, mild
eosinophilia, reversible subjective visual disturbances (overbrightness of
lights, change in visual color perception, difficulty in focusing, decrease in
visual acuity and double vision), and reversible photosensitivity reactions.
Marked overdosage, coupled with certain predisposing factors, has produced
brief convulsions in a few patients.
Precautions: As with all new drugs, blood and liver function tests are advis-
able during prolonged treatment. Pending further experience, like most
chemotherapeutic agents, this drug should not be given in the first trimester
of pregnancy. It must be used cautiously in patients with liver disease or
severe impairment of kidney function. Because photosensitivity reactions have
occurred in a small number of cases, patients should be cautioned to avoid
unnecessary exposure to direct sunlight while receiving NegGram, and if a
reaction occurs, therapy should be discontinued. The dosage recommended
for adults and children should not arbitrarily be doubled unless under the
careful supervision of a physician. Bacterial resistance may develop.
When testing the urine for glucose in patients receiving NegGram, Clinistix®
Reagent Strips or Tes-Tape® should be used since other reagents give a
false-positive reaction.
Dosage: Adults: Four Gm. daily by mouth (2 Caplets® of 500 mg. four times
daily) for one to two weeks. Thereafter, if prolonged treatment is indicated,
the dosage may be reduced to two Gm. dally. Children may be given
approximately 25 mg. per pound of body weight per day, administered in
divided doses. The dosage recommended above for adults and children
should not arbitrarily be doubled unless under the careful supervision of a
physician. Until further experience is gained, infants under 1 month
should not be treated with the drug.
How supplied: Buff-colored, scored Caplets® of 500 mg. for adults, conve-
niently available in bottles of 56 (sufficient for one full week of therapy) and in
bottles of 1000. 250 mg. for children, available in bottles of 56 and 1000.
References: (1) Based on 23 clinical papers, 1512 cases. Bibliography on
request. (2) Bush, I. M., Orkin, L. A., and Winter, J. W., in Sylvester, J. C.:
Antimicrobial Agents and Chemotherapy — 1964, Ann Arbor, American
Society for Microbiology, 1965, p. 722.
Winthrop Laboratories, New York, N. Y. 10016
NegGram
Brand of
nalidixic acid
a specific anti-gram-negative
eradicates most urinary
tract infections...
• Low incidence of untoward effects; no fungal
overgrowth, crystalluria, ototoxic or nephrotoxic
effects have been observed.
• “Excellent” or “good” response reported in
more than 2 out of 3 patients with either chronic
or acute gram-negative infections.1
*As many as 9 out of 10 urinary tract infections are now caused
by gram-negative organisms: E. coli, Klebsiella, Aerobacter,
Proteus, Paracolon or Pseudomonas2. . . However, infections of the
urethra and prostate caused by non-gonococcal gram-negative
organisms are believed to be less prevalent.
Ohio Physician as Film Participant
Discusses the "‘Flabby” Male
Dr. Herman K. Hellerstein, associate professor of
medicine and director of the Fitness Evaluation Pro-
gram, Western Reserve University School of Medi-
cine, is one of the participants in a film, entitled
"Reconditioning of Coronary Prone and Coronary
Stricken Subjects.”
Dr. Hellerstein and his colleague on the film panel,
Dr. J. Willis Hurst, engage in an outspoken dis-
cussion on the "flabby” American male and the rea-
sons why he is in "dreadful” condition.
Dr. Hellerstein quotes from impressive statistical
evidence concerning the relationship of smoking to
heart disease, and emphasizes the responsibility of the
practicing physician to look for signs of the coronary
prone individual during the patient’s first office visit.
It is a doctor-to-doctor discussion and is aimed at
an audience of professional biomedical personnel.
This is one of a number of films produced under
direction of the U. S. Public Health Service and
available on a short-term loan basis from: Public
Health Service Audiovisual Facility, Atlanta, Georgia
30333; Attn.: Distribution Unit.
A $40,000 Milbank faculty fellowship has been
awarded to Western Reserve University School of
Medicine in the name of Dr. Eugene Vayda, senior
clinical instructor in preventive medicine.
Ohio State University Offers
Courses for Physicians
The Center for Continuing Medical Education of
the Ohio State University College of Medicine has
announced a number of postgraduate courses of in-
terest to physicians. Additional information may be
obtained by writing William G. Pace, M. D., direc-
tor of the center at 320 West Tenth Avenue in
Columbus.
Courses announced at this time are the following:
September 12-14 — Medical Education Seminar
September 15-17 — Otolaryngology
September 19-21 — Practical Perimetry
September 22-24 — Contact Lens Seminar
October 26 — Diabetes Seminar
October 31 - November 23 — Board Refresher
Course in Psychiatry
November 17 — Muscular Dystrophy
* * *
Four physician faculty members in the Ohio State
University College of Medicine were promoted to
professor effective July 1.
They are: Dr. Robert J. Atwell, Department of
Medicine; Dr. William A. Newton, Jr., Department
of Pathology; Dr. Martin D. Keller, Department of
Preventive Medicine; and Dr. Howard D. Sirak, De-
partment of Surgery.
Hall
Established 1916
Asheville, North Carolina
An institution for the diagnosis and treatment of psychiatric and neurological illnesses,
rest, convalescence, drug and alcohol habituation. There are ample facilities for classification
of patients
Insulin coma, electroshock, psychotherapy, occupational and recreational therapy are employed. The
hospital is equipped with complete laboratory facilities, including: electroencephalography and x-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town in the beautiful Smoky
Mountain Range, an ideal location for rehabilitation.
WM. RAY GRIFFIN, Jr., M. D. MARK A. GRIFFIN, Sr., M. D.
ROBERT A. GRIFFIN, M. D. MARK A. GRIFFIN, Jr., M. D.
For rates and further information write APPALACHIAN HALL, Asheville, N. C.
778
The Ohio State Medical Journal
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for August, 1966
781
The Historian’s Notebook
Health Officers of Cincinnati, Ohio
And the Problems of Their Day
1900 to 1960
KENNETH I. E. MACLEOD, M. D., M.P.H.*
PART II
( Continued From July Issue )
T
^HE importance of school nursing was every-
where being stressed "the value of their work
being immediately demonstrated.” Fifteen pub-
lic and six parochial schools "are presently supplied,
eight more than were supplied in the previous year,”
Dr. Landis reported.
1911
A total of nearly 14,500 specimens were examined
in the Public Health Laboratory, an increase of over
79 per cent over the previous year. The improve-
ment, in consequence in the quality of the milk
supply, "is shown both chemically and bacteriologi-
cally ...”
An outbreak of poliomyelitis in 1911 caused the
city much worry. There were 103 cases with 38
deaths.
The opening of "the first open-air school” was
heralded by Dr. Landis as "the most important step
in the anti-tuberculosis campaign . . .”
In 1912, according to the Bureau of the Census,
Cincinnati had an estimated population of 394,650.
The death rate that year was 16.34 per 1,000 popula-
tion, and the birth rate per 1000 live births was
19.93.
The district physicians were placed on full time
in 1912, marking "the completion of a plan of re-
organization begun shortly after the new Board as-
sumed control in 1909 ...” But this was not for
the first time. There was a time in the 1880’s when
they had also been on full time.
The School Nurse
Dr. Landis, quite enthusiastic about the role of the
school nurse in promoting the health of the school
child, wrote in his annual report in 1912:
The school nurse is the connecting link between the school
and the home. She is the teacher of parents, pupils and
families in practically applied hygiene. Her work prevents
*Dr. Macleod, Cincinnati, is Commissioner of Health, City of
Cincinnati.
Submitted March 16, 1966.
loss of time on the part of the pupil by reducing the number
of exclusions for contagious diseases. Many minor ailments,
when properly treated by the school nurse, will not prevent
the regular attendance of the child. She gives practical dem-
onstrations in the homes, or required treatments and fre-
quently finds the source of the trouble, which if undiscov-
ered, would render useless the work of the school physician.
Summer Pure Milk Stations
"The value of the Summer Pure Milk Stations” Dr.
Landis wrote, "demonstrates that the milk station
baby has a better chance for life during the hot
months than the baby of parents of average means
. . . 'Pure milk for babies of all classes’ would not
be a bad slogan ...”
1912
Among other matters of interest during 1912, Dr.
Landis noted that "three midwives were prosecuted
for failure to report promptly gonorrheal infection
in the newborn ...”
The Cincinnati Association for the Blind he praised
for "excellent service rendered not only to afflicted
individuals but to the community at large. Several
lives have been saved and 27 newborn babies were
rescued from a possible life of blindness . . .”
The Tuberculosis Dispensary operated conjointly
with the Anti-Tuberculosis League had done excel-
lent constmctive work. One thousand new patients
were examined; 5,700 home visits were made by the
nurses. But a survey of all cases
ascertained that the Municipal Hospital (Dunham) had been
the dumping ground for tuberculosis patients from our sister
cities . . . All cases reported are now investigated and no
patient may be admitted to the Municipal Hospital unless
he has had an admission card signed by the district physician.
In regard to the control of communicable disease,
and shades of a salaried medical service under social-
ized medicine, Dr. Landis wrote,
The surveillance over communicable diseases by men en-
gaged on "full time” has proven eminently more satisfactory
than the old way. The district physician cannot now be
accused of having ulterior motives and as a result, the feel-
782
The Ohio State Medical Journal
ing of the general practitioner toward the Health Depart-
ment is most friendly . . .
According to Dr. William H. Peters, the chief
School Medical Inspector,
dental inspection in our public and parochial schools was
carried on under the supervision of the Cincinnati Dental
Society. Examinations were carried out in 24 schools, and
nearly 12.000 children were examined and referred to pri-
vate dentists or to the Cincinnati Dental Clinic. There were
902 children treated at the Free Dental Clinic. An experi-
mental class was maintained in the Sixth School District to
show the necessity as well as the results which may be ob-
tained by proper hygienic mouth conditions . . .
In 1912 a system of barber shop inspections was
instituted. Bake shop inspection had been inaugu-
rated the previous year.
In 1912, there were 70 arrests and prosecutions
made for expectorating on the street cars and side-
walks.
Nearly 2,000 privy vaults were cleaned out, aban-
doned and filled with fill during the year, and 857
sewer connections were completed.
During the year, visits to immigrants and the
majority of fumigations were carried out by the
Medical Inspection Division.
The passage of a pasteurization requirement, mak-
ing it mandatory that all milk "not obtained from
tuberculin tested cows be pasteurized” was a singu-
larly important event.
A survey of tuberculosis cases during July and
August revealed the fact that
many patients have been attracted from outside the city by
the prospect of free treatment in the Tuberculosis Hospital,
which condition unquestionably contributes materially to our
heavy death rate fom this cause . . .
Dr. C. Bahlman, the Department’s Chemist and
Bacteriologist, noted that "all prosecutions have been
carried into the Police Court. Very satisfactory re-
sults were obtained. Of the 86 cases, 65 were con-
victed. The total fines assessed amounted to S3, 325.”
1913
An ice-strike during the summer forced the city to
place S5,000 to the credit of the Health Department
and the Council authorizing the Department "to buy,
sell and deliver ice to the people ...”
In an inter-city study of departmental organiza-
tion, etc., "the impression was received that the
Cincinnati Department of Health has set a much
higher general standard for appointment and sendee
than any of the cities answering the letter of
inquiry ...”
On tuberculosis control Dr. Landis wrote deplor-
ingly,
The slight effort of the various agencies engaged in anti-
tuberculosis work on the death rate seems to indicate the
advisability of employing other and additional methods in
combating it. The employment of an additional district
physician who shall devote his entire time to the epidemiol-
ogical study of this disease, is suggested . . .
On a need for improved industrial hygiene, Dr.
Landis pointed out that
this is of enormous importance to workmen, employees and
taxpayers. Many cases of disability and not a few deaths
could be prevented by employing experts to detect and cor-
rect unsanitary conditions in workshops and factories . . .
On venereal disease Dr. Landis was ’’pleased to
report that since the work of locating and quarantin-
ing cases in the hospital was begun, fewer advanced
cases are treated in the hospital and clinics and fewer
new cases are applying for treatment in their private
practice . . .” Two district physicians were placed
on "detached sendee” to investigate industrial hygiene
and to locate and quarantine actively infectious cases
of V. D.
There were 14 school nurses in the Department’s
employ in 1913 but the demand for an increase in
this sendee continued.
A sanitary inspector "to cover the suburbs” had
been given a motorcycle for this purpose. How-
ever, he had been involved in an accident and "this
mode of transportation was therefore abandoned.”
Need for Better Pay Stressed
Dr. Landis wrote with some vehemence on the fact
that higher pay was attracting men from the Division
of Food Inspection into the Federal agency concerned
with this work. He also noted that "lack of funds is
limiting the scope of usefulness of the laboratory.”
"No research work can be attempted because of the
mass of routine work . . . The salary of the Bacteri-
ologist should be increased and an assistant pro-
vided ...”
Dr. Peters, the Chief School Medical Officer, noted
that there were over 1,000 new cases of tuberculosis
during the year, 459 of them sent to the Tuberculosis
Hospital and 12 to St. Francis. The dispensary op-
erated jointly by the Health Department and the Anti-
Tuberculosis League served as a clearing house for
these patients.
On prostitution. Dr. Landis wrote:
During the month of February, 224 inmates of 49 houses
of prostitution were examined ... 65 per cent of those
found diseased were carrying on their occupation with certifi-
cates of health received by legally qualified physicians. All
diseased prostitutes were sent to "O” Ward at the City
Hospital. Certificates are misleading, giving a false sense of
security’ to patrons . . . and are responsible to some extent
for the spread of V. D. Common decenq* and the general
welfare of the public demands the wiping out of this perni-
cious system . . .
The total number of sick poor seen by the district
physician was 4,428. "In our efforts to minimize
charity, 96 were sent to family physicians. During
the year, 266 cases were referred to the visiting
nurses of the Department for the Prevention of
Blindness . . .”
The average daily attendance at the eight Milk Sta-
tions during the summer was 441. Twenty thousand
pamphlets on baby care were distributed. "Through
the generosity of Mrs. Charles P. Taft, 25,500 pints
of milk were sold at cost and 12,300 given away ...”
(To Be Continued in September Issue)
for August, 1966
785
SQUIBB MOTES ON THERAPY
Behind continued high blood pressure readings
lies the possibility of organic damage 3
MANY OF THE aspects of essential hypertension are
unpredictable— either because there are a number
of mechanisms involved or because individuals differ in
their responses to these mechanisms.1
There is one aspect of hypertension, however, that
seems, in many cases, predictable. . . when the blood
pressure is elevated to a marked degree for an adequate
period of time, this in itself leads to perpetuation of
the syndrome with resulting vascular damage through-
out the body.”14 All too often the disease progresses
until there is damage to one of three vital organs: the
heart, the kidney, the brain.
“Hypertension is certainly a major factor in the gene-
sis of coronary heart disease, and it is even more
important when compounded with obesity.”4
“[Vascular deterioration] can be clearly seen in the
kidney with a degree of damage that can be measured
by renal function studies.”10
. . most evidence suggests that reduction of blood
pressure, when it is too high, not only relieves the heart
of excess work but reduces vascular damage.”1
“In short, treatment is indicated.”1
Antihypertensive therapy will not restore the blood ves-
sels to normal. Yet many of the vascular changes and
symptoms caused by increased blood pressure may be
arrested or alleviated when the blood pressure is re-
duced to normotensive levels.7
Reducing the blood pressure helps curtail further vascu-
lar damage and improves the prognosis — when damage
is not too far advanced before therapy is started.14
Essential hypertension is an indication not only for
treatment, but for early and adequate treatment of the
patient in question.
Reduce the blood pressure with Rautrax-N
Rautrax-N combines the antihypertensive-tranquilizing
action of whole root rauwolfia with the antihypertensive-
diuretic action of bendroflumethiazide in one conven-
ient medication. The two drugs complement each other
so that smaller doses of both are possible.
Rauwolfia combined with bendroflumethiazide is par-
ticularly effective in long-term therapy,15'17 since bene-
ficial effects do not diminish with continuous daily
administration.
For most patients 1 or 2 Rautrax-N tablets daily are
sufficient for maintenance therapy. The simplicity, con-
venience and economy of such a dosage schedule are
of particular benefit to older patients.
References: 1. Page, I. H., and Dustan, H. P.: The Usefulness of Drugs in the
Treatment of Hypertension, in Ingelf inger, F. J.; Reiman, A. S., and Finland,
M.: Controversy in Internal Medicine, Philadelphia, W. B. Saunders Co.,
1966, p. 95. 2. Hollander, W.: The Evaluation of Antihypertensive Therapy
of Essential Hypertension in I ngelf inger, F. J.; Reiman, A. S., and Finland,
M.: Controversy in Internal Medicine, Philadelphia, W. B. Saunders Co.,
1966, p. 97. 3. Nickerson, M.: Antihypertensive Agents and the Drug Therapy
of Hypertension, in Goodman, L. S., and Gilman, A.: The Pharmacological
Basis of Therapeutics, ed. 3, New York, The Macmillan Co., 1965, p. 727.
4. Berkson, D. M.: Indust. Med. & Surg. 32:371, 1963. 5. Cohen, B. M.:
M. Times 91:645, 1963. 6. Lee, R. E., et al.: Am. J. Cardiol. 11:738, 1963.
7. Moyer, J. H.: Am. J. Cardiol. 9:821, 1962. 8. Moser, M.: New York J.
Med. 62:1177, 1962. 9. Wood, J. E., and Battey, L. L.: Am. J. Cardiol. 9:675,
1962. 10. Moyer, J. H., and Heider, C.: Am. J. Cardiol. 9:920, 1962. 11.
Moser, M., and Macaulay, A. I.: New York State J. Med. 60:2679, 1960.
12. Judson, W. E.: Nebraska M. J. 44:305, 1959. 13. Hodge, J. V.; McQueen,
E. G., and Smirk, H.: Brit. M. J. 1:5218, 1961. 14. Moyer, J. H., and Brest,
A. N.: Hypertension Recent Advances, Philadelphia, Lea & Febiger, 1961,
p. 633. 15. Berry, R. L., and Bray, H. P.: J. Am. Geriatrics Soc. 10:516,
1962. 16. Reid, W. J.: J. Am. Geriatrics Soc. 13:365, 1965. 17. Feldman,
L. H.: North Carolina M. J. 23:248, 1962.
Contraindications: Severe renal impairment or previous hypersensitivity.
Warning: Ulcerative small bowel lesions have occurred with potassium-
containing thiazide preparations or with enteric-coated potassium salts sup-
plementally. Stop medication if abdominal pain, distension, nausea, vomiting
or G.l. bleeding occur.
Precautions and Side Effects: The dose of ganglionic blocking agents, vera-
trum or hydralazine when used concomitantly must be reduced by at least
50% to avoid orthostatic hypotension. Caution is indicated in patients
with depression, suicidal tendencies, peptic ulcer; electrolyte disturbances
are possible in cirrhotic or digitalized patients. Marked hypotension during
surgery is possible; consider discontinuing two weeks prior to elective surgery
and observe patients closely during emergency surgery. Rauwolfia prepara-
tions may cause reversible extrapyramidal symptoms and emotional depres-
sion, diarrhea, weight gain, edema, drowsiness may occur. Bendroflumethia-
zide may cause increases in serum uric acid, unmask diabetes, increase
glycemia and glycosuria in diabetic patients, and may cause hypochloremic
alkalosis, hypokalemia; cramps, pruritus, paresthesias, rashes may occur.
Dosage and Supply: Initial dosage, 1 to 4 tablets daily, preferably at meal-
time. Maintenance, 1 or 2 tablets daily. Rautrax-N is supplied as capsule-
shaped tablets containing 50 mg. Rauwolfia serpentina whole root (Rau-
dixin®), 4 mg. bendroflumethiazide (Naturetin®), 400 mg. potassium chloride.
Also available: Rautrax-N Modified — capsule-shaped tablets containing
50 mg. Rauwolfia serpentina whole root (Raudixin), 2 mg. bendroflumethia-
zide (Naturetin), 400 mg. potassium chloride. Both potencies available in
bottles of 100. For full information, see Product Brief.
RAUTRAX- N
Squibb Rauwolfia Serpentina Whole Root (50 mg.) with Bendro-
flumethiazide (4 mg.) and Potassium Chloride (400 mg.)
Squibb
OSMA Executive Secretary Is Named
On Two National Committees
Hart F. Page, Executive Secretary of the Ohio State
Medical Association, has been named to a newly or-
ganized liaison committee between the Medical So-
ciety Executives Association and the American Medi-
cal Association.
The MSEA-AMA Liaison Committee was created
after months of planning on the part of MSEA of-
ficers, Dr. F. J. L. Blasingame, Executive Vice-Presi-
dent of the AMA, Aubrey Gates, director of AMA
Field Services, and other AMA personnel.
The purpose of this new committee is to contribute
to the improvement and strengthening of relationship
between AMA staff members and executive personnel
of state and county medical society headquarters of-
fices. The committee will meet several times a year
with AMA staff personnel on the division level.
The Medical Society Executives Association is an
organization of executive secretaries and other execu-
tive personnel of state and county medical societies,
and related groups.
Mr. Page earlier this year was named a member
of the Advisory Committee to the Director of the
AMA’s Communications Division. This nine-man
committee of medical society executives also meets
several times a year, goes over plans for the public
relations activities of the AMA, and provides advice
to the director of the Communications Division on
other matters.
Grand prize winner among 69 exhibits shown at
the recent 6 1st annual American Urological Associa-
tion meeting in Chicago was an entry from the Uni-
versity of Cincinnati Medical Center Division of
Urology. Dr. Arthur T. Evans, director of the Di-
vision, and Dr. Joseph M. Malin, Jr., chief resident
in urology, prepared the exhibit, "A Teaching Aid
to Prostatic Surgery.”
Blue Shield Symbol Protected
By Appeals Court Decision
The National Association of Blue Shield Plans won
a key court decision to protect the Blue Shield name
and symbol.
According to NABSP, the Fifth United States Cir-
cuit Court of Appeals on June 16 reversed a lower
court decision permitting the United Bankers Life
Insurance Company, a Texas firm, to use the name
and symbol "Red Shield.”
The higher court ruled that the words and the
symbol "Red Shield” are confusingly similar to Blue
Shield. United Bankers is selling its "Red Shield”
health insurance in competitiotn with Group Medical
& Surgical Service, the Texas Blue Shield Plan which
was a coappelant in the suit.
The National Association of Blue Shield Plans is
the national coordinating organization for the 74 Blue
Shield Plans in the United States that provide prepaid
medical and surgical care benefits to 53 million
persons.
Life Insurance Medical Research Fund
Sponsors Grants and Fellowships
The Life Insurance Medical Research Fund will
award more than $1.5 million in scientific grants and
fellowships during the coming year.
A total of 58 medical research projects will re-
ceive grants during the 1966-67 academic year. New
fellowships will go to 20 unusually promising medi-
cal students.
The grants and fellowships are provided through
the contributions of more than 140 life insurance
companies in the United States and Canada.
One of the research grants goes to Western Re-
serve University for studies by Dr. Harry Rudney on
biosynthesis of isoprenoid precursors of cholesterol
and ubiquinone; $33,000.
Fellowships go to two Ohio students: Karen R.
Leininger, Columbus; and Scott Ik Monroe, Cleveland.
Accredited by The Joint Commission on Accreditation of Hospitals.
WINDSOR HOSPITAL
A NONPROFIT CORPORATION
— ESTABLISHED 1 8 9 8 —
Chagrin Falls, Ohio 44022
247-5300 (Area Code 216)
A hospital for the treatment
of Psychiatric Disorders
Booklet available on request.
JOHN H. NICHOLS, M. D., Medical Director G. PAULINE WELLS, R. N., Admin. Director HERBERT A. SIHLER, Jr., Pres.
MEMBER: American Hospital Association — National Association of Private Psychiatric Hospitals — Ohio Hospital Association
for August, 1966
791
New drugs take exams, too.
Today, virtually every medical school in the
United States cooperates with pharmaceutical
manufacturers in the clinical evaluation of new
and promising drugs. Just as you might find it
significantly more difficult to practice medicine
without the useful new compounds made avail-
able through original pharmaceutical research
in the past twenty years — prescription-drug
manufacturers would find it equally difficult to
obtain extensive, long-term, dependable evalu-
ations of new therapeutic agents without the
close cooperation of medical staffs and clinical
facilities of medical schools and teaching hos-
pitals. Such cooperation leads toward more
effective care of more patients — the common
goal of medical and pharmaceutical research —
toward reduction in the cost of disease, toward
increase in useful longevity.
This message is brought to you as a courtesy of this publica-
tion on behalf of the producers of prescription drugs.
Pharmaceutical
Manufacturers Association
Pharmaceutical
Advertising Council
1155 Fifteenth St.. N. W„ Washington, D.C. 20005
Palliation for Pelvic Carcinoma 1
A Study of Isolated Pelvic Perfusion
With Chemotherapeutic Agents
ROBERT N. SWANEY, M. D., and WILLIAM G. PACE, M. D.
OVER the past three years, pelvic perfusion
with chemotherapeutic agents has provided
various degrees of palliation of pelvic pain
secondary to advanced pelvic carcinoma. The per-
fusions were performed on 2 6 patients at the Ohio
State University Hospital. Three patients were per-
fused a second time for recurrence of pain several
months later. The procedure was selected because
of recurrent carcinoma which was refractor)7 to all
other therapy. Most of these patients had been given
maximum irradiation to the pelvis and many were
addicted to narcotics for the control of pain.
Unfortunately, systemic chemotherapeutic agents
are relatively ineffective in controlling pelvic pain.
Chordotomy, especially for the control of bilateral
pain, is fraught with complications.
Early attempts to isolate the pelvic circulation
carried a high rate of leakage from the system. In
1962 Martin and White demonstrated excellent con-
trol of leakage in an isolated pelvic circuit. With the
development of the abdominal-extremity tourniquet1
isolation technique, we are now able to deliver high
doses of chemotherapeutic agents to a localized area.
Since this technique effectively isolates the blood
supply from the rest of the body,2 destruction of
the bone marrow is no longer a threat.
Patient Selection
The original lesion in 16 patients was carcinoma of
the cervix. It was in this group that the three re-
perfusions were performed for recurrence of pain.
Submitted October 5, 1965.
The Authors
• Dr. Swaney, Columbus, is Resident in Surgery,
The Ohio State University Hospitals.
• Dr. Pace, Columbus, is a member of the At-
tending Staff, Department of Surgery, The Ohio
State University Hospitals; Associate Professor of
Surgery, The Ohio State University College of
Medicine.
All patients in this group had had maximum irradia-
tion therapy and some, radical hysterectomy. The
universal complaint in this group was pain in the
back, pelvis, or legs, which required a high degree
of analgesic control. Hydronephrosis or complete
ureteral obstruction was a constant finding and was
usually located on the most painful side.
Five patients had pelvic recurrence from a primary
carcinoma of the colon or rectum.3 Some type of
resection or diverting colostomy had been performed
in this group. Pelvic pain and hydronephrosis were
fairly constant findings in this group also.
In a miscellaneous group of five patients, two had
carcinoma of the penis, two had recurrent melanoma
and melanoma metastatic in the pelvis, and one had
carcinoma of the bladder.
We have presently established strict criteria for pa-
tient selection. Body weight is the most important
single factor. Application of the abdominal tourni-
quet in an obese patient has proven to be unsuccess-
795
ful. Ideally, a candidate should weigh approximately
100 pounds. The patient must have significant pelvic
pain, which cannot be controlled with mild anal-
gesics. Recurrent disease must be localized to the
pelvis, and there must be no evidence of distant
metastases. The disease must not be amenable to
surgical or irradiation therapy. The general condi-
tion and cardiovascular status should be physiologi-
cally sound to withstand the procedure. Finally, the
patient should exhibit good mental stability.
Technique
The Hartford Corporeal Tourniquet was used to
isolate the pelvic circulation (Fig. 1). In the origi-
nal work on pelvic isolation, the tourniquet was
Fig. 1. Hartford Corporeal Tourniquet.
applied after a transabdominal incision was made to
prevent the small bowel from being crushed by the
tourniquet. This laparotomy has since been found
to be unnecessary, and we now use a closed technique
in which the tourniquet is applied to the intact mid-
abdominal wall. The tourniquet effectively occludes
the abdominal aorta, vena cava, and all soft tissue col-
lateral arteries and veins. The epidural plexus is oc-
cluded by instilling saline under pressure through a
radiopaque ureteral catheter placed in the epidural
space. Bilateral mid-thigh pneumatic tourniquets
complete the pelvic isolation (Fig. 2).
An extensive preoperative examination was carried
out, evaluating for metastatic disease and determining
the status of the urologic system by intravenous pye-
lography and cystoscopy. Contrast studies of the
lower and upper gastrointestinal tracts were routine.
Blood volume deficits were fully corrected. Four
days before perfusion, the patients were given a non-
residue diet and a nonabsorbable intestinal antibiotic.
Prior to surgery, a small radiopaque ureteral cath-
eter was positioned in the epidural space by a mem-
ber of the Anesthesia Department. The location
of the catheter was then confirmed by lateral roent-
genograms and the injection of an appropriate con-
trast material.
At the outset of the operative procedure, clotting
time was controlled with heparin. The femoral artery
and vein of each extremity was then isolated and
cannulated. Inflow and outflow circuits on both
sides were necessary because occlusion of the aortic
bifurcation by the tourniquet prevented adequate
perfusion to the opposite side of the pelvis. The
mid-torso tourniquet was then applied, and the pelvic
circuit was started on bypass. The epidural catheter
was simultaneously filled with saline, and a pressure
of 30. cm. of water was maintained. The pneumatic
tourniquets around the upper thighs were inflated to
complete the pelvic isolation circuit.
A tracer dose of radioactive material was added to
the perfusion circuit to monitor for possible leaks in
the system.
Once isolation of the pelvis was confirmed, 5-fluor-
ouracil, 20 mg/kg; methotrexate, 5 mg/kg; and
phenylalanine mustard, 1.5 mg/kg were added to
the perfusate and perfusion was maintained for one
hour. Initially all three chemotherapeutic agents
were used simultaneously; but in recent perfusions,
the chemotherapeutic agents were limited to 5-fluor-
ouracil and phenylalanine mustard. Periactin® was
added to the perfusate in order to increase the blood
flow to the tumor site. At the completion of the
perfusion, the pelvic circuit was flushed with saline
and albumin solution until the venous lines returned
a clear solution. After complete washout of drugs,
one unit of fresh whole blood was pumped back
into the pelvic circulation.
When the Hartford Tourniquet was removed,
there was invariably a transient fall in blood pressure.
After initial stabilization, the leg tourniquets were
removed, and the epidural space was decompressed.
Postoperative Morbidity
The morbidity associated with the pelvic per-
fusion is extremely low. One patient sustained a
79 6
The Ohio State Medical Journal
mesenteric tear; this patient was of short stocky
build and difficulty had been encountered in apply-
ing the tourniquet.
Postoperative ileus usually lasted 24 to 36 hours,
which compares favorably with most major surgical
procedures. Usually the patient had an onset of
diarrhea toward the end of the first postoperative
week and leukopenia was noted about the eighth to
twelfth day. This usually resolved in four or five
days. Most patients were ambulator}7 on the second
postoperative day, and little or no analgesic control
was required. In all cases the original pelvic pain
was relieved.
Results
Over the past three years, 26 patients have been
perfused by this method. The majority of the pa-
tients have had advanced carcinoma of the cervix.
Three of these have had a second perfusion for a
total of 29 perfusions.
In a total of 29 perfusions, there have been four
deaths within 30 days. In all 29 perfusions, pelvic
pain was completely relieved immediately after this
procedure. The relief has lasted from several months
to two years. During this period the patient has
been able to live a reasonably comfortable and use-
ful life. In some cases there was a disappearance
of hydronephrosis which was secondary to ureteral
obstruction by tumor.
Five patients have presented with advanced car-
cinoma of the rectum recurrent in the pelvis with-
out distant metastasis. One member of this group
is alive and well more than two years after perfusion.
She has been able to maintain her full secretarial
duties and is free of pain. Her pelvic mass has di-
minished since the time of perfusion. Her only
complication was a colostomy stricture, which re-
quired revision six months after perfusion.
One patient died of toxicity and sepsis five days
after perfusion. Difficulty had been encountered
writh both the tourniquet and the epidural catheter
because of obesity. The perfusion had been dis-
continued when it became evident there was a mod-
erate leak.
The last three perfusions do not have long term
follow-up, but pain relief has been significant.
Summary
In the closed system outlined here, total isolation
of the pelvis has permitted perfusion of the pelvis
with chemotherapeutic agents up to 90 minutes with
no evidence of leak. This procedure has been carried
out 29 times in 26 patients. The results have been
gratifying in that some selected patients with ad-
vanced pelvic carcinoma have enjoyed additional
months of pain-free, useful living.
From the Department of Surgery, The Ohio State Univer-
sity Hospitals. Columbus, Ohio. Supported by a grant from
the Hartford Foundation to the Midwest Foundation for Re-
search and Education. Ohio State University Development
Fund #521806, and in part by the P. H. S. Research Grant
#FR-34, Clinical Research Center, Ohio State University
Hospitals.
References
1. Lawrence, W., Jr.; Kuehn, P.; Masle, E. T., and Miller, D.
G. : An Abdominal Tourniquet For Regional Chemotherapy. /. Surg.
Res., 1:142-151 (July) 1961.
2. Martin, D. S., and White, H. M., Jr^ Control of Leak in
Pelvic Perfusion. Cancer Chemotherapy Reports, 16:553-555 (Feb.)
1962.
3. Pace, William G., and Knoernschild, H.: Pelvic Perfusion
and Carcinoma of the Rectum. Amer. ]. Surg., 109:52-56 (Jan.)
1965.
Hippocrates
• His ivas the torch from which a thousand fires
Took flattie and flourished through the ancient past;
Who flared the first of superstition’s pyres
The knowledge of the doctors’ world recast.
A true physician, worthy of his calling
And dedicated to his healing art,
He found the treating practices appalling,
And hastened to inject his wiser part.
• His teas the pen to set down rules of living
That rightly followed must bring strength again:
A sound mind in a healthy body giving
The victory over suffering and pain.
His teas the wisdom, born of inspiration
And nourished with foresight and common-sense,
That marked his path so every generation
Could follow in his steps with confidence.
— Marie Markle, 637 North Avenue, Dayton, Ohio 45426.
for August, 1966
797
Brain Scanning
D. BRUCE SODEE, M.D.
RADIOISOTOPE brain scanning seeking surgi-
cally correctable lesions has become a recog-
- nized aid in diagnosis.1'3 However, with the
refinement in scanning equipment most investigators
are now seeking the vascular anatomy of the brain as
well as isolating brain tumors. This paper will pre-
sent a simplified discussion of the scanning equip-
ment, radiopharmaceuticals, and the technical fac-
tors pertaining to brain scanning so the practitioner
can better understand this new diagnostic aid.
Scanning Equipment
Rectilinear Scanner
Many of the hospitals are equipped now with
rectilinear scanners which traverse back and forth
over the patient’s head. These scanners utilize 3 by 2
inch, 5 by 2 inch, or larger sodium iodide crystals,
which gather the isotopic data emitting from the pa-
tient. The information obtained may be displayed
on film, on a cathode storage tube, or may be
mechanically reproduced on paper. The defect of
rectilinear scanning is that we are over an area a
short period of time so that statistics or number of
counts that we record coming from the patient may
be limited.
Stationary Scanner
Stationary scanners are now under investigation in
several institutions. The stationary scanner utilizes
either a large diameter thin crystal or a large surface
phosphor as the detector. The information obtained
may also be displayed in several fashions. This sys-
tem can record information much more rapidly than
the rectilinear scanner. However, because of the
large area being viewed, it is most difficult to bring
out small lesions. Both of these scanning systems
will be utilized clinically for brain scanning.
Radiopharmaceuticals
R1SA I131 was one of the first successful radiophar-
maceuticals for brain scanning.4 However, its slow
clearance from the blood delayed the brain scanning
procedure for 24 hours. This radiopharmaceutical
has been shown to localize in tumors. However, with
Presented before the Ohio State Neurosurgical Society Meeting in
Columbus, May 14, 1965.
Submitted for publication December 31, 1965.
The Author
• Dr. Sodee, Cleveland, is Director, Nuclear
Medicine Department, Doctors Hospital and Ren-
ner Clinic Foundation, Cleveland, Ohio. Assist-
ant Clinical Professor of Radiology, George Wash-
ington University, Washington, D. C.
overlying blood background small tumors may be
missed.
Aiercury 203 Neohydrin®. This compound replaced
RISA I131 in most clinical laboratories three years
ago.1 Its rapid blood clearance and concentration in
abnormal tissue made the finding of tumors much
easier.
Mercury 197 Neohydrin®. This compound has
largely replaced mercury 203 Neohydrin as approxi-
mately 10 per cent of the mercury administered is
retained for a long time by renal tissue and the
mercury 197 compound delivers much less radiation
dose to the kidneys.3
T echnetium 99m. This man-made six hour half-
life nuclide formed in the degradation of molyb-
denum 99 is now undergoing clinical evaluation.5
Tc 99m in the form of pretechnetate stays extracel-
lular and therefore tumors can be seen because of
their neovascularization. However, because of the
intravascular concentration of this nuclide, some tu-
mors will be missed because of the brain’s normal
overlying vascularity. This isotope gives an extremely
low radiation dose to the patient. However, since it
is not retained in tumor tissue, it lacks one of the
diagnostic points of mercury 203/197 and RISA.
Positron Emitters. The positron emitters have
been utilized at the large centers that had facilities
for their production.6 Since most of these emitters
have short half-lives and are cyclotron produced, they
have not been widely accepted as primary brain
scanning agents.
Pathophysiology of Brain Scanning
We have found that all malignant brain tumors,
as well as meningiomas, retain the mercurial com-
pounds. Over the last four years we have primarily
798
The Ohio State Medical Journal
IDEAL SCAN TIME
TIME, ( HOUIS POST DOSE )
Fig. 1. Relative Concentration of Isotope at Proper Scan Time.
utilized mercury 203 chlormerodrin or mercury 197
chlormerodrin. You will note in Figure 1 that the
majority of tumors concentrate the mercurial com-
pound over a six hour period. However, the best
scanning time has been found to be between one and
two hours, as we visualize the mercurial concentra-
tion in the tumor as well as the neovascularity of
the tumor. By scanning between one and two hours,
we also see the normal vascularity of the brain as
seen on scan (Fig. 2). If an abnormal concentra-
( Continued on page 803)
Fig. 2. Interpretation of the Brain Scan.
for August, 1966
799
Case Report No. 1
i::
ft
B
I:
:
:
i
a three ^ . A 35 year old white woman with
mitted foHowhl 0fy °f jrem!tent frontal headaches was ad-
tted following a grand mal seizure. She was semicoma
tose, responsive to pain and areflexic with no other positive
sureT^and" ne^' ,Lkumbar Puncture revealed normal pres-
ures and negative laboratory study of soinal flnirl
E WSlono°Hnfebrile 3nd had ^ id Iri
nalysis. Blood urea nitrogen was normal. Initial raoid
ain scan done with 1 millicurie of technetium 99m ad
ministered intravenously, was abnormal, to th^urprTse of
the clinicians concerned. Ure following the
patient was entirely normal with no abnormal neurologic
findings, nonsymptomatic except for memory loss of the
previous day The mercury 197 chlormerodrin scan done
was abnormal in exactly the same area as the technetium
99m scan. During the following week the patient remained
nonsymptomatic and a repeat brain scan was still quite
abnormal Carotid arteriography revealed a mass lesion in
he area described on scan. At surgery a meningioma was
found and totally removed. The patient has had a complete
recovery. ^
800
The Ohio State Medical Journal
Case Report No. 2
Case Report No. 2. A 45 year old white woman with
a six month history of progressing left hemiparesis. Initial
scan series revealed gross concentration of the isotope in
the entire temporal lobe. At surgery an astrocytoma grade
1 was found and was thought to be totally removed. One
year later the patient developed further signs and on re-
scan the tumor can be seen to be across the midline and
involving the parietal lobe on the right. Surgical biopsy
revealed the tumor to be changed to a grade 4 astrocytoma.
for August, 1966
801
Case Report No. 3
Case Report No. 4
rjsut?
**«*.,#**
«*> A>
-~3t .*%**»
«r V
a. % :
middle cerebral
thrombosis
VERTEX
VERTEX
!
LEFT
Case Repost No. 3
Case Report No. 3. A 42 year old white woman developed
epilepsy six months prior to evaluation. Examination re-
vealed the patient to have slight personality changes with
left hemiparesis. The brain scan revealed a cystic-type
lesion involving almost the whole of the right frontal lobe.
At surgery this was proven to be cystic glioma.
Case Report No. 4. A 70 year old woman with acute
signs suggestive of middle cerebral thrombosis. Scan re-
pealed mercury retention throughout the area of vascularity
by the right middle cerebral artery. Mercury is retained by
the infarcted tissue and as the infarcted tissue clears, so does
the mercury concentration.
Case Report No. 5. A 56 year old man with primary
bronchogenic carcinoma surgically removed. Over a ten
day period the patient developed ill-defined personality
changes. Scan revealed a 3V2 cm lesion in the right tem-
poral lobe.
»' n. la*.
m**asto»l«
bfOftcKogsnic ca
T umot
y- for
Tumor
802
The Ohio State Medical Journal
(Continued from page 799)
tion is noted on these earlier scans we then re-scan
the patient at a later time looking for the retained
abnormal concentration of mercury. In this way we
can differentiate between vascular and nonvascular
abnormalities. In Table 1 are listed the disease proc-
esses that we have found where there is tissue con-
Table 1. Disease Processes that Accumulate Mercury
Primary Malignant Tumors
Metastatic Malignant Tumors
Meningiomas
Vascular Lesions (hematomas, A-V malformations
brain infarctions and abscesses)
centration of mercury. As will be noted this in-
cludes so-called benign lesions such as meningiomas,
cerebral infarcts, and abscesses.
The Brain Scan as a Screening Tool
The brain scan has been most useful in selecting
patients for correctable surgery at the time when they
have minimal symptomatology. All institutions that
are now doing brain scans have found many examples
of this type of patient. (See Case Report No. 1.)
Brain Scan as a Follow-Up Tool
Since the mercurial concentration in tumor tissue,
this procedure has been useful in following the neuro-
'A&TJb&m.
Case Report No. 6. A 50 year old man with a ten year
history of increasing frequency of left orbit headaches which
recently had become associated with vertigo. Brain scan
revealed increased vascular concentration particularly when
on the left lateral view at the level above the sylvian ridge.
On repeat scan five hours later all concentration had disap-
peared, therefore, the abnormality was thought to be vascular.
Arteriograms revealed this to be an arteriovenous fistula.
t
t
J - -tJf 1*3
‘jr
*
for August, 1966
803
surgical patient postoperatively and during radiation
therapy. (See Case Report No. 2.)
The Brain Scan for Exact Localization
Many times the carotid arteriogram reveals dis-
placement of normal arterial structures, but if there is
lack of tumor stain the extent of tumor involvement
is difficult to ascertain. With exact anatomical land-
marks on the brain scan there is no difficulty making
an exact estimate of a lesion’s site, size or extent of
infiltration. (See Case Report No. 3.)
The Brain Scan as an Estimate of Neurologic
Loss Following Loss of Blood Supply
Mercury localizes in infarcted tissue, therefore, the
extent of cerebral infarction and the longevity of the
residue may be ascertained by brain scan. In small
cerebral thrombosis where there is adequate collateral
supply, mercury is not found to localize in the af-
fected area. (See Case Report No. 4.)
Extent of Metastatic Involvement
With today’s brain scanning technique, metastatic
involvement of 1-2 cm. in size can be ascertained.
This is of paramount importance in the management
of primary carcinoma, such as breast carcinoma, and
has been of great aid to the neurosurgeon as the
localized cerebral metastases may be removed if there
is expected longevity of the patient. (See Case Report
No. 5.)
Vascular Lesions
The congenital AV malformations are usually quite
large and may be easily seen on the earlier brain
scanning views. Subdural hematomas are one of
the easiest neuropathological lesions we have to
recognize. (See Case Report No. 6.)
Discussion
Isotopic brain scanning is now an accepted screen-
ing test and is now being widely utilized by the
general practitioner, neurologist, internist, and neuro-
surgeon. This available isotope scanning procedure
has no patient morbidity and gives valuable clinical
information. Patients with the earliest of neurologic
symptoms or behavior disorders may be found to have
correctable neurosurgical lesions at a stage in their dis-
ease where a cure might be possible. In cerebral vas-
cular disease valuable information as to the status of the
vascular supply of the brain may be inferred by the
brain scan. One of the most valuable uses of this
procedure has been the assurance that if the patient
has a technically good normal brain scan, in all
probability he does not have a neurosurgical lesion.
Therefore, the referring physician and the patient
may be reassured at a very early stage with no pa-
tient morbidity. With the advancement in the radio-
pharmaceutical and nuclear medicine instrument in-
dustry, the brain scanning procedure is one of the
isotope procedures that is available on a routine
screening basis.
References
1. Brinkman, C. A.; Wegst, A. V., and Kahn, E. A.: Brain
Scanning with Mercury 203 Labeled Neohydrin. /. Neurosurg.,
19:644-651 (Aug.) 1962.
2. McAfee, J. G., and Taxdal, D. R.: Comparison of Radioiso-
tope Scanning Cerebral Angiography and Air Studies in Brain Tumor
Localization. Radiology, 77:207-222 (Aug.) 1961.
2. Sodee, D. B.: The Results of 350 Brain Scans with Radio-
active Mercurial Diuretics, abstracted. /. Nucl. Med., 4:185, 1963.
4. DiChiro, G.: RISA Encephalography and Conventional Neuro-
radiological Methods. Act. Radiol, suppl. 201:1-102, 1961.
5. Witcofski, R.; Maynard, D., and Meschan, I.: The Utiliza-
tion of 99m Technetium in Brain Scanning. /. Nucl. Med., 6:
121-130 (Feb.) 1965.
6. Brownell, G. L., and Sweet, W. H.: Localization of Brain
Tumors with Positron Emitters. Nucleonics, 11:40-45 (Nov.) 1955.
VIRAL CHEMOTHERAPEUTIC RESEARCH is a rapidly expanding field
occupying the efforts of biologists, pathologists, biochemists, physiologists,
and organic chemists. With this formidable armada, success should be just around
the corner; however, one wonders if the wily virus might not be just one step
ahead of us, changing its coat as the climate demands. Many viruses, both DNA
and RNA viruses that have been found affected by antiviral agents, are rapidly
altered to a resistant state in the presence of the drug. The importance of these
findings must await widespread use of viral chemotherapeutic drugs.
From past experience one must conclude that viral chemotherapy is a definite
probability. The nature of the "antiviral” activity for the common upper respira-
tory diseases must be such that it will find a broad, nonselective use. Fertile
avenues of approach appear to be prevention or amelioration of symptomatology,
stimulation of nonspecific cellular defense mechanisms, and interference with
enzyme systems common to many viruses. In addition, a more thorough under-
standing of the virus disease process, of methods of concentrating drugs in desired
tissues and cells, and of the mechanisms of recovery from viral diseases will ulti-
mately aid in the conquest of these diseases. — D. A. Buthala: Annals of the New
York Academy of Sciences, 130:17-23, July 30, 1965.
804
The Ohio State Medical Journal
Obesity
Phenmetrazine Effect Without Dietary Restriction
JOHN R. HUSTON, M. D.
The Author
• Dr. Huston, Columbus, Clinical Associate Pro-
fessor, Department of Medicine, The Ohio State
University College of Medicine, is a member of
the Attending Staffs of University, Riverside
Methodist, and Grant Hospitals.
THE objective evaluation of an oral anorexiant is
often complicated by factors which may lead to
invalid conclusions of efficacy. Most investiga-
tions have been carried out with little attention given
to the influence of dietary restriction, motivation, and
psychotherapeutic support from physician or nurse.
Another critical factor is the reliability of the pa-
tient’s adherence to prescribed medication.
The present controlled study is an attempt to over-
come such limitations by using unrestricted diets and
eliminating motivational elements. In an effort to
attain ideal testing conditions, an appetite depressant
was studied in a group of obese women living in an
institution wffiere environmental and subjective vari-
ables could be substantially controlled.
Phenmetrazine (Preludin®) *, an oral anorexiant of
wide clinical use over the past decade, was chosen for
this trial. The drug is a sympathomimetic amine
belonging to the oxazine group of compounds. Phar-
macologic studies1 confirmed by later clinical trials2-6
have shown that, in prescribed doses, it produces ef-
fective appetite suppression and weight reduction
with comparatively few side effects.
Materials and Methods
A double blind cross-over study, using phenmet-
razine and placebo, was performed in 33 obese,
mentally defective women 16 to 64 years of age.
The majority were 25 to 44 years old. Their I. Q.’s
(Binet-L or Wechsler Adult Intelligence Scale)
ranged from 26 to 77 wdth an average of 55. They
received the ordinary diet (3000 to 3500 calories)
served to all residents of the institution. As a group
they appeared indifferent to their obese condition and
during their residence made no effort at any time to
reduce.
Patients were divided randomly into two groups
approximately equal in size. Since some patients
were transferred, only 33 remained to the end of the
30-week study, with 21 in Group I and 12 in Group
II. However, as will be seen later, the unequal num-
* PreludirKg), 2 - phenyl - 3 - methyl - tetrahvdro - 1 , 4 -oxazine hydro-
chloride, brand of phenmetrazine hydrochloride, Geigy Pharmaceuti-
cals, Ardsley, New York.
From the Columbus State School, Columbus, Ohio.
Submitted November 22, 1965.
ber of subjects in each group did not seem to affect
the outcome of the study.
After a 5 -week base line period, medication was ad-
ministered once daily in the form of a phenmetrazine
75 mg sustained release tablet or identical placebo
under two different code letters, A and B. Each
group took the tablets in alternating sequence as
shown in Fig. 1. Medication periods were varied
from twm to four to six weeks.
From the start of the study, weights were recorded
once weekly on the same day and hour. In the middle
5 Wks. 4 Wks. 2 Wks. 7Wks. 6Wks. 6 Wks.
i ■
5 Wks. 4 Wks. 2 Wks. 7 Wks. 6 Wks. 6 Wks.
| | No medication; Hf| Medication A; Medication B.
Fig. 1. Sequence of medication.
7-week period without medication, weights were just
as carefully recorded for comparison with previous
and later medication effects.
During the medication periods patients were
brought into the medical office each morning after
breakfast and received either one phenmetrazine or
one placebo tablet from the nurse who made sure that
the tablet was sw^allow^ed. Neither the investigator
nor the nurse in charge knew the identity of the
tablets. All patients were observed throughout treat-
ment for possible side effects.
Results
Final evaluation showed that Group I (21 pa-
tients) had started medication with placebo, while
for August, 1966
805
Group II (12 patients) had received the active drug
first. Compared to placebo, statistically significant
weight losses occurred at the end of each phen-
metrazine treatment period in each group (Figs. 2
and 3).
In Group I, initial weights had varied from 151
to 245 lbs. in individual patients and averaged 180.4
lbs for the group. Weight dropped slightly at the
end of the 5 -week period without medication to a
No Medication
Placebo
Phenmetrazine
No Medication
Phenmetrazine
Placebo
5 Weeks
4 Weeks
2 Weeks
7 Weeks
6 Weeks
6 Weeks
Weight loss
Weight gain
Weight loss
Weight gain
Weight loss
Weight gain
0.20 Ib./wk.
0.10 Ib./wk.
1.20 Ib./wk.
0.16 Ib./wk.
0.83 Ib./wk.
0.22 Ib./wk.
Pounds
Fig. 2. Group I (21 patients). Average weekly response
of weight.
No Medication
5 Weeks
Phenmetrazine
4 Weeks
Placebo
2 Weeks
No Medication
7 Weeks
Placebo
6 Weeks
Phenmetrazine
6 Weeks
Weight loss
0.18 Ib./wk.
Weight loss
0.50 Ib./wk.
Weight loss
0.05 Ib./wk.
Weight loss
0.10 ib./wk.
Weight gain
0.10 Ib./wk.
Weight loss
0.67 Ib./wk.
Pounds
Fig. 3. Group II (12 patients). Average weekly response
of weight.
mean of 179.4, showing an average loss of 0.20 lb.
weekly. The reason for this small weight loss is
unknown, but it may possibly be due to a slight
motivation effect produced by the weekly weighings.
After four weeks on placebo, average weight in-
creased 0.10 lb. weekly. In the following period of
two weeks on phenmetrazine, weight loss was 1.20
lbs. weekly. During the subsequent 7-week period
without medication patients very slowly regained
some weight at the rate of 0.16 lb. each week, which
was slightly above the weekly gain on placebo. When
the drug was resumed, weight loss averaged 0.83 lb.
weekly for the 6-week period. In the final six weeks
on placebo, weight again increased by 0.22 lb. per
week.
Grot/p II which had started medication on phen-
metrazine showed a slightly different, though sig-
nificant, pattern of weight loss on the drug. In these
patients initial weights ranged from 138 to 252 lbs.,
with an average of 177.7 lbs., which decreased
slightly to 176.8 lbs. at the end of the 5 -week period
without medication. This was a loss of 0.18 lb.
weekly, comparable to the 0.20 lb. in Group I for
the same period.
In Group II, the first course of phenmetrazine
was four weeks, with a mean loss of 0.50 lb. weekly.
In the following 2-week placebo period, weight de-
creased almost imperceptibly by 0.05 lb. each week.
The weight loss on the drug, compared to that on
placebo, was significantly greater. During the 7-
week period without medication, slight weight losses
were also noted. In the following six weeks on
placebo, weight gain occurred at the rate of 0.10
lb. weekly. The final 6-week drug period showed
a significant loss of 0.67 lb. weekly compared to the
0.10 lb. gain on immediately preceding placebo dos-
age for a similar period.
Comparison of the 6-week drug periods showed an
average weekly weight loss of 0.83 lb. in Group
I and 0.67 lb. in Group II.
Throughout the study no side effects were reported
or observed in any patient.
Discussion
Results showed that phenmetrazine produced sig-
nificant weight losses in both of the groups treated,
while placebo exerted little or no effect. The care
taken to eliminate or control known factors which
might bias the result further supported the efficacy
of the drug. At no time during the study did the
physician or the nurse in charge discuss the subject
of weight reduction with the patients or encourage
them towards this end. Thus, psychologic factors
commonly acknowledged to promote weight loss were
reduced to a minimum, and the weight losses noted
could validly be attributed to the drug.
In this regard, a recent interesting study7 showed
that phenmetrazine significantly reduced food intake
in subjects of normal intelligence only when they
806
The Ohio State Medical Journal
were told that they might receive an appetite de-
pressing drug. This expectation, however, did not
significantly alter their food consumption while they
received placebo. Perhaps, in our study, the regi-
men of daily medications and weekly weighings
subtly produced the same result as would be ob-
tained by telling patients they might receive an ap-
petite depressant drug. However, it is unlikely that
our mentally retarded group would be affected to
the same extent as persons of normal intelligence.
While greater weight losses than those observed in
our study have been reported2’4 in patients treated
in a physician’s office where they are encouraged and
motivated to lose weight, usually with the help of
dietary restrictions plus an appetite depressant, this
study demonstrates significant weight loss while pa-
tients received phenmetrazine alone. However, in
each case on stopping phenmetrazine there was an
abrupt alteration in the pattern of weight loss to
insignificant amounts or, more frequently, to weight
gain. This would indicate that phenmetrazine is
effective only while being taken and does not alter
the factors which produce obesity, at least as observed
in the 2- to 6-week courses here employed.
Although poor eating habits which induce obesity
can often be traced to some emotional problem, a
decrease in caloric intake is necessary for sustained
successful weight reduction. Since dietary restrictions
alone impose an austerity leading to further tensions
and irritability, the use of an appetite depressant
is usually helpful. Physicians are in effect treating
a symptom and ignoring the cause when they use only
appetite depressants in the management of obesity.
This study supports the concept that phenmetrazine
is an effective adjunct in the comprehensive manage-
ment of the overweight patient.
Summary
Phenmetrazine, an anorexigenic agent belonging
to the oxazine group of compounds, was evaluated
in a double blind cross-over study with matching
placebo in 33 mentally retarded, obese women 25 to
44 years of age. Medication was administered once
daily after breakfast, the drug being given in the
form of a 75 mg sustained release tablet.
Factors conducive to biased results were eliminated
as far as possible. The elements of motivation, ex-
pectation and psychologic support were reduced to a
minimum. Diets were uniform and unrestricted and
patients’ adherence to prescribed medication was care-
fully supervised.
The study ran from 30 consecutive weeks, including
an initial 5-week base line period and an interim
7-week period without medication. In two randomly
divided groups medication was reversed after courses
of two to six weeks.
Phenmetrazine was found to be an effective ap-
petite depressant producing significant average weight
losses of 0.7 to 0.8 lb. weekly over a 6-week period.
Placebo exerted little or no effect and during some
periods of the study produced a slight weight gain.
No side effects were observed or reported.
Since diets were unrestricted and psychologic fac-
tors were virtually absent, the weight losses may be
attributed to the action of phenmetrazine alone.
References
1. Thoma, O., and Wick, H.: Uber einige Tetrahydro-1, 4-oxaz-
ine rait sympathicommetischen Eigenschaften. Naunyn Schmiedeberg
Arch. Exp. Path., 222:540-554, 1954.
2. Gelvin, E. P.; McGavack, T. H., and Kenigsberg, S.: Phen-
metrazine in the Management of Obesity. Amer. J. Dig. Dis., 1:
155-159 (April) 1956.
3. Ressler, C.: Treatment of Obesity with Phenmetrazine Hydro-
chloride, a New Anorexiant. /. A. M. A., 165:135-138 (Sept. 14)
1957.
4. Fazekas, J. F. : Ehrmantraut, W. R., and Kleh, J.: A Study
of the Effectiveness of Certain Anorexigenic Agents. Amer. J. Med.
Set., 236:692-699 (Dec.) 1958.
5. Cass, L. J.: Evaluation of Appetite Suppressants. Ann. Intern.
Med., 51:1295-1302 (Dec.) 1959.
6. Fineberg. S. K.: Obesity-Diabetes and Anorexigenics. J.A.M.A.,
175:680-684 (Feb. 25) 1961.
7. Penick, S. B., and Hinkle, L. E., Jr.: The Effect of Expecta-
tion on Response to Phenmetrazine. Presented at the American Psy-
chosomatic Society, Atlantic City, New Jersey, April 28, 1963.
SCHIZOPHRENIA. - — Twenty male and 22 female schizophrenics were treated
by conjoint family and milieu therapy in two mental hospitals with reduced
use of tranquillizers. No individual psychotherapy was given. None of the
so-called shock treatments was used, nor was leukotomy. All patients were dis-
charged within one year of admission. The average length of stay was three
months. Seventeen per cent were readmitted within a year of discharge. Seventy
per cent of the others were sufficiently well adjusted socially to be able to earn
their living for the whole of the year after discharge. These results are the
first to be reported on the outcome of purely family and milieu therapy with
schizophrenics, and they appear to us to establish at least a prima facie case
for radical revision of the therapeutic strategy employed in most psychiatric units
in relation to the schizophrenic and his family. This revision is in line with
current developments in social psychiatry in this country. — A. Esterson, M. B.,
CH. B., D. P. M.; D. G. Cooper, M. B., CH. B., D. P. M., and R. D. Laing,
M. B., CH. B., D. P. M., London, England: British Medical Journal, 2:1462-1465,
December 18, 1965.
for August, 1966
807
Intussusception of Small Bowel
On a Cantor Tube
Report of a Case
NOEL PURKIN, M. D., and SAMUEL S. TEITELBAUM, M. D.
THE occurrence of intussusception of small bowel
on an indwelling intestinal decompression tube
prompted a perusal of the literature on the subject.
The surprising finding was that there have been only
two other cases of this nature reported in the world
literature to date.
Although the decompression tube has been in ex-
istence for over 40 years, few cases of complications
arising from its use have been reported in recent lit-
erature. It is well known and remembered that there
were many articles written about intestinal decom-
pression tubes at the time of their inception, as well
as many cases documenting the complications arising
from their use. Cantor2 and Harris5 describe the many
complications which may occur. Among these are
laryngeal edema, intestinal perforation, distention,
and intussusception. Harris4-5 alludes to a further
complication in which the mercury bag may rupture
or fall off the tube.
Following the report of McGoon,1 and Cantell and
Warren,3 Cantor2 published a review on the effect of
variation in the length of the decompression tube
upon the bowel wall. It was felt that the ideal length
would be that which would least interfere with the
normal small bowel functions of motility, secretion,
and absorption. If the 4 foot tube was permited to
pass down into the gastrointestinal tract and the tube
was then fastened to the face with adhesives, the
vigor of the peristaltic activity would be noted to re-
sult in an intussusception-like effect, and the bowel
would pleat tightly on the tube. The shorter the
length of tube down the bowel, the tighter the pli-
cation on it. The incidence of intussusception ap-
peared directly proportional to the tightness of the
plications.
It was Cantor’s conclusion that the position of the
tube head was extremely variable, regardless of the
length of the tube down the bowel. The only accurate
method of localization was by means of x-ray. He
also stated that the intestinal decompression tube
should never be fastened to the face of the patient
and that permitting the tube to pass downward only
From Mount Sinai Hospital of Cleveland, Cleveland, Ohio. Sub-
mitted December 16, 1965.
808
The Authors
• Dr. Purkin, Cleveland, is Co-Chief Resident,
Department of General Surgery, Mount Sinai Hos-
pital of Cleveland.
• Dr. Teitelbaum, Cleveland, is Assistant Direc-
tor of Surgery (Education), Mount Sinai Hospital
of Cleveland.
as fast as the peristaltic activity or pull of the tube
head would allow resulted in the smallest degree of
plication of the bowel and hence the least interference
with the normal physiology of the bowel. It was felt
that 6 to 10 feet of intestinal tube interfered least
with peristaltic activity and produced the least plica-
tion. In the event that the tube were to remain within
the bowel for any length of time, or were to be used
for feeding, the 10 foot length of tube was found
most suitable, because it resulted in the greatest sur-
face area of mucosa available for secretion and ab-
sorption, and the least interference of peristalsis.
Cantor’s findings seem to fit in well and support
the pathogenesis of intussusception of the small
bowel on an intestinal tube as postulated by
McGoon.1 McGoon purports that peristaltic waves
act upon the bag at the end of an indwelling tube
exactly as though it were a food bolus and force
it distally within the intestinal lumen. However, the
long tube trailing behind offers resistance to the
forward movement of the bag, especially if the tube
is anchored externally to the face. Since each action
has an equal and opposite reaction and since the bag
in the intestine resists distal propulsion, the intestine
itself is, therefore, drawn proximally over the semi-
fixed bag and tube. Repeated peristaltic activity may
thus draw the entire length of the intestine proxi-
mally around the bag until it has telescoped over a
length of tube many times shorter than the length
of the involved intestine.
Under normal conditions, the adjacent peritoneal
surfaces of each infolded pleat of bowel show no
The Ohio State Medical Journal
more tendency to adhere than do the normal adjacent
loops of intestine. Consequently, on withdrawal of
the tube, plication disappears and the intestine returns
to normal status. When, however, intraperitoneal con-
ditions which are conducive to adhesion formation
develop — preceded by a fibrinous exudate on the serosal
surface of the intestine, such as occurs in the post-
operative phase as well as following peritonitis — the
adjacent peritoneal surfaces of each plication may ad-
here. The fixed plication resembles, to some extent,
an intestinal polyp with its intraluminal projection
and its attachment to the intestinal wall and may
produce and lead an intussusception. This also ac-
counts for the possibility of an intussusception de-
veloping even after withdrawal of the intestinal tube.
A failure to appreciate the complication which may
arise was believed to have been responsible for the
resulting fatality in one of the reported cases. It is
also noted that the occurrence of this complication,
following the use of an air-filled bag, was one of the
factors which led Harris to experiment with the use
of mercury. The treatment of this complication is
surgical intervention by exploratory laparotomy, re-
duction of the intussusception, and resection if neces-
sary, dependent on compromise of the bowel wall.
Often, the Cantor tube may have to be withdrawn
completely.
Case Report
The case being reported is that of a 41 year old Para III,
Gravida III, white woman who was admitted with urinary
frequency of increasing severity over a five-year period.
Physical examination, aside from a marked cystocele and
rectocele, was essentially not remarkable. Three days after
admission, she underwent a vaginal hysterectomy and ante-
rior and posterior repair. During surgery, the patient de-
veloped a period of moderate hypotension. A 500 cc. blood
loss was replaced. A vaginal drain and pack were left in.
Five days postoperatively the patient manifested a temper-
ature of 101. 4°F. (38.6 C.), a distended abdomen but with
bowel sounds present, and brown vaginal bleeding. The fol-
lowing day her temperature was 100. 0°F., her abdomen was
still distended but with fewer bowel sounds, and an enema
was fairly effectual.
The next day, one week postoperatively, her symptoms
had increased and a Cantor tube was inserted. The patient
was followed with serial abdominal films, with the radio-
logic impression of a paralytic ileus rather than a simple
mechanical obstruction. Following insertion of the Cantor
tube and its progression down the bowel, the radiologic ap-
pearance of the postoperative paralytic ileus improved. A
chest film at that time showed no evidence of pulmonary
infiltration. Two days after insertion of the Cantor tube, the
patient received two courses of Prostigmine® 1:1000, 0.5
cc. at 20 minute intervals for a period of three injections,
resulting in good bowel movements. Several hours later,
she began to bleed vaginally and was taken back to the
operating room, where the anterior repair was resutured.
The surgical impression was that of an infected vaginal
cuff hematoma.
The patient’s radiologic and clinical appearance was
greatly improved, and the Cantor tube was removed five
days after its insertion. However, the day after withdrawal,
the patient vomited 100 cc. of a brown, foul smelling ma-
terial. The abdomen again became very distended and,
although she had had a bowel movement that morning,
the feeling was that she had redeveloped her ileus, and the
Cantor tube was reinserted. Abdominal x-rays showed gas
in the colon, and it was felt that the degree of ileus was
not too impressive. However, three days after the reinsertion
of the Cantor tube, the patient, still not greatly improved,
was taken to x-ray for a barium study through the Cantor
tube. Preliminary films showed no significant degree of
bowel distention. The Cantor tube was in the jejunum to
the right of the vertebral column, and a mechanical obstruc-
tion was not evident at this time. When the barium was in-
jected, however, it was noted that there was a disparity of
the lumen of the jejunum, with the proximal jejunum ap-
pearing more dilated than that of the more distal portion.
The area of transition appeared to be just distal to the
mercury bag. This, however, was transient in nature, and
follow-up films taken several hours later showed the barium
to have traversed the area, and the proximal jejunum to
appear less dilated. The transit time appeared to be within
normal limits. It was felt that the x-ray examination had
demonstrated no complete obstruction to the passage of
barium through the small bowel. However, it was believed
that the alteration in the mid-jejunum would have to be
correlated with the clinical findings (Fig. l).
Two days after the x-ray examination, the patient had two
bouts of emesis with colicky abdominal pain. While making
rounds the previous night, the house officer had noted the
Cantor tube fastened to the patient’s nose with a piece of
tape, and when this was released her complaints of abdom-
Fig. 1 Fig. 2
Figs. 1 & 2. Abdominal films of barium swallow. Cantor tube in jejunum to right of vertebral column. There is
a disparity in lumen of jejunum appearing just distal to mercury bag.
for August, 1966
809
inal cramps subsided to a great degree. A repeat x-ray was
obtained, which showed stasis of barium with cecal dilata-
tion and small bowel collapse (Fig. 2). It was the impres-
sion that small bowel obstruction was present, and the pa-
tient was taken to the operating room.
At surgery, dilated loops of small bowel were found, and
there was a loop of dilated bowel that was tacked down to
the posterior parietal peritoneum. The sigmoid colon was
seen to be plastered over the vaginal cuff, but there was no
abscess or hematoma. The Cantor tube could be felt well
down in the small bowel. The dilated loop of mid-jejunum
was delivered into the incision. It was markedly thickened
and hard, measuring about 6 to 8 cm. in diameter and ap-
proximately 25 to 38 cm. in length. The Cantor tube was
felt just below and above it. The feeling at this time was
that this was an intussusception, which was reduced by gen-
tle pressure distally on the mass. Following the reduction
of the intussusception a perforation was seen in the involved
small bowel. About 6 inches of the small bowel was re-
sected, and an end-to-end anastomosis was performed. The
bowel was then examined, and serosal tears of the cecum
were plicated with No. 4-0 silk. Following this, the small
bowel was re-examined and seen to be re-intussuscepting
over the Cantor tube, which had been left in place. The tube
was then completely removed and the intussusception was
easily reduced. Postoperatively, the patient made an unevent-
ful recovery and was discharged from the hospital 10 days
later.
The pathologic specimen consisted of a piece of small
intestine measuring 9 cm. in length. At one end, the external
diameter was 2.8 cm. At the other end the external diameter
was 3.5 cm. The external surface of the gut was shiny in
places but congested. Part of the serosal aspect on one side
was covered up by a fibrinous, white exudate. On the same
surface near about the middle of the piece of intestine, there
was an indurated area having an average diameter of 1.8
cm. The mucous membrane of the piece of intestine was
congested, except over a linear area in the central part
where it appeared white. Grossly, the mucosa and the wall
of the intestine appeared edematous. Microscopic examina-
tion revealed marked hemorrhage and edema of small bowel
with organizing fibrinous peritonitis.
Discussion
The reason for the intussusception in this case
seems to fit closely to McGoon’s pathogensis, ie, once
the tube had been fixed to the nose, the patient com-
plained of severe colicky pain and emesis, and it was
postulated that this was the time that the pleats of
bowel became tight and with the altered intraperi-
toneal conditions became adherent with one another
with a resulting intussusception. It is salient to note
that a 10 foot Cantor tube was used in this instance
and the tube was seen to have been down approxi-
mately 51/2 feeb so at least one °f Ike principles pro-
pounded by Cantor2 had been present. However, it
further emphasizes Cantor’s statement that one of
the prime dictums in intestinal decompression tube
usage is that the tube must not be fixed to the nose
of the patient. The diagnosis in this case hinges upon
the awareness of the possibility, though rare, of the
occurrence of this type of lesion, plus a close x-ray
follow-up correlated with clinical findings.
Summary
The case presented is that of a 41 year old white
woman who, after vaginal hysterectomy and post-
operative vaginal bleeding, developed paralytic ileus
and a subsequent partial small bowel obstruction re-
sulting from a small bowel intussusception sec-
ondary to intestinal decompression tube intubation.
Diagnosis was made by clinical findings and x-ray
evaluation. The patient required resection for a per-
foration of the bowel wall incumbent on the intus-
susception.
References
1. McGoon, D. C.: Intussusception: A Hazard of Intestinal In-
tubation, Surgery, 40:515-519 (Sept.) 1956.
2. Cantor, M. O.; Acker, E.; Scharf, A., and Foster K.: Effect
of Variation in Length of Decompression Tube upon Bowel Wall.
Amer. J. Surg., 82:697-702 (Dec.) 1951.
3. Warren, K. W. and Cattell, R. B.: Stenosis of the Intestine
after Strangulated Hernia; With Fatal Complication Following In-
testinal Intubation. Amer. J. Surg., 75:729-732 (May) 1948.
4. Harris, F. I.: Intestinal Intubation in Bowel Obstruction.
Surg. Gynec. Obstet., 81:671-678 (Dec.) 1945.
5. Harris, F. I. and Gordon, M.: Intestinal Intubation in Small
Bowel Distention and Obstruction. Surg. Gynec. Obstet., 86:647-658
(June) 1948.
ORAL CONTRACEPTIVES. — The exact mode of action of oral contracep-
tives is incompletely understood at present. It is suggested that the "classi-
cal’’ pill (various gestagen-estrogen combinations) has at least two points of attack:
it inhibits ovulation by blocking the release of luteinizing hormone, and it renders
the cervical mucus hostile to sperm penetration.
It is likely that the "sequential” pill inhibits ovulation by suppressing the
release of both follicle-stimulating hormone and luteinizing hormone. Whether it
also has an additional point of action cannot be decided at present.
Finally, the pill based on "low-level luteal supplementation” is capable of
controlling fertility without inhibiting ovulation. In this case changes in the
endometrium and/or cervical mucus may be responsible for the contraceptive
effect. — Egon Diczfalusy, M. D., Stockholm, Sweden: British Medical Journal,
2:1394-1399 (December 11) 1965.
810
The Ohio State Medical Journal
Pregnancy in Acute Leukemia
Report of a Case
T. D. STEVENSON, M. D, WILLIAM C. RIGSBY, M. D„ and
D. P. SMITH, M. D.
ACUTE LEUKEMIA is a tragic and fortunately
rare complication of pregnancy7, which usually
^ results in death of both mother and infant.
Moloney in a recent review found 267 reported cases
of leukemia occurring in pregnancy7, and in 222 cases
in which information concerning the type of leukemia
was available there were 102 cases of acute leukemia.1
Acute myeloblastic leukemia was the most common
type encountered comprising 63 per cent of the acute
leukemias. The reported cases of acute leukemia in
pregnancy have increased in the past few years. This
increase has been attributed to both increased case
recognition and to an increasing incidence of the
disease.1’2 Acute leukemia usually occurs as a com-
plication of an existing pregnancy. It is rare for a
woman with acute leukemia to become pregnant.
We have studied a patient with acute myeloblastic
leukemia who became pregnant while in remission of
her disease. The patient was receiving an antileukemic
drug at the time of conception and was maintained in
a partial remission with chemotherapy throughout the
course of pregnancy. She subsequently delivered a
normal premature male infant. It is the purpose of
this report to record our experience in the manage-
ment of this patient and to comment on the use of
antileukemic drugs in pregnancy’.
Case Report
This 20 year old white woman was seen in May, 1963,
complaining of recurrent ulcers in her mouth of approxi-
mately three months’ duration. She had been well until
February, 1963, when she first noticed a small ulceration
on the tip of her tongue, which enlarged, became very pain-
ful, and was followed by similar ulcerations in the buccal
mucosa. Local measures were not successful in controlling
the ulcerations, and it was difficult for the patient to eat.
Fatigue and weakness appeared and became severe.
On examination the significant findings were the presence
of numerous small ulcers on the tongue and buccal mucosa,
which were covered with a small amount of white exudate.
The spleen was palpable 2 cm. below the left costal margin.
There was moderate generalized lymphadenopathy. The
remainder of the physical examination was not remarkable.
Hematologic study revealed: hemoglobin 10.8 Gm. per
100 ml., hematocrit 34 per cent, white blood cell count
15,900 cu.mm., differential polymorphonuclear leukoq7tes 11
per cent, lymphocytes 1 per cent, monocytes 35 per cent,
myeloblasts 35 per cent, myelocytes "A” 3 per cent, eosin-
The Authors
• Dr. Stevenson, Columbus, Associate Professor
of Pathology, is Director of Hematology, Clinical
Laboratories, Ohio State University Hospital.
• Dr. Rigsby, Columbus, is Assistant Professor of
Obstetrics and Gynecology, The Ohio State Uni-
versity- College of Medicine.
• Dr. Smith, Sycamore, Ohio, is a member of the
Active Staff, Wyandot Memorial Hospital at Upper
Sandusky.
ophils 15 per cent. A bone marrow specimen was aspirated
from a spinous process and showed complete replacement of
the normal marrow elements by myeloblasts, many of which
contained Auer bodies (Fig. 1). The hematologic findings
were diagnostic of acute myeloblastic leukemia, and the pa-
tient was given 6 mercaptopurine, 150 mg. per day.
The oral ulcers healed completely in two weeks. A de-
crease in the white blood cell count with an increase in
mature granulocytes in the peripheral blood was noted
after several weeks, and the 6 mercaptopurine was grad-
ually reduced to a maintenance dosage of 50 mg. per day.
The patient felt well except for easy fatigue until Jan-
uary7, 1964, when she noted morning nausea and vomiting
and reported that she had not had a menstrual period since
November, 1963. A pregnanq7 test was positive. The
blood count (Januaqq 1964) w-as as follows: hemoglobin
9-6 Gm. per 100 ml., hematocrit 28 per cent, white blood
cell count 3,150 cu.mm., platelets 100,000 cu.mm., dif-
ferential polymorphonuclear leukoq-tes 40 per cent, lym-
phocytes 32 per cent, eosinophils 4 per cent, monocytes
24 per cent. Since she had become pregnant while taking
50 mg. of 6 mercaptopurine daily, this medication was
continued.
During the next few months, she complained of increasing
fatigue and weakness. The platelet count decreased, the
white blood cell count increased, and prednisone 30 mg.
per day was added to her regimen. The white blood cell
count continued to rise, and desacetylmethydcochicine* 4 mg.
per day was added during the fifth month of her pregnancy
in the hope that it might be useful in controlling the leu-
kemic process. Recurrent anemia required transfusions for
correction.
In July, 1964, in the seventh month of pregnancy, the
patient developed cramping abdominal pain and was ad-
mitted to the Ohio State University Hospital. She was
thought to be in early labor, but her pain and uterine con-
tractions subsided 48 hours after admission. Hematologic
studies revealed: hemoglobin 11.0 Gm./lOO ml., hematocrit
37 per cent, white blood cell count 59,800 cu.mm., platelets
33,000 cu.mm., reticuloq-tes 0.5 per cent, differential-
submitted November 30. 1965.
*Colcemid®
for August, 1966
811
Fig. 1. Photomicrograph of initial bone marrow sm ear show-
ing myeloblasts and myelocytes. The insert shows a myelo-
blast luith an Auer body in the cytoplasm.
myeloblasts 74 per cent, myelocytes 16 per cent. Bone
marrow examination revealed replacement of the normal
marrow elements by myeloblasts. The fibrinogen level was
0.98 Gm./lOO ml. The findings were consistent with prog-
ression of leukemia despite drug therapy, and Colcemid®,
and 6 mercaptopurine were discontinued. Methyl guanyl
hydrazone (methyl GAG) was considered the drug of choice
despite its toxicity, since remission had been reported in a
significant number of patients with acute myeloid leukemia
following the use of this drug.
After the initial infusion of 150 mg. of methyl GAG,
the patient went into labor, and six hours later she was
delivered of a normal, male infant weighing 1730 Gm. (3
lbs. 13 oz.). The delivery was uneventful, and the child
was without evidence of developmental abnormalities. Ex-
amination of the placenta showed no remarkable abnormal-
ities. The cord hemoglobin was 18.4 Gm. per 100 ml.,
and the infant’s white blood cells were normal.
After delivery, the patient’s oral temperature rose daily
to 104°F. There was no obvious source of infection im-
mediately postpartum, but she subsequently developed large
furuncles on the scalp. Culture of exudate from the scalp
lesions revealed Pseudomonas Aeruginosa and Staphylococcus
Aureus, and she was treated with Colistin and sodium
methicillin. Her temperature gradually returned to normal
after the initiation of antibiotic therapy, and 150 mg. of
methyl GAG was given intravenously daily. A gradual
reduction in the white blood count occurred, and a bone
marrow examination two weeks after the initiation of treat-
ment with methyl GAG revealed an increased number of
mature granulocytes and a decrease in myeloblasts. The
patient improved clinically with a gradual return of strength.
At the time of discharge from the hospital, the hemoglobin
was 12.0 Gm. per 100 ml., hematocrit 39 per cent, white
blood cell count 94,000 cu.mm., platelets 29,000 cu.mm,
differential polymorphonuclear leukocytes 28 per cent, mye-
locytes 30 per cent, myeloblasts 32 per cent, lymphocytes 10
per cent.
After discharge from the hospital, the patient was main-
tained in clinical remission with weekly injections of methyl
GAG, but anemia and thrombopenia gradually became more
severe. In February, 1965, seven months postpartum,
and 18 months after the initial diagnosis of leukemia,
she was readmitted to the hospital because of marked
weakness and fever. The white blood cell count was 50,000
cu.mm., hemoglobin 9.3 Gm. per 100 ml., hematocrit 31.5
per cent, platelets 21,000 cu.mm., differential-myeloblasts
82 per cent, myelocytes 18 per cent. She died 24 hours
after admission to the hospital.
Postmortem examination revealed changes consistent with
acute myeloblastic leukemia in relapse. The final anatomic
diagnoses were: (l) Acute myelogenous leukemia with
leukemic infiltration of esophagus, lungs, gastrointestinal
tract, liver, spleen, lymph nodes, and kidneys. (2) Pul-
monary edema.
The infant was discharged from the hospital weighing
2175 Gm. (4 lbs. 13 oz.) at the age of one month. He
has shown normal growth and development, and at the age
of 1 year his weight was 22p4 lbs., length 2914 inches,
and there was no evidence of a developmental abnor-
mality. A complete blood count revealed no abnormal-
ities except a moderate iron deficiency anemia (Hemoglobin
10.8 Gm./lOO ml.).
Discussion
The use of antileukemic drugs during the first tri-
mester of pregnancy is considered dangerous, and
some authorities recommend the limitation of treat-
ment to symptomatic and supportive care and the ad-
ministration of corticosteroids.3’ 4 In our patient,
conception occurred while she was receiving 6 mer-
captopurine and was followed by a relatively unevent-
ful pregnanqc The infant was born prematurely but
showed no evidence of developmental abnormalities.
This experience is not unique. There are six cases
in addition to our own in which 6 mercaptopurine
has been given during the first trimester of preg-
nancy.1 In these seven cases six infants were born
alive, two dying shortly after birth, one was stillborn,
and none showed evidence of developmental abnor-
malities. This experience indicates that 6 mercapto-
purine can be given during the first trimester in
amounts not exceeding 2.5 mg. /kg. of body weight
without fear of inducing fetal abnormalities or abor-
tion. We agree with Frankel and Myers that therapy
of acute leukemia with 6 mercaptopurine need not be
restricted during the first trimester.5 Indeed, it would
seem unwise to withhold therapy since treatment with
an effective antileukemic drug affords a reasonable
chance for completion of pregnancy and the birth of
a normal infant.
There is little information concerning the effect in
pregnancy of the other drugs which were used in this
case. Desacetylmethylcochicine is a stathmokinetic
agent and is not widely used in the treatment of acute
leukemia. Lessman and Sokal have reported a patient
with chronic myeloid leukemia, who conceived and
delivered a normal infant while on continuous treat-
ment with this drug.6
Methyl GAG has been reported to produce com-
plete remission in 45 per cent of patients with acute
myeloblastic leukemia receiving optimal treatment.7
The highest response rate has occurred in patients in
whom the leukemic cells showed Auer bodies and/or
significant granulation as was the case in our patient.
Methyl GAG is extremely toxic, and produces mar-
812
The Ohio State Medical Journal
row hypoplasia, mucosal ulcerations, phlebitis, and,
in some instances, hypoglycemia.8 Following the ini-
tial infusion of 150 mg. of Methyl GAG, our patient
went into labor, which was probably only coincidence
but an effect of the drug on the uterus cannot be ex-
cluded. At any rate no immediate toxic effects were
noted on the infant, and the partial remission ob-
tained postpartum was attributed to this drug.
The side effects of prolonged corticosteroid admin-
istration are well known, and fluid retention may be
exaggerated during pregnancy. Suppression of the
adrenal function of the infant may also occur as a
consequence of corticosteroid administration to the
mother and should be sought for diligently in the
newborn.
Leukocytosis and the presence of immature white
blood cells in the peripheral blood are often asso-
ciated with pregnancy. Kuvin and Brecher found
leukocytosis in 20 per cent of normal women in the
last trimester of pregnancy and myelocytes or meta-
myelocytes in the peripheral blood in 25 per cent.9
Even though there are hematologic changes consistent
with increased myelopoiesis, there is no evidence that
either acute or chronic leukemia of any type is made
worse by pregnancy. The principal adverse effect
of pregnancy in acute leukemia is the limitation im-
posed on the amount and type of antileukemic drug
administered. Therapeutic abortion is not indicated
and may be more dangerous than continuation of the
pregnancy.
The management of this type of patient is dif-
ficult, since complications may occur at any time,
and delivery is particularly hazardous because of the
possibility of hemorrhage and puerperal infection.
Thrombocytopenia is the most common cause of ab-
normal bleeding, but hypofibrinogenemia has also
been reported.10 The use of corticosteroids and
platelet transfusions may ameliorate the bleeding due
to thrombocytopenia, and replacement therapy should
be instituted if fibrinogen is decreased. Delivery was
not associated with untoward bleeding in our patient
even though the platelets were decreased, but her
fibrinogen level was normal.
Rapid deterioration of patients with acute leukemia
is common in the immediate postpartum period. The
causes of this deterioration are often not immediately
apparent, and both exacerbation of the leukemic proc-
ess and infection may be responsible. The hematolog-
ic status of the patient should be carefully followed,
because more vigorous treatment of leukemia is often
necessary in the postpartum period. Close medical
observation is necessary to detect infection, and we
feel that antibiotic therapy should be promptly in-
stituted after appropriate bacteriologic studies, if
fever develops.
There are several aspects concerning infants born
of leukemic mothers that are of interest. Very little
information is available regarding delayed toxicity
in the infant from the prenatal administration of
antileukemic drugs to the mother. There is no evi-
dence of delayed toxicity from 6 mercaptopurine
administration, but experience is limited. The pos-
sibility of transmission of leukemia from the mother
to the infant is of obvious importance. Finch, in a
review of the transmission of leukemia, found no
evidence of leukemia in infants born to women with
leukemia, but Cramblett et al have reported the
development of leukemia at 9 months of age in an
infant born of a leukemic mother.11’12 Although
there may be no immediate evidence of leukemia in
the infant, careful follow-up is necessary to exclude
the later development of the disease. For this rea-
son Moloney has urged that all cases of leukemia in
pregnancy be reported with follow-up studies on the
infant.1 In our case, the infant showed no evidence
of leukemia at 1 year of age and is remarkably nor-
mal considering the hazards associated with his intra-
uterine existence.
Pregnancy is uncommon in patients with acute
leukemia but it is apparent that the presence of acute
leukemia, and the administration of some types of
antileukemic drugs do not prevent pregnancy. A
discussion of the philosophic reasons for preventing
pregnancy in women with acute leukemia is beyond
the scope of the present report, but it may be fairly
stated that the development of pregnancy does not
simplify the management of leukemia.
Summary
A woman with acute leukemia conceived while
receiving the antileukemic dmg 6 mercaptopurine.
Antileukemic therapy was maintained through the
course of pregnancy, and she subsequently delivered
a normal, premature infant. It is suggested that preg-
nancy is not an absolute contraindication to the treat-
ment of acute leukemia with effective antileukemic
drugs, eg, 6 mercaptopurine.
References
1. Moloney, W. C.: Management of Leukemia in Pregnancy.
Ann. New York Acad. Sci., 114:857-867, 1964.
2. Boggs, D. R.; Wintrobe, M. M., and Cartwright, G. E.:
The Acute Leukemias. Medicine, 41:163-225 (Sept.) 1962.
3. Dameshek, W., and Gunz, F.: Leukemia, ed 2, New York:
Grune and Stratton, 1964.
4. Wintrobe, M. M.: Clinical Hematology, ed 5, Philadelphia:
Lea and Febiger, 1961.
5. Frenkel, E. P., and Meyers, M. C.: Acute Leukemia and
Pregnancy. Ann. Intern. Med., 53:656-671 (Oct.) I960.
6. Lessmann, E. M., and Sokal, J. E.: Conception and Preg-
nancy in a Patient with Chronic Myelocytic Leukemia under Con-
tinuous Colcemid Therapy. Ann. Intern. Med., 50:1512-1518
(June) 1959.
7. Levin, R. H.; Henderson, E.; Karon, M., and Freireich, E. J:
Treatment of Acute Leukemia with Methylglyoxal-bis-guanylhydra-
zone (Methyl GAG). Clin. Pharmacol. Ther., 6:31-42 (Jan.) 1965.
8. Regelson, W., and Holland, J. F.: Clinical Experience with
Methylglyoxal bis (quanylhydrazone dihydrochloride): A New Agent
with Clinical Activity in Acute Myelocytic Leukemia and the Lym-
phomas. Cancer Chemother. Rep., 27:15-2 6, (March) 1963.
9. Kuvin, S. F., and Brecher, G.: Differential Neutrophil
Counts in Pregnancy. New Eng. J. Med., 266:877-878 (April 26)
1962.
10. Yahia, C. ; Hyman, G. A., and Phillips, L. L. : Acute Leu-
kemia and Pregnancy. Obstet. and Gynec. Survey, 13:1-21 (Feb.)
1958.
11. Finch, S. C.: Transmission of Leukemia. Progr. Hemat.,
2:192-205, 1959.
12. Cramblett, H. G. ; Friedman, J. L., and Najjar, S.: Leukemia
in an Infant Born of a Mother with Leukemia. New Eng. J. Med.,
259:727-729 (Oct. 9) 1958.
for August, 1966
813
A Clinicopathological Conference
From The Ohio State University Hospital, Columbus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
J. B. McMILLAN, M.B., Ch.B., President
PRESENTATION OF CASE
First Admission: Three and a half years prior
to his death this white man, aged 54, was first
admitted to Ohio State University Hospital for
treatment of a right pleural effusion that had been
recurring for two and a half years. Thoracentesis
had been performed five or six times, and diuretics
had been given intermittently. During this period
the patient had also been treated with P32 for lym-
phatic leukemia. The patient denied all cardiopul-
monary symptoms except dyspnea on exertion.
On physical examination the vital signs were nor-
mal. No lymph nodes were palpable. There was
dullness in the lower half of the right chest with
associated physical findings of a pleural effusion.
The spleen was palpable 6 cm. below the left costal
margin and the liver 4 cm. below the right; both
organs were tender. The blood pressure was 100/60.
The remainder of the physical examination gave nor-
mal findings.
The laboratory examinations showed a white blood
count of 26,300 with 22 per cent neutrophils, 2 per
cent eosinophils, 72 per cent lymphocytes, and 4 per
cent monocytes; the hemoglobin was 14 Gm., the
red cell count 5.7 6 mil., the platelet count 530,000,
reticulocytes 3 per cent. The fasting blood sugar,
the urea nitrogen, uric acid, creatinine, serum electro-
lytes, alkaline phosphatase, van den Bergh, total
protein and albumin/globulin ratio were within nor-
mal limits. The chest x-ray showed a right pleural
effusion and questionable cardiomegaly.
A thoracentesis yielded 1,800 cc. of clear serous
fluid having a specific gravity of 1.015 and contain-
ing 540 mg. of protein per 100 ml. Smear of the
fluid showed many mature lymphocytes and eosino-
phils; no growth was obtained on culture. Cytoxan®
(500 mg.) was inserted into the right pleural space.
The patient was discharged on the second hospital
day.
Second Admission
Eight months later the patient was again admitted
for thoracentesis since fluid had been accumulating
Submitted May 25, 1966.
Presented by
• Robert L. Wall, M. D., Columbus, and
• Colin R. Macpherson, M. D., Columbus;
Edited by Dr. Macpherson.
more rapidly in the last month. The physical and
laboratory findings were very similar to those of the
previous admission except that there was now atrial
fibrillation. A right thoracentesis removed 1,600 cc.
of serosanguineous fluid that did not clot. Papanico-
laou smear of the fluid was reported as Class III
with the specimen consisting almost entirely of red
blood cells and mature lymphocytes with an occasional
atypical lymphocyte. Cytoxan (1,000 mg.) was in-
jected into the pleural cavity. The patient was dis-
charged on treatment with HydroDIURIL® (50 mg.
twice daily) and a low salt diet, to be followed by
his family physician.
Third Admission
After five months the patient was readmitted with
massive ascites but otherwise in much the same state.
On chest x-ray the heart had normal size and con-
tour, but the heart sounds were distant and one ob-
server heard a friction rub. Fibrocalcific infiltrations
were seen in both hilar areas, resulting in enlarge-
ment of the right hilum. There were changes com-
patible with right fibrothorax and loculated pleural
effusion on the right side. Two paracenteses were
performed and a total of 4,500 cc. of fluid was ob-
tained; 1,000 mg. of Cytoxan was injected intra-
peritoneally without incident. The patient was dis-
charged on the third hospital day to continue treat-
ment on HydroDIURIL (70 mg. twice daily) and
digitalis.
Fourth Admission
In the following five months the patient’s ascites
became increasingly difficult to manage medically and
he was readmitted for paracentesis. He had had
increasing dyspnea on exertion and paroxysmal noc-
814
The Ohio State Medical Journal
turnal dyspnea. There was massive ascites, and the
neck veins filled from below. Pleural friction rubs
were heard at the left base posteriorly. The electro-
cardiogram showed atrial fibrillation, low voltage, in-
complete left bundle branch block, and nonspecific
myocardial changes. The blood pressure was 100/70.
At paracentesis, 4,000 cc. of fluid was removed and
1,000 mg. of Cytoxan was instilled into the peritoneal
cavity. He was discharged on the second hospital
day with instructions to take a thiazide diuretic (500
mg. per day), digitoxin, and a low salt diet.
Final Admission
During the next two years the patient underwent
18 combined thoracenteses and paracenteses. He had
been taking digitoxin and diuretics daily. His final
admission was for treatment of his chronically recur-
ring pleural effusion and ascites.
His blood pressure was 105/90, pulse rate 120
per minute and irregular, respirations 20 per min.,
temperature 96°. The patient had obvious anasarca.
There were erythematous eruptions on his abdomen.
The pupils were miotic and funduscopic examina-
tion was not possible. The neck showed venous en-
gorgement at 90°. There was no lymphadenopathy.
The respiratory movements on the right were de-
creased, with dullness and decreased breath sounds.
The left side had wet rales throughout the lung fields.
The heart had the rhythm of atrial fibrillation, was
not enlarged to percussion; the heart sounds were
distant and no murmurs were described. The radial
pulses were decreased bilaterally; the veins of the
upper extremities were markedly engorged. There
was marked ascites. The liver was palpable 4 cm.
below the right costal margin; the spleen was not
palpable. The scrotum and lower extremities showed
marked edema.
The white blood cell count was 11,700 with 50
per cent neutrophils, 4 per cent eosinophils, 30 per
cent lymphocytes, and 12 per cent monocytes; red
blood count 4.9 mil., reticulocytes 3 per cent, platelets
860,000; hemoglobin 15.5 Gm. The urine had a
specific gravity of 1.018, a pH of 6, and contained
many epithelial cells. The uric acid was 7.8 mg.,
creatinine 2.5 mg., fasting blood sugar 96 mg./lOO
ml. The alkaline phosphatase was 7.7 units; inorganic
phosphorus 6.7 mg./lOO ml.; total protein 6.9 Gm./
100 ml. with 3.6 Gm. of albumin and 3.3 Gm. of
globulin. The van den Bergh was normal, and the
prothrombin time was 42 per cent of normal. The
serum sodium was 137, the potassium 4.8, chloride
92, and C02 combining power 34 mEq./liter. The
chest x-ray showed bilateral pleural effusions and an
air-fluid level on the right side. A patchy infiltrate
was described in the area of the lingula.
The patient, in critical condition upon admission,
deteriorated rapidly. In an attempt to relieve his
dyspnea, a thoracentesis was performed and 1,000
cc. of yellow-pink, turbid, lymph-like fluid was re-
moved from his right chest. He was treated with
digitalis, Aldactone®, Mercuhydrin®, and 100 cc. of
albumin in an attempt to produce diuresis. Termi-
nally, it was believed that he was in pulmonary
edema. Phlebotomy was unsuccessful, and he died
quietly on the second hospital day.
CLINICAL DISCUSSION
Dr. Wall: This was a man in his sixth decade
who early in that decade developed a right pleural
effusion. Although we don’t have the details of his
outpatient history7, he apparently was found to have
chronic lymphatic leukemia and was given radioactive
phosphorus. I think there is little doubt throughout
his course that he had chronic lymphatic leukemia.
However, this seemed to be fairly easily controlled
in most of its aspects, and at the time of the man’s
death his chronic lymphatic leukemia was still rela-
tively mild as it relates to his blood. It might not
be relatively mild as it relates to tissue infiltrates,
but I would wonder if his chronic lymphatic leukemia
actually had much to do with his death.
At his first admission, the problem was one of
pleural fluid that recurred, unilateral on the right,
for which he had been tapped a number of times
before he was seen. It is important, I think, that at
that time, if this is a true observation, he had a
normal sinus rhythm to his heart and there was only
very questionable cardiomegaly on x-ray. His pleural
effusion did show a fairly significant population of
lymphocytes and, while this is not diagnostic, many
times the pleural effusions related to leukemia can
have some extra lymphocytes in them, surely in chronic
lymphatic leukemia patients. If we would believe,
as the clinical people did at that time, that this was
probably related to his primary7 disease, then their
use of intrapleural alkylating agents is valid and it
will reduce the pleural effusion. Most frequently it
will reduce it in relationship to obliteration of the
pleural space rather than actually being too effective
at lymphatic blockage.
Apparently this helped him to some degree. Eight
months later, however, he was readmitted and this
time he had different problems, namely, those of
ascites and edema which apparently weren’t present
before, and at this time he had atrial fibrillation but
again without any significant cardiomegaly. The elec-
trocardiogram at that time apparently showed some
low voltage and myocardial changes, but in the ab-
sence of cardiomegaly, which seems to be important
throughout his entire observation period. No addi-
tional information regarding venous pressure distribu-
tions, neck veins and things like that, is present at
this time. So we now know that where he had a
long-standing recurrent right pleural effusion he now
had significant ascites and edema. On subsequent
readmissions to the hospital the ascites and peripheral
for August, 1966
815
edema became more marked and persisted for the
remaining few years until his death.
It is important, I think, that when for the first time
his blood pressure was reported, it was 100/60, and
at no time did he show any significant wide pulse
pressure or hypertension. His pulse rate at many
times was quite low, but most of the time it was
above 100 to 120, in the absence of anemia related
to his chronic lymphatic leukemia. On the third ad-
mission one observer heard a friction rub over his
cardiac area, and his heart sounds were distant and
remained distant until his death. No murmurs are
described until late in the course of his disease.
At this time they did note that his neck veins were
significantly distended.
Again in another five months, or about two years
before his death, he was readmitted and at this time
there was no significant cardiomegaly, and the man
again had ascites and dependent edema. Now he had
developed paroxysmal nocturnal dyspnea, which is a
newly described event, and his effusions at this time
were bilateral. They were also thought to be ac-
companied by a pleural effusion rub at this time,
distinct from his previous friction rub which was
thought to be pericardial. His edema was much
more massive at this time and extended to his thighs.
Again his blood pressure showed very narrow pulse
pressure; it was only 30 mm. His neck veins were
markedly distended in upright sitting position. His
electrocardiogram showed a low voltage and now an
incomplete left bundle branch block and myocardial
changes, probably ST segment and T wave changes.
So the man does seem to have had progressive myo-
cardial disease, but his myocardial disease never
tended toward cardiomegaly at any time, which prob-
ably is significant.
Then we didn’t hear from him for two years, until
he came in for only a 24-hour stay before he died.
During that two-year interval he had had 18 thoro-
paracenteses. On admission again his blood pressure
was low with a very narrow pulse pressure of only
15 mm. of mercury, a pulse of only 120 in a man
with generalized anasarca, no cardiomegaly, no mur-
murs, and distant heart sounds.
No Question About Leukemia
In reconstructing his history, I think this man had
chronic lymphatic leukemia, even though we don’t
have any description of bone marrow examination
at any time. I’m sure it was done or radioactive
phosphorus wouldn’t have been used. It was mild,
because at the time of his death he still did not have
any significant anemia, thrombocytopenia, or any of
the sequelae that we see in the patient with progres-
sive chronic lymphatic leukemia whose course is one
of gradual deterioration and death.
Could his pleural effusions originally have been
related to his chronic lymphatic leukemia? Surely;
it’s not an uncommon event, although it is an uncom-
mon event in easily controlled chronic lymphatic
leukemia patients. Would there be other reasons to
develop isolated pleural effusions without other fluid
collections as he did, which actually preceded signifi-
cantly his ascites and edema? Surely; these people
can get node and lymphatic infiltration with localized
obstruction. It’s unusual to stay that way that long,
but again this man was influenced by repeated intra-
pleural therapy using Cytoxan, and this could have
influenced the rate of recurrence. Could it all have
been cardiac in origin? It’s possible, but it kept re-
curring for two and a half years before he got any
ascites, in the absence of cardiomegaly and with
fairly respectable cardiac function up until that time.
Constrictive Pericarditis ?
In a person who shows massive ascites, hepato-
megaly at times unassociated with splenomegaly, peri-
pheral massive edema, and with a long chronic course,
one must think of constrictive pericarditis. We
never had any description of significant calcification
of the pericardium on any of his x-rays, but there
are limitations in reading those in a person with
recurrent pleural effusion. Could he have constrictive
pericarditis? There is a good possibility, I think,
in a man with a significantly lowered systolic pres-
sure, a normal pressure, a very narrow pulse pres-
sure, marked venous neck distention, no murmurs, a
low voltage as his myocardium gradually deteriorates,
no auricular fibrillation to begin with and later au-
ricular fibrillation, which I understand is not too un-
common in constrictive pericarditis. A pericardial
friction rub, which we cannot ignore, was described
at least by one observer, and in the face of all of the
measures one usually uses in congestive failure —
such as sodium restriction, diuresis, digitalis — he
didn’t show any significant improvement. This is
also a little characteristic of constrictive pericarditis.
Could he have nonconstrictive pericarditis? Could
he have mediastinal pericarditis? adhesive pericar-
ditis ? which is surely uncommon. Could he have an
immobile heart sitting in the middle here? I think
he could. Could he have a tricuspid stenosis? He
could, but there is very little evidence to support it
— the lack of murmurs, the lack of significant cardio-
megaly as his disease progresses. Not many things
support that diagnosis.
I don’t know which of these is true, but I think
from the evidence available I would undoubtedly go
with chronic lymphatic leukemia, possibly with a
pleural effusion originally occurring related to that
disease, and with subsequent constrictive pericarditis
over a period of some time. If this is true, then it
would indeed be tragic, because there is always the
possibility that this is amenable to surgical correc-
tion. As for the specific etiologic agent, I would
first suggest, for reasons of frequency, a tuberculous
816
The Ohio State Medical Journal
origin, but there is very little evidence to support this.
Maybe we could see the electrocardiograms and
x-rays.
Dr. Freimanis : The first film that I have, shows
indeed a considerable effusion; it is mainly on the
right side — in fact, at that time we could not identify
any fluid on the left side at all. However, there is
a quite massive right-sided pleural effusion. The
size of the heart cannot be measured accurately be-
cause the pleural effusion extended down and lies
next to the right heart border. However, it is worth
noticing that the heart does not protmde particularly
far to the left and the left lung is not particularly
congested.
About a year after the original film, the fluid in
the right side is increased somewhat more, and a
year later he came back with the same thing. So
there is the continuous presence of pleural fluid on
the right side which was gradually increasing in
spite of the fact that it was being removed and
treated otherwise, without any really good demonstra-
tion of underlying primary pulmonary disease either
on the right or left side. The heart always remained
small, even in the rather late stages of the disease.
A pyelogram showed normal kidneys. An upper
G. I. series showed an intrinsically normal esophagus,
stomach and duodenum.
Terminally, the patient still shows a massive right-
sided pleural effusion. Now he also has a left-sided
pleural effusion which is quite massive. There is pul-
monary edema and a lingular infiltration was de-
scribed. This may be an area of pneumonitis, it may
be just some more pulmonary edema. At this point
he was in heart failure and yet remarkably enough
the heart still remained probably about the same size.
He had pulmonary edema, bilateral pleural effusion,
and again ascites and enlargement of the liver and
spleen. As far as calcifications in the heart are con-
cerned, I cannot see any. This of course does not
exclude constrictive pericarditis.
Dr. Ryan : The E. K. G. is not of much more
help than the x-rays. It just shows atrial fibrillation.
Notice there are no P- waves. Look at the sharp
reduction of the voltages of all the QRS complexes,
which is consistent with pericardial effusion; it is
consistent with any gross accumulation of fluid. The
T-waves are inverted, very nonspecific, and may very
well be due to digitalis.
CLINICAL DIAGNOSIS
1. Chronic lymphatic leukemia.
2. Persistent pleural effusion.
3. Constrictive pericarditis.
PATHOLOGIC DIAGNOSIS
1. Chronic lymphatic leukemia.
2. Constrictive pericarditis.
3. Mediastinal fibrosis.
4. Chylous ascites and pleural effusion.
5. Tracheal diverticulum.
DISCUSSION OF PATHOLOGY
Dr. Macpherson: The diagnosis really could
be made essentially on the gross features at autopsy.
This picture shows a very markedly distended upper
mediastinal vein that did not collapse and was in keep-
ing with the remark in the protocol that they "filled
from below.’’ This was the first point that was striking
at the autopsy. The next picture shows the abdominal
cavity, and the striking feature here is this chylous
material; there were 6,000 cc. in the peritoneal cavity.
This fluid was sterile on culture, and the purulent ap-
pearance is due entirely to the presence of fat drop-
lets. There was thickening of the mesentery, and this
was actually a very chronic process; there is fibrosis,
thickening of the wall, and the bowel is matted to-
gether. This appearance, I believe, is secondary to
chemical irritation.
There is marked thickening of the capsule of the
liver; it is patchy and there were marked adhesions
around. The spleen is even more grossly involved
than the liver was — the so-called sugar-icing spleen.
All of the organs in the peritoneal cavity showed
marked thickening of the capsule, and the chylous
fluid was also present in the chest.
Here we have the pericardial sac, and you see here
adherence of the heart to the pericardium. There was
no pericardial effusion. There was marked thicken-
ing of the parietal pericardium where it came in con-
tact with the pleura and mediastinum. This was con-
tinuous with the thickening of the under surface of
the diaphragm and of the peritoneum over that area.
So what we had essentially was a tremendously mat-
ted, thickened, fibrotic pericardium, pleura, and medi-
astinum. There were pleural effusions on both sides,
a small one on the right and a larger one (about 500
cc.) on the left, and in addition the left lung only
showed considerable edema. The right lung was
atelectatic and was quite contracted down and cov-
ered with a thick capsule. There was calcium in the
parietal layer of the pericardium; it was patchy and
was present in sort of flat plaques and was not uni-
form at all.
When we opened up the trachea, there was a very
interesting observation, namely, a small fistula in the
trachea just at the bifurcation. It was found to com-
municate with a typical chronic, caseous lymph node.
This was the only evidence of tuberculosis anywhere
in the body. It is certainly very unusual to find this
in the absence of active disease elsewhere.
Histologically, there is an infiltrate of lymphocytes
in the bone marrow, which was essentially normal
throughout but showed small patches of lymphocytes
here and there. This was interpreted as being evi-
dence of chronic lymphatic leukemia because virtually
every organ examined showed the infiltrates of chronic
/ or August, 1966
817
lymphatic leukemia. The mediastinal lymph nodes
were not grossly enlarged but they all showed dis-
organization of their structure and infiltration out
through the capsule of the node. The pleura showed
a thick layer of fibrous tissue on the surface and
beneath that extensive infiltrates due to chronic lym-
phatic leukemia. The same thing was seen to a
much lesser degree in the pericardium. It was also
seen in the spleen and in the intestinal tract. So,
even though the lymphatic leukemia was obviously
quite quiescent clinically and did not show much evi-
dence in the blood, it was very widespread through-
out the body but nowhere did it show evidence of
great activity. The cells were primarily mature lym-
phocytes; there were few mitotic figures; there were
few primitive cells.
We must first explain the congestive heart failure.
There was no evidence of any valvular disease or any
significant disease of the coronary arteries; there was
no fibrosis nor infiltrate of the myocardium. There
was extensive constrictive pericarditis which was
linked up to the fibrosis of the pleura and of the
mediastinum. There was also virtual absence and
nonfunction of the right lung. We felt that this was
constrictive pericarditis but we were not really able
to decide whether it was primarily a tuberculous peri-
carditis, complicated by the other events that followed
it, or whether it was primarily a Cytoxan-induced
pericarditis with the extensive fibrosis which was also
seen in the pleura and in the mediastinum. As to the
chylous ascites, this is quite clearly due to obstruc-
tion of the thoracic duct by the massive fibrosis in the
mediastinum and elsewhere. This would be one
point in favor of saying that the pericarditis was
probably related to the Cytoxan therapy, but I don’t
think that we can exclude the possibility of a tuber-
culous etiology complicated by the treatment of the
lymphatic leukemia.
General Discussion
Dr. Ryan: Usually as you approach constrictive
pericarditis, this is a very difficult plane for the sur-
geon to identify. I do know that we used to say
that there were localized constrictions and then this
became unfashionable — that the whole heart had to
be involved. Now we are beginning to accept evi-
dences of localized constrictions, if they are in the
right place (as in the sulcus between the atria and
ventricles), that mimic valve defects. This certainly
didn’t look like the usual constrictive pericarditis;
it looked like a pretty free space.
Dr. Macpherson: I think the space was not as
free as it appeared in that picture because there had
been extensive dissection before they could get it
loosened up to that degree. But there was not the
uniform and massive fibrosis that one normally asso-
ciates with this entity. On the other hand, the points
that we felt were in favor of constrictive pericarditis
were the degree of fibrosis of the parietal pericardium
with calcification, and secondly, the fact that the heart
was not markedly dilated at all.
Dr. Ryan : Dr. Wall, do you have any comments ?
Dr. Wall: No. We still put these substances
in the pleural space. We have been more impressed
in recent years that maybe we need to get surgical
assistance when we get a man like this with recurrent
effusions: have a surgeon split an intercostal space
and put in a mushroom catheter, suck out the area,
and plaster the visceral and parietal pleura against
each other and obliterate the space that way and
maybe do less damage in the long run.
Heart Failure in Constrictive Pericarditis
Dr. Ruppert: When we speak of constrictive
pericarditis we are speaking of right heart failure?
Dr. Ryan: You are speaking of whole heart
failure.
Dr. Ruppert: This goes back to the question:
When we see classic constrictive pericarditis, do we
see pulmonary edema? Do we see pleural effusion?
Dr. Ryan: Yes. You do not have the usual
symptomatology of acute pulmonary congestion, but
if you make pressure measurements you will find
that the pulmonary venous pressure is elevated, the
pulmonary artery diastolic pressure is elevated, the
right ventricular end-diastolic pressure is elevated, the
right atrial pressure is elevated, and the right atrial
pressure, the right ventricular end- diastolic pressure,
the pulmonary artery end-diastolic pressure, and the
pulmonary venous pressure all achieve about the
same level, about 20 to 25 mm. The problem is
that this disease progresses equally on both sides of
the heart apparently, unlike the usual hypertensive,
whose left side gives way, or the aortic valve dis-
ease, whose left side also gives way.
Dr. Browning: The original pleural effusion
was clear fluid. Apparently it was not chyle at that
time. Also 1.015 specific gravity with only a half
gram of protein suggests more a transudate than an
exudate, doesn’t it? I wonder if that is consistent
with the leukemic fluid.
Dr. Wall: In lymphosarcoma, most patients
have transudates, not exudates.
Dr. Macpherson: We felt that the time in-
terval between the instillation of the Cytoxan into
the pleural cavity and the development of fluid in the
abdominal cavity would be consistent with fibrosis
leading to a chylous ascites as a late complication.
We didn’t think that it had been there all the time.
818
The Ohio State Medical Journal
Metamucil
. to counteract the
constipation which
is etiologically
important and
. to protect the
mucosal surface
against physical
irritants.
Average Adult Dosage:
One rounded teaspoonful of Metamucil (or one
packet of Instant Mix Metamucil) in a glass of
cool liquid one to three times daily.
S EARLE
Research in the Service of Medicine
for August, 1966
821
a.
New Public Health Regulations
On PKU Testing in Ohio
SECTION 3701.501 of the Revised Code of Ohio
requiring phenylketonuria tests for all newborn
infants, went into effect July 1, 1966. Regu-
lation HE-45-01, implementing that section, was ap-
proved by the Public Health Council on June 11.
Information in regard to the law and regulations
are presented herewith in three documents issued by
the Ohio Department of Health and released to The
Journal by Dr. E. W. Arnold, director of health.
Following are (1) the new regulation approved by
the Ohio Health Council, (2) an information sheet
concerning the screening program, and (3) supple-
mentary material entitled "Guthrie Inhibition Assay
Screening,” containing among other data the names
of consultants in the field.
STATE OF OHIO
DEPARTMENT OF HEALTH
PUBLIC HEALTH COUNCIL
TESTING FOR PHENYLKETONURIA
CHAPTER HE-45
Authority: Section 3701.501 of the Revised Code
Regulation HE-45-01
Phenylketonuria test on
newborn infants.
HE-45-01. Phenylketonuria test on
newborn infants.
(A) The Ohio department of health laboratory
shall provide, without charge, screening and quantita-
tive tests for phenylketonuria, and specimen collection
outfits for tests to be performed in the department’s
laboratory. The result of each test performed by the
said laboratory shall be transmitted in writing to the
person who submitted the specimen or to the hospital.
In addition, any elevated phenylalanine blood levels
six mg. per hundred ml. or above shall be reported to
such person immediately by telephone or telegram.
In the event the result of a test performed by the
said laboratory is a phenylalanine blood level four mg.
per hundred ml. or above, the person who submitted
the specimen shall cause to be submitted a second
specimen to said laboratory as requested in the de-
partment’s report to such person.
(B) If any laboratory other than the department’s
laboratory desires to perform tests for phenylketon-
uria, as required by section 3701.501 of the Revised
Code and this regulation, such laboratory must first
apply to and receive approval from the director of
health and shall:
(1) Use either the Guthrie Inhibition Assay
blood screening test or a quantitative fluorometric
procedure approved by the director; provided, other
tests may be permitted if prior written application
has been made and approval given by the director;
(2) Use filter paper disc controls with each
Guthrie plate, and serum controls of known re-
activity for the fluorometric procedure;
(3) Complete each test within three working
days after receiving the specimen and promptly
transmit the results of each test performed to the
person who submitted the specimen on forms pre-
scribed and provided by the director;
(4) In addition to complying with subdivision
(B) (3) of this regulation, report by telephone or
telegram to the person who submitted the specimen
any elevated phenylalanine blood levels of six mg.
per hundred ml. or above;
(5) Request the person who submitted a speci-
men which had a test result of a phenylalanine
blood level four mg. per hundred ml. or above to
submit a second specimen to the department of
health laboratory, or to another laboratory approved
by the director under this regulation;
(6) Report monthly to the department of
822
The Ohio State Medical Journal
health the total number of infants tested and the
total number of tests performed, and immediately
report to the department the names of infants show-
ing elevated levels of phenylalanine above six mg.
per hundred ml. and the name and address of the
person submitting the specimen. These reports
must be substantiated by records which shall be
kept in the laboratory for not less than two years;
(7) Accept and test unknown specimens from
the department of health, and report results of
testing such specimens to the department within
turn weeks.
(C) The person required to file a certificate of
birth under section 3705.14 of the Revised Code shall
cause specimens to be collected as follows:
(1) The attending physician shall cause a blood
specimen to be collected from each newborn child
which shall be not sooner than 24 hours after the
first protein feeding, and a specimen collected from
an infant receiving antibiotics parenterally or orally
shall be so labeled; provided, a blood specimen
shall be collected from a premature infant when the
attending physician determines that such speci-
men collection is no longer contraindicated;
(2) Where a birth does not occur in a hospital,
the attending physician or midwife shall cause a
blood specimen to be collected for testing for
phenylketonuria. Such specimen shall be collected
within the first two weeks of life, but not sooner
than 24 hours after the first protein feeding;
(3) If there is no physician or midwife in at-
tendance at the time of birth, the local registrar of
vital statistics, when notified that such a birth has
occurred, shall report the occurrence of the birth
to the health commissioner of the health district in
which the birth occurred. The health commis-
sioner shall cause a blood specimen to be collected
for testing for phenylketonuria within seven days
after being notified of the birth of a newborn child,
but not sooner than 24 hours after the first protein
feeding;
(4) A specimen shall be sent to the laboratory
not later than 48 hours after it is collected;
(5) A repeat specimen shall be collected within
72 hours if the first is inadequate or unsatisfactory.
(Adopted June 11, 1966; effective July 1, 1966.)
PHENYLKETONURIA
Information for Hospitals and Physicians
Screening of Newborn Infants for
Phenylketonuria
Ohio Department of Health
Bureau of Laboratories
The Ohio Department of Health Laboratory will
provide, without charge, screening and quantitative
tests for phenylketonuria, and specimen collection
outfits for tests to be performed in the department’s
laboratory upon the request of the hospital adminis-
trator.
I. SUPPLIES
The department of health laboratory provides the
hospital with specimen collection kits which consist
of (1) a special four-part, numbered filter paper
collection form, with instructions for collection of the
specimen, (2) a disposable, sterile lancet and (3) a
preaddressed envelope for mailing the specimens to
the Ohio Department of Health Laboratory. These
kits will be provided to the hospital at approximate
six-month intervals. The quantity will be determined
by the number of births anticipated. Extra un-num-
bered filters can be obtained by private physicians
upon request.
II. IDENTIFICATION
All information requested on the filter paper col-
lection form must be provided. This information
should be clearly printed with a ball point pen. Label
specimens collected from infants using antibiotics.
III. SPECIMENS
A. Method of Collection
Note on infant’s record the fact that the specimen
has been taken: hold record in record room pending
laboratory results. Collect the blood specimen from
a heel puncture using a sterile disposable lancet.
Apply pressure to the heel, allowing a large drop to
form. Blot it off on the filter paper so that one drop
fills each of the three printed circles and soaks
through the paper. The appearance of the blood
spot should be similar on both sides of the paper.
Two full drops are better than three tiny drops. Re-
peated dabbing of tiny drops will not give an ade-
quate specimen. Specimens not adequate for testing
will be returned to the sender.
B. Time of Collection
The blood specimen for testing should be obtained
no sooner than 24 hours after the first protein feeding
except :
"(A) An infant receiving only breast milk should
have the specimen taken during the fourth to the
tenth day of life.
"(b) An infant of less than 4]/2 pounds birth
weight should have the specimen taken during the
seventh to 14th day of life.
"(c) An infant from whom a specimen cannot be
obtained in the hospital within these criteria (for
example, discharged from the hospital too soon, born
outside the hospital) should have the specimen taken
within the first two weeks of life.”
IV. STORAGE
After the filter paper specimens have been air-
for August, 1966
823
dried, they should be placed in the small transparent
envelope and stored in the larger mailing envelopes.
V. MAILING
Specimens are to be mailed to the laboratory twice
weekly. Specimens should never be kept for more
than four days. Early detection of PKU is of prime
importance.
VI. REPORTING OF TEST RESULTS
Two copies of each test result are sent to the hos-
pital, one for the hospital record and one to be trans-
mitted by the hospital to the physician.
Results of tests are reported in three categories :
A. "Less than 4 mg. per hundred ml.”
A "less than 4 mg./lOO ml.” result indicates a
negative test or a "normal” blood phenylalanine level.
B. Unsatisfactory specimen
This report is returned to the sender when there is
an insufficient blood sample or diluted blood on the
filter paper. A repeated specimen is necessary in
these instances.
C. 4 mg./IOO ml. or Over
A level of 4 mg./IOO ml. or higher should be
considered a "presumptive positive” test. This re-
sult is not diagnostic of phenylketonuria. A con-
firmatory test should be performed.
The physician is contacted by letter when a speci-
men shows a result of 4 mg./IOO ml. blood phenyl-
alanine.
(a) A second blood filter paper specimen is re-
quested from the infant.
(b) A blood filter paper specimen is also re-
quested from the mother to check for "Maternal
PKU.”
The physician is contacted by telephone when a
specimen shows a result of 6 mg./IOO ml. or higher
blood phenylalanine.
(a) One filter paper will be sent for collection
of infant’s urine.
(b) One blood filter paper specimen is also re-
quested from the mother to check for "Maternal
PKU.”
(c) A blood collection kit containing microhema-
tocrit tubes. These hematocrit tubes are to be filled,
two-thirds full, with whole blood, sealed and mailed
to the laboratory for a quantitative analysis.
The importance of obtaining and mailing these
blood specimens to the Ohio Department of Health
Laboratory promptly cannot be emphasized enough.
VII. DIAGNOSIS AND TREATMENT
If the "special” repeat specimen is still above the
normal range, the physician is urged to take imme-
diate steps to obtain consultation. (See names and
addresses of consultants beginning on page 825.)
It is imperative not to start treatment until a child
has been properly diagnosed as phenylketonuric.
Treatment with a low phenylalanine diet requires
close attention to nutritional needs and is reserved
only for the confirmed case of PKU. Physicians
treating confirmed cases of PKU may request Lofe-
nalac® from the Division of Maternal and Child
Health for their patients whose families cannot af-
ford the cost of the special diet. Consultation re-
garding nutrition management of a child with PKU
is available from nutritionists on state or local health
department staffs.
GUTHRIE INHIBITION ASSAY
SCREENING FACTORS TO
CONSIDER
Initial Testing
1. The infant on breast feeding may not have an
adequate protein intake within 24 hours after the
start of breast feeding. Consideration should be
given to testing these infants at the end of their
hospital stay. If they are discharged from the hos-
pital under three days it is imperative to retest in the
physician’s office on the first return visit.
(Michigan regulations state "an infant receiving
only breast milk shall be tested during the fourth to
tenth day of life.”)
(Additional test filters will be supplied to the pri-
vate physician on request.)
2. Infants on antibiotics should have the filter
paper marked "antibiotics.” Tests thus marked will
be performed by other methods. Because the Guthrie
relies on bacterial action, the presence of antibiotics
can be recognized after the test is completed, thus
requiring retesting and the delay in reporting.
3. Physicians may wish to enlist the aid of their
local City or County Health Department to locate
infants discharged prior to their being on formula
for 24 hours. Arrangements can be made for the
physician to request the public health nurse to take
the sample specimen in the home. This would also
provide a continuity of health care that many of these
people would not otherwise receive.
Prematurity
1. Many premature infants will show an elevation
of phenylalanine. Retesting should continue until
levels return to normal or a diagnosis of PKU or
other condition is made. Frequency of retesting
should be determined by the physician giving due
consideration to the degree of prematurity and levels
of phenylalanine found.
2. When phenylalanine levels are elevated it is
desirable to use quantitative testing including ex-
amination of the tyrosine and other amino acids.
In a recent study of premature infants born at
Cincinnati General Hospital, 25 per cent of premature
infants not given supplemental doses of ascorbic
824
The Ohio State Medical Journal
acid developed elevation of tyrosine and phenylalanine
in the blood and excreted large amounts of tyrosine
and tyrosine derivatives. Tyrosine levels may range
from 10 to 75 mg./lOO ml. — usually excluding the
diagnosis of PKU.
3. These infants should be followed until levels
become normal.
Some Known Reasons for Phenylalanine Eleva-
tions on the Guthrie Screening other Than
PKU. (Sometimes Termed Phenylalaninemia or
Hyperphenylalaninemia)
1. High protein feeding: A surprising number
of full term infants apparently are unable to met-
abolize proteins completely in early infancy. Chang-
ing the formula to one with a lower protein content
will sometimes return the level to the normal range.
(See listing of protein values of some common infant
feedings, on this page.
2. Some infants with an elevation of both phenyl-
alanine and tyrosine require the addition of 100 mg.
of vitamin C daily to return both levels to the normal
range. (Some infants require additional folic acid.)
3. The repeat test following a trial of lower pro-
tein formula and additional vitamin C should be a
fasting specimen.
4. If the phenylalanine levels remain elevated
(in the absence of the keto acids and their derivatives)
the possibility of a carrier state should be considered.
Exploration of family antecedents may reveal a his-
tory of mental retardation. Because PKU follows
an autosomal recessive inheritance pattern, it would
be most unusual to find other immediate family mem-
bers (besides siblings) with the disease. In the
pedigree there is a greater likelihood of consanguinity
than found in the general population; however, PKU
may show up by mutation or by accidental union of
two people who happen to carry the same recessive
gene.
5. The possibility of atypical PKU or other dis-
ease entities should be explored.
6. Elevations in the levels of tyrosine and phenyl-
alanine have been observed in infants with untreated
galactosemia, tyrosinosis and liver disease of all types,
particularly those that are inflammatory. Jaundice
may or may not be present. (Vitamin C has no
effect.)
7. A small number of infants have unexplained
laboratory findings and should be watched carefully
and tested frequently.
Establishing a Diagnosis
The Guthrie Inhibition Assay is a screening test
only.
The diagnosis of PKU can be made only with
quantitative testing.
Suggested criteria for establishing a diagnosis
include:
lllllllllllllllllllllllll
Listing of Protein Values of Some
Common Infant Feedings
Some Common Protein Content ( normal dilution)
Infant Feedings Grams per 100 ml.
Human Milk 1.1
SMA® S-26® 1.5
PM 60/40-Similac® 1.5
Enfamil® 1.5
Bremil® 1.5
Similac-20® 1.7
Soyalac® 2.05-2.85
Modilac* 2.15
Nutramigen® 2.2
Bakers-Modified Milk 2.2
Carnalac* 2.28
Veramel* 2.5
Lactum* 2.7
Meat Base Formula 2.85
Mull-Soy® 3.1
Sobee® 3.2
Cow’s Milk-Powdered 3.2
Cow’s Milk-Undiluted 3.3
Olac® 3.4
Skim Milk 3.4
Evaporated Milk 3.6
Alacta* 3.6
Protein Milk 3.8
Probana® 3.9
Dryco* 4.0
Hi-Pro* 4.6
From Nelson, Waldo E., Textbook of Pediatrics, Eighth Edi-
tion, 1964
* Trade name products
lllllllllllllllllllllllll
1. Fasting phenylalanine level over 15 mg./lOO
ml. by a quantitative method.
2. Tyrosine less than 5 mg./lOO ml.
3. Leucine and valine within normal limits.
4. Urine phenylalanine over 100 mg./lOO ml.
5. Urine orthohydroxyphenylacetic acid present.
It must be remembered that the presence of phenyl-
pyruvic acid in the urine (which is easily tested for)
may be delayed as late as six weeks or even three
months.
Phenylalanine and orthohydroxyphenylacetic acid
may be present in the urine as early as one to two
weeks of age. There is danger of severe growth re-
tardation and mental retardation from "over treat-
ment.” Death may also occur from "over treatment.”
Great harm may be done by treating suspected cases
without a firm diagnosis and without adequate moni-
toring.
It is strongly suggested that the physician seek con-
sultation to determine explanation of the biochemical
findings.
The following resource physicians are among those
who will provide consultation and follow the PKU
aspects of children on request of the private physician:
Thomas M. Teree, M. D., Babies and Childrens
Hospital, University Hospital of Cleveland, Univer-
sity Circle, Cleveland, Ohio 44106; Phone: 791-7300,
Ext. 2811.
Derrick Lonsdale, M. D., Cleveland Clinic, 2020
( Continued on Next Page )
for August, 1966
825
East 93rd Street, Cleveland, Ohio 44106; Phone: 231-
6800, Ext. 601.
Kathryn Huxtable, M. D., Metropolitan General
Hospital, 3395 Scranton Road, Cleveland, Ohio;
Phone: 351-4820.
Antoinette Eaton, M. D., Children’s Hospital, 561
S. 17th Street, Columbus, Ohio 43205.
Betty Sutherland, M. D., Children’s Hospital Re-
search Foundation, 240 Bethesda, Cincinnati, Ohio
45229; Phone: 281-6161.
State Services for Crippled Children will pay for
the diagnostic metabolic evaluation at one of the
centers if the physician requests this service.
Follow-Up Treatment
1. Because of the difficulties inherent in admin-
istering the low phenylalanine diet, physicians are
urged to carry out treatment in consultation with one
of the treatment centers. [Emphasis on this point
urged by Health Department personnel.]
2. Treatment requires the services of the physician,
the nutritionist, the laboratotry, and home follow-up.
When possible it is advisable to have social work and
psychology services available.
3. Some physicians prefer to follow these chil-
dren and sometimes need assistance — the Ohio De-
partment of Health offers the following services:
A. Consultation Service: Upon the request of
the local physician the state consultants in Nutri-
tion and Nursing in Mental Retardation provide a
consultant service which includes:
1. A meeting with the local physician so that
there can be a clear understanding and working
relationship with the physician.
2. A home visit to the family to further explain
the diet and care of the infant. (It is preferred
that the local public health nurse be included so
that she can coordinate this service with the pri-
vate physician.)
B. Information Service: Information, pamphlets,
leaflets, films, etc., on phenylketonuria and dietary
management (recipes) are available to the physician,
local health departments, hospitals, etc., (to families
on the request of the physician.)
C. Services provided by the Division of Public
Health Laboratories:
1 . Repeat blood specimen spotted on filter
paper is tested on infants whose initial PKU Blood
Test or four-weeks PKU Blood Test show 4-6 mg./
100 ml. phenylalanine.
a. This repeat specimen is tested by the
Guthrie Inhibition Assay Method.
b. The repeat test is negative if it shows
less than 4 mg./ 100 ml. phenylalanine.
c. If the result of the repeat test is 4 mg./
100 ml. phenylalanine or higher, the con-
firmatory test procedure is initiated.
2. Quantitative serum phenylalanine tests using
the paper chromatograph technique are run as a con-
firmatory test of blood screening determinations
which show 6 mg./ 100 ml. phenylalanine or higher.
(Tyrosine and other amino acids are also scrutinized.)
As previously stated, the physician is urgently re-
quested to seek assistance from centers when ques-
tions arise. If the physician prefers that the state
laboratory do additional testing, these services are
provided :
a. Quantitative serum phenylalanine determina-
tions run at monthly intervals are suggested if the
original serum phenylalanine test shows results
of 4-10 mg./lOO ml. phenylalanine and the infant
does not respond to suggestions under "Known
reasons for elevated phenylalanine levels.’’
b. Twice monthly rechecks are advised for those
infants showing a level of 10 mg./lOO ml. phenyl-
alanine or higher if the physician has not referred
the family to one of the centers for diagnosis.
c. If a diagnosis of phenylketonuria is made,
quantitative serum and urine phenylalanine tests
will be performed at the physician’s request. Al-
though the Guthrie has been used as a monitor
in several states, there are differences of opinion
about using it without any other laboratory work.
The Guthrie alone is definitely not adequate for
monitoring when levels are below 4 mg./lOO ml.
or when the child is ill.
Policies Related to Lofenalac® Provided Through
the Division of Maternal and Child Health in
the Ohio Department of Health
The physician should:
1. Indicate that the family has a financial need.
2. Send a record of the diagnostic blood and
urine values, and methods used to determine the
values.
3. If the diagnosis was established at one of the
centers previously listed this should be stated.
4. Request the amount required for a three months
supply (to be reordered two weeks before the fam-
ily supply is exhausted) and indicate where it is to
be sent, i. e., physician’s office, parents’ home, Local
Health Department.
5. Mail a record of test results to the Ohio De-
partment of Health, Division of Maternal and Child
Health, Box 118, Columbus, Ohio, at least once
every three months. (Not required of Centers.)
6. There have been deaths from phenylalanine
starvation which were related to inadequate laboratory
monitoring of the diet therapy. Therefore, unless
the children are followed at one of the centers, or
unless laboratory findings are reported, it is the
policy of the Ohio Department of Health to discon-
tinue supplying the Lofenalac.®
826
The Ohio State Medical Journal
New Executive Secretary Takes Office with
The State Medical Board of Ohio
NEWLY APPOINTED executive secretary of
the State Medical Board of Ohio is William
Thomas Washam, M. D., LL. B., former prac-
ticing physician in Jackson, and more recently Colum-
bus attorney, specializing in the medico-legal field.
Dr. Washam has accepted the post on a part-time
basis and will continue to devote some of his time to
his law practice.
Dr. Washam fills the post left vacant when Dr.
H. M. Platter, retired on December 31, 1965, after
48 years of service with the Medical Board. Dr.
Donald F. Bowers, of Columbus, a member of the
Board, has been performing the duties of secretary
until a successor to Dr. Platter could be named.
A native of Jackson, Dr. Washam practiced there
from 1946 to 1962. He is a past president of the
Jackson County Medical Society and a former dele-
gate of the Society to the OSMA. Active in com-
munity affairs of Jackson, he was twice elected to
four-year terms on the local school board and was
board president for three years.
Dr. Washam’s interest in law developed out of
medico-legal cases in which he was called as an ex-
pert witness. He began his studies by taking night
classes at Ohio State University and Franklin Uni-
versity, commuting to Columbus while continuing
his practice in Jackson. He later moved to Columbus
as medical examiner for the Bureau of Workmen’s
Compensation while continuing his law studies.
He received his law degree from Franklin Univer-
sity in 1965 and was admitted to the Ohio Bar also
in 1965. He has the distinction of holding top
scholastic honors in three fields. He won a Phi
Beta Kappa key in 1943, was elected a member of
Alpha Omega Alpha medical honorary in 1945, and
was made a member of the Order of the Curia in
1964 at Franklin University Law School.
The State Medical Board is the state agency
charged with the responsibility of licensing physicians
and limited practitioners in Ohio and enforcing the
law as it applies to the healing arts.
The board consists of eight physicians, one an
osteopathic physician, who are appointed by the
Governor with the approval of the Ohio General
Assembly. The full term of office is seven years.
The executive secretary is appointed by the Board.
Members of the State Medical Board are the fol-
lowing: Dr. Domenic A. Macedonia, Steubenville,
president; Dr. John D. Brumbaugh, Akron; Dr.
Donald F. Bowers, Columbus; Dr. J. O. Watson,
Columbus, the osteopathic member; Frederick T.
Merchant, Marion; Dr. Mervin F. Steves, Cincinnati;
Dr. Ralph K. Ramsayer, Canton; and Dr. Lloyd R.
Evans, Columbus.
Dr. Washam received his medical degree from
Ohio State University College of Medicine in 1945,
and graduated cum laude. He took a rotating extern-
W. T. Washam, M.D., LL.B.
ship at University Hospital as a senior in medicine,
and a rotating internship at Milwaukee County
(Wis.) General Hospital.
He is a member of the Jackson County Medical
Society, the Ohio State Medical Association, and the
American Medical Association; also the Columbus
Bar Association, Jackson County Bar Association,
Ohio State Bar Association, and the American Bar
Association.
While maintaining ties in Jackson, Dr. and Mrs.
Washam and their three children are making their
residence in Columbus.
Technicians Receive Certificates
In Laboratory Animal Care
Sixteen Cincinnatians have received junior animal
technician certificates from the national Animal Care
Panel. They were among 35 graduates of a training
course for laboratory animal workers which was started
in Cincinnati in September 1963. University officials
report this to be one of the first courses of its type
in the nation.
The course was a joint project of the University
of Cincinnati College of Medicine, Children’s Hospi-
tal Research Foundation, Christ Hospital Institute of
Medical Research, and the Cincinnati branch of the
Veterinary Medicine Association, groups especially
concerned with care for laboratory animals.
for August, 1966
827
6 Dean Of Toledo Physicians’
' Horse And Buggy ' Doctor Retires After 57 Years ;
Continued House Calls Throughout His Career
'Never Regretted'
Giving Up Teaching
For Medical Work
Dr. Claude E. Price is a
“horse-and-buggy” doctor,
but only in a figurative sense.
He still cheerfully makes
house calls.
But he won’t do it for long.
The doctor is 88, and after
making those calls among his
general practice patients- all
over town for more than half
a century, he has announced
his retirement — effective at 5
p.m. today.
Before Dr. Price used a
“horse-and-buggy” (which he
always . r e n t ed ) he either
walked or took a trolley car.
Even if he rode way out to
the end of the old East Broad-
way st r e e t car line, he
charged the patient just $2
or $3.
But that was in 1909, when
a $5 fee was high. After out-
growing trolleys and buggies,
he bought his first auto — a
second-hand 1913 Oldsmobile.
Dr. Price, called “the dean
of Toledo physicians” by a
colleague, notes a gradual but
significant decline in the prac-
tice of doctors making house
calls, except in dire situations.
Though he still makes many
calls, he admits that most
patients don’t expect it.
“Young people, in particu-
lar, aren’t used to that kind
of service.”
Asked how many babies he
has delivered, the doctor an-
swered, “Who knows? My last
baby has two kids of her
own.”
Dr. Price’s wife, Ruth,
drives him on his house 'Calls,
to and from the office, and to
Academy of Medicine meet-
ings, which he hates to miss.
During World W a r II Dr.
Price’s office nurse joined the
navy. So, Mrs. Price, a grad-
uate nurse herself, filled in.
She never left. Although she
too is retiring today, Mrs.
Price still has a lot of work.
“Retiring’s no simple pro-
cedure,” she said. “Retirees
don’t just throw their old files'
out the office window, unscrew
their shingle, go home, and
forget it.”
Grew Up On Farm
The Prices were married 48
years ago. When they met,
Mrs. Price was a. student
nurse at Flower Hospital.
The doctor, a native of Indi-
ana, fresh out of medical
school at Western Rese r v e
University in Cleveland, might
never have come here at all
if the Cleveland hospitals
hadn’t been bursting with in-
terns.
It was almost by chance
that young Claude Price be-
came a doctor at all'.
He spent his first 22 years
on his father’s farm near
Brookston, a Hoosier hamlet
of about 300 (1,202 by ihe
last census). Deciding that
he’d like to be a teacher, he
enrolled in Valparaiso Col-
lege and then went on to. In-
diana University where he
was graduated with a master
of science degree in his fa-
vorite fields, philosophy and
psychology.
Before he “got a chance to
teach, the head of the philos-
ophy department buttonholed
young Price and asked him,
“Ever thought about medi-
cine?”
“No, not much,” was the
reply.
Chat With Professor
“Come into my office then,
and we’ll discuss it,” Prof.
E. H. Lindley said. “Every
time I go into a drugstore, I
can barely keep from taking
up medicine myself.”
Quite a chat, they had.
The young man thought
over his professor’s words for
two days before deciding in
favor of medical school (West-
ern Reserve, Class of ’08).
“I’ve never been sorry,”
the doctor said.
“After all, there’s quite a
bit of philosophy in medi-
cine,” his wife chimed in.
The Prices’ youngest son,
Scott, also changed horses in
the middle of the stream.
Scott was graduated from
Michigan State University as
an agricultural major, ran a
farm for about 12 years, then
decided to enter Wayne State
University medical school in
Detroit. He’s now practicing
medicine in Dearborn, Mich.
The Prices have another
son, Halford, of Lafayette,
Ind. ; a daughter, Mrs. Mau-
rine Harvey, of Chicago, and
10 grandchildren.
Dp. Price has given his col-
lection of medical books to
the University of Toledo.
“The books may be old, but
the body hasn’t changed much
either in the last hundred
years, has it?” Mrs. Price ob-
served.
The doctor owns a pair of
identical and ingenious “pat-
ented” examination chairs,
manufactured about 1891.
Protruding from each
chair’s profusion of iron curl,
cues are five pedals and
umpteen levers. When oper-
ated by Dr. Price, the devices
permit a patient to be ob-
served in virtually any posi-
tion.
“I’m 'going to give one to
the Henry Ford Museum at
Greenfield Village, if they
want it,” the doctor beamed.
After today, Dr. and Mrs.
Price plan to take it easy at
home. They live at 2347 Rob-
inwood Ave.
—Blade Photo
NO MORE STETHOSCOPES, SUGAR PILLS, OR HOUSE CALLS
Dr. Price looks back on neatly 60 years medical practice
Reprinted by Permission from The Toledo Blade, June 30, 1966
828
The Ohio State Medical Journal
• • •
OSMA Scholarships Awarded
Two Medical Students Will Enter School This Fall under
Program, Bringing to Seven Those Receiving Scholarships
DR. LAWRENCE C. MEREDITH, President,
on July 15 announced the names of the two
winners of the Ohio State Medical Associa-
tion’s Medical Scholarships. The winners are Law-
son Charles Smart, of Boardman, a suburb of Youngs-
town, and Harold Linn Mast, of Smithville, near
Wooster. Each of the winners will receive a schol-
arship of $2,000 ($500 a year) to help meet some
of the expenses of medical school.
Smart and Mast were selected from a group of 14
Ohio youths who had completed premedical studies
and who had submitted applications for the scholar-
ships.
Smart, the Son of Mr. and Mrs. Lawson C. Smart
of Boardman, completed his premedical studies at Mt.
Union College, Alliance, where he graduated magna
cum laude. He has been accepted in the University
of Pittsburgh School of Medicine and will be in the
freshman class of 1966.
stimulate among young men and women of Ohio
interest in becoming Doctors of Medicine with em-
phasis on becoming family physicians serving non-
metropolitan communities
The members of the
were: Luther W. High,
Lawson C. Smart
Scholarship Subcommittee
M. D., chairman, Millers-
Harold L. Mast
The Rural Need
Mr. Smart indicated in his application that he felt
there was a need for more physicians to practice in
rural areas, and it is his desire, after receiving his
medical degree, to practice in a rural community.
Fred G. Schlecht, M. D., Youngstown, is Mr.
Smart’s family physician.
Harold Linn Mast, son of Mr. and Mrs. Glenn M.
Mast, Rt. #3, Wooster, will enter the Ohio State
University College of Medicine in the Fall of 1966.
Mast completed his premedicine courses at the
University of Wisconsin where he finished in the
upper third of his class. Mr. Mast also indicated his
desire to become a family physician practicing in a
small community, after completing his medical studies.
Mr. Mast’s wife, a medical technologist, will work
at the Ohio State University to help meet some of
the expenses of medical school.
Dr. John Paul Miller, Orrville, is Mr. Mast’s
family physician.
The two winning applicants were selected in a
competition judged on the basis of character, inte-
grity, intelligence, mature personality, interest in
community life, leadership and scholastic ability.
The scholarships, administered through a Subcom-
mittee of the Ohio State Medical Association Com-
mittee on Rural Health, were initiated in 1949 to
burg; Walter A. Campbell, M. D., Coshocton; Jasper
M. Hedges, M. D., Circleville; E. D. Mattmiller,
M. D., Athens; and Leonard S. Pritchard, M. D.,
Columbiana.
Seven in All
In September of this year there will be seven stu-
dents in medical school who are winners of the Ohio
State Medical Association scholarships. The scholar-
ships are a part of the Association’s continuous
activities to interest medical students in becoming
family physicians serving nonmetropolitan commu-
nities, as well as assisting these communities in find-
ing physicians to serve their medical needs.
Other such activities include annual programs for
medical students in which they are acquainted with
this type of practice; a preceptorship program where
medical students spend one or two weeks with family
physicians; and the Ohio State Medical Association
Physician Placement Sendee.
Dr. William J. Flynn, Youngstown, discussed ad-
vances in treatment of cancer at a meeting of the
Mount Union College Health Foundation in Alliance.
The foundation brings in speakers who discuss medi-
cal topics before students interested in medical and
nursing careers.
for August, 1966
829
W Oman’s Auxiliary Highlights . . .
Ohioan Is Named President-Elect of National Auxiliary;
Keynote Sounded at Pre-Election Conference in Columbus
By MRS. S. L. MELTZER, Publicity Committee
Chairman, 2442 Dorman Dr., Portsmouth 45662
T WAS WONDERFUL HEADLINE NEWS out
of Chicago the last of June ! Another out-
standing Ohio doctor’s wife — Mrs. Karl F.
Ritter of Allen County (you read about her in last
month’s column) — has brought great honor to her
state. She was elected to the office of President-Elect
at the 1966 convention of the Woman’s Auxiliary to
the American Medical Association. It is with some-
thing akin to humility that we here in Ohio ac-
knowledge gratefully and happily the action of the
National House of Delegates. It is only recently
that another top Ohio woman — Mrs. William H.
Evans of Mahoning County — - was honored with the
highest office in Auxiliary work and the fact that
National has again looked toward Ohio for leader-
ship is — to put it mildly — gratifying and exhilarat-
ing. Certainly our pride in Gerby Ritter understand-
ably knows no bounds. (And don’t forget that the
President of the American Medical Association this
year is from Cuyahoga County — Dr. Charles L.
Hudson ! )
The new National President-Elect needs no intro-
duction. Most of us know well her dedication, her
competence and her many years of devoted service in
Auxiliary work — on the county, state and national
levels. At just this last State convention Ohio added
Gerby’s name to the limited and privileged roster of
honorary members. And now — this greatest honor
of all ! We are delighted and we offer our warm,
ecstatic congratulations. Ohio has done it again !
Your reporter did not attend National convention
this year but she did manage to latch on to news
tidbits. A record-breaking number of amendments
passed and six new directors have been added to the
National Board because of the marked increase in
Auxiliary membership. There was the traditional,
delightful Ohio breakfast, hosted this year at the
Drake Hotel by Mrs. James N. Wychgel, state presi-
dent. I don’t know when or how this Ohio break-
fast idea got its start at National convention, but
based on my own observations other years, it is a
time of togetherness and friendship and fun.
Two other Ohio women were named to serve the
National Auxiliary this year: Mrs. John D. Dickie,
of Lucas County, as advisor to the Program Develop-
ment Committee, and Mrs. Herbert F. Van Epps, our
immediate past president, as North Central regional
chairman in Safety and Disaster Preparedness. Mrs.
Van Epps served as chairman of delegates. We also
came up with another honor — Tuscarawas County
won the AMA-ERF award in the 35 to 50 member-
ship category for the largest amount given — $2,-
6 50.00. Imagine that — with a membership of 48
women ! Shows what can be done when there’s the will
to do it. Once again, California beat us to the
punch for top honors in AMA-ERF with a contribu-
tion of $43,562.95 as against Ohio’s $38,502.77.
(We came in second.) There is some solace in the
realffiation that California’s Auxiliary membership is
9,070 and ours 5,599. Yet there is a vast reservoir
of untapped memberships in our state. There is so
much more than we can do — that we must do !
Pre-Election Conference
"If the doctors of this nation are too busy to get
into politics, then their wives can do it and probably
do an even better job.” If any words could have
been said to keynote the Pre-Election Activities Con-
ference on July 7 at the Pick-Fort Hayes Hotel in
Columbus, it was these words of former Vice-Presi-
dent Richard Nixon as uttered at the American Medi-
cal Association convention and quoted that July day
by Dr. Robert E. Howard, OSMA President-Elect.
This recent outstanding Conference, remarkably
well attended, was held under the joint sponsorship
of the Ohio State Medical Association, the Ohio
Medical Political Action Committee and the State
Auxiliary. It was held for Ohio’s doctors’ wives as
a measure of education — as a means of impressing
upon them the urgent need for political action. Dr.
Lawrence C. Meredith, OSMA President, presided
at the morning session and discussed 'Why We Are
Here.” He urged that we "think creatively, think
collectively, form key clubs, and act aggressively.”
All toward one vital end — "to win and win big in
November.” (There are eight key Congressional
races in Ohio this year.) There is little personal
glamour in all this, Dr. Meredith pointed out, but
"consistent time and effort and elements of every-
830
The Ohio State Medical Journal
day common sense activity can make the woman’s
touch noted.”
Dr. Frank H. Mayfield, of Hamilton County, chair-
man of the board of directors of OMPAC, discussed
his group’s objectives and activities. "We had better
make sizeable gains in the House of Representatives,”
he warned, "or else ...” He said that political cam-
paigns have one, and only one, objective: To win,
How are they won ? By votes. And how are votes won ?
For the most part, people make up their minds about
what to buy, whether to vote and how to vote on the
basis of advice from someone whose opinion they
respect. OMPAC can become the spearhead of the
fight in Ohio, declared Dr. Mayfield, to help in
the nationwide battle to keep medicine’s friends in
the Congress and to retire its opponents. How much
OMPAC can do is contingent on whether or not it
gets the enthusiastic support of thousands of Ohio
physicians, their wives and others, and whether or
not they are willing to put up money to back up their
beliefs and aims. OMPAC provides financial assist-
ance to Ohio candidates for public office who war-
rant the support of the medical profession and who
may need financial assistance in their campaigns.
Mrs. Frank Gastineau, of Indiana, a past national
president and member of the board of directors of
AMPAC (American Medical Political Action Com-
mittee) presented "AMPAC’s 1966 Program.” "Ask
yourself the question,” she urged, "do I really care
what happens to my country?” She reminded her
audience that campaigns are won by votes and that
candidates need helping hands in their campaigns in
addition to money. She cited the comment of Sen-
ator George Murphy, of California, who said he won
because ”175,000 women signed up to work for me.”
Hart F. Page, Executive Secretary of OSMA, pre-
sented an "Analysis of Ohio’s 1966 Political Cam-
paign.” He discussed the change in Ohio politics
being brought about by the reapportionment of the
Ohio General Assembly. He urged the doctors’
wives to pay strict attention to Ohio General As-
sembly elections as well as Congressional races.
The afternoon session was presided over by Dr.
Howard, President-Elect. "After Medicare, What?”
he asked. "The answer is apparent: Those who
forced through the Medicare Program will try to
ram through additional 'Great Society’ health meas-
ures.” He emphasized that this makes the year 1966
a crucial one, legislatively speaking. An intense
fight to keep Congress from enacting additional dan-
gerous medical-health schemes must be launched, he
declared.
"You cannot fold up and quit,” said Charles S.
Nelson, consultant to OMPAC and former Executive
Secretary of OSMA. "Even one small gain is a
step forward. Each year, build a little more. And
don’t panic.” He outlined the following steps that
can and have to be taken by local auxiliaries:
1. Get in touch with officers of your county medi-
cal society.
2. Find out how many members of the Auxiliary
are willing to help;' you will need much help. 3. Find
out about your Congressional district — the counties
Mrs. Karl Ritter
in your district — - the make-up of the individual
counties — the type of people, their voting record
(such information can be obtained from political
leaders.) 4. Get information about the candidates
- — • what are their voting records ? - — who are the
worthy candidates ? — get an over-all picture of the
candidate, study the man as a whole — get to know
the campaign manager as well as the candidate.
5. Ask "what can we do” (no move can be made
without the candidate’s knowledge and consent). 6.
In larger communities, organize pre-registration
drives. (There are doctors and their wives who are
not registered.) 7. Get voters to the polls. 8.
Check on absentee ballots, voters who are sick — go
to the hospitals to talk to the patients. 9. Offer
services to the headquarters of the party of your
choice.
"It’s easier to get out the vote when people are
scared or mad,” Mr. Nelson said. He made one
important additional point: Auxiliaries on the local
level can do the organizational and background work;
then it has to be carried forward as individuals or
groups of individuals. (Medical societies can’t en-
gage in political activities because of legal barriers;
that is why the Medical Political Action Committee
was "born.”
James S. Imboden, field representative for AMPAC
for the state of Ohio and neighboring states, also
addressed the conference. "Get into the habit of
politics,” he advised. "It’s a long range project . . .
gain a foothold now, at least . . . zero in on what
we can do . . . use bumper stickers on your cars
. . . display yard sign for candidate . . . line up the
Postcard Party, the Coffee Party, the Dial-a-Dozen Pro-
gram” (more on this in next month’s Journal). Mrs.
James N. Wychgel, state auxiliary president, dis-
for August, 1966
833
cussed "Let’s Get the Job Done.’’ "Educate a man,”
she remarked, "and you educate one person; educate
a woman and you educate a whole family.” She
suggested the use of "tools of the trade” — press
clippings, OSMA-gram, The Ohio State Medical Jour-
nal, The Journal of the AMA, the Legislative Round-
Up, the weekly AMA News, U. S. News and World
Report.
Mrs. Harry L. Fry, state legislative chairman, and
George Saville, also an OMPAC consultant and
former OSMA Executive Secretary, took part in the
lively question-and-answer portions of the morning
and afternoon sessions.
Calling Frankie Fry
Do you want to know more about all this? Do
you feel you need help in this new field (for us) of
political action? Do you need to be stimulated, en-
couraged, informed even more? Frankie Fry may
live in Cincinnati but she’s got the legislative wander-
lust and no place is too far for her to go, if she
thinks she can be of help. She’s got what it takes
— in enthusiasm, energy and pertinent information.
(Fm not her personal publicity agent, believe me!)
But I do know how much she has on the ball and I
also know how much county auxiliaries need that
kind of stimulation and help.
I’ve had to hold over local activity accounts to
make room for this recent and vital Pre-Election
Activities Conference. I’m sure you will agree with
me that it warrants the priority.
Dr. Irvine H. Page, senior consultant in research
at the Cleveland Clinic, received the 12th annual
Oscar B. Hunter Memorial Award at the American
Therapeutic Society meeting in Chicago.
Dr. Howard D. Sirak, professor of surgery in the
Ohio State University College of Medicine, is the
author of a new book entitled Operable Heart Disease
— Patho-Physiology, Diagnosis and Treatment. The
publisher is C. V. Mosby Co., St. Louis.
Ohio State University College of Medicine has
been awarded a $25,000 U. S. Public Health Service
grant to study and evaluate methods of disinfecting
inhalation therapy equipment. The cooperative proj-
ect will be directed by Dr. Colin R. Macpherson,
Department of Pathology, and Dr. William Hamel-
berg, Division of Anesthesia.
Dr. Glen E. Miller, West Liberty physician and
secretary of the Logan County Medical Society, has
been named Logan County health commissioner on a
part-time basis.
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The Ohio State Medical Journal
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for August, 1966
835
Obituaries
Ad Astra
J. Herbert Bain, M. D., New Concord; Ohio State
University College of Medicine, 1933; aged 59; died
June 13; member of the Ohio State Medical Asso-
ciation, the American Medical Association, and the
American Academy of General Practice. Born in
Bloomfield and a graduate of Muskingum College,
Dr. Bain in 1935 assumed the practice of his father,
the late Dr. Jacob Harper Bain in New Concord. In
addition to his private practice, he was health director
for Muskingum College and active in local commu-
nity affairs; served as president of the Muskingum
County Medical Society, and was immediate past
president of the Ohio College Health Association;
also a member of the Masonic Lodge and the Pres-
byterian Church. Survivors include his widow and
two sons.
Duane Eugene Banks, M. D., Akron; Western
Reserve University School of Medicine, 1930; aged
62; died June 15; member of the Ohio State Medi-
cal Association, the American Medical Association,
and the American Urological Association; Fellow of
the American College of Surgeons; diplomate of the
American Board of Urology. Dr. Banks moved to
Akron in 1932 and practiced there since that time
except for a tour of active duty in the Navy Medical
Corps during World War II. He was immediate
past president of the Cleveland Urological Society,
and was a member of the Presbyterian Church.
Among survivors are his widow and a son.
Archie A. Boal, M. D., Jacksonville Beach, Flo-
rida; Kentucky School of Medicine, 1895; aged 94;
died on or about June 17; former member of the
Ohio State Medical Association. Dr. Boal practiced
in Zaleski from 1896 to 1922 and in Columbus from
1922 to 1962. He is survived by a daughter, in
Jacksonville Beach.
Nicholas Edward dayman, M. D., Cleveland;
Western Reserve University School of Medicine,
1928; aged 63; died June 22; member of the Ohio
State Medical Association and the American Medical
Association; Fellow of the American College of Sur-
geons; diplomate of the American Board of Ob-
stetrics and Gynecology. A practitioner in Cleveland
since 1933, Dr. dayman was associate clinical profes-
sor of obstetrics and gynecology at Western Reserve.
Shortly before his death Dr. dayman witnessed the
graduation of his daughter, Dr. Julie Ann dayman,
from Western Reserve University School of Medicine.
Other survivors include his widow, another daughter
and a sister.
John Montfort Finney, M. D., Spokane, Wash.;
University of Cincinnati College of Medicine, 1910;
aged 85; died June 11. After receiving his medical
degree, Dr. Finney moved out of the state, practicing
first in Idaho and later in Spokane. Dr. Nancy E.
Finney, of Xenia, is a sister. Other survivors include
his widow, three sons, a daughter and a brother.
Eugene R. Hammersley, M. D., Tuscarawas; Ohio
State University College of Medicine. 1928; aged
61; died May 27; member of the Ohio State Medi-
cal Association, the American Medical Association,
American Academy of General Practice, and the
American Society of Anesthesiologists. A practicing
physician of long standing in the Tuscarawas area.
Dr. Hammersley was associated- for many years with
the Naval Reserve and was a Navy flight surgeon dur-
ing World War II. Among local affiliations, he was
a member of the V. F. W., the Elks Club, and the
Lutheran Church. He was past president of the
Tuscarawas County Medical Society. Surviving are
a son, a daughter, a brother and two sisters.
Theodore P. Herrick, M. D., Euclid; Harvard
Medical School, 1919; aged 73; died June 2; former
member of the Ohio State Medical Association and
the American Medical Association; member of the
American Academy of Pediatrics. A specialist in
pediatrics of long standing, Dr. Herrick helped
found the Northern Ohio Pediatrics Association, and
was associated for many years with well baby clinics
in his area. He was formerly on the faculty at
Western Reserve. Two sons, a brother and a sister
survive.
William Henry Price, M. D., Detroit, Mich.;
Cleveland-Pulte Medical College, Cleveland, 1899;
aged 88; died February 20; practitioner of long stand-
ing in Detroit.
James Garfield Powell, M. D., Painesville; Ohio
State University College of Medicine, 1931; aged 64;
died May 29; member of the Ohio State Medical Asso-
ciation, the American Medical Association, and the In-
dustrial Medical Association. A practitioner of long
standing in Painesville, Dr. Powell was a past presi-
dent of the Lake County Medical Society. During
World War II, he served in the Medical Corps over-
seas. Affiliations included memberships in several
Masonic bodies, the Eagles Club, and the Odd Fellows
Lodge. Among survivors are his widow, two sons,
and his father.
Julius Moses RogofJ, M. D., Bell Island, Conn.;
Western Reserve University School of Medicine,
1908; aged 82; died on or about June 28. Former
associate professor of experimental medicine at West-
836
The Ohio State Medical Journal
ern Reserve, Dr. Rogoff pioneered in research on the
adrenal gland, and was founder of the Rogoff Foun-
dation for Medical Research and Training. Surviving
are his widow, two sisters, and a brother, Dr. Her-
man M. Rogoff, of Akron.
Sarolta Hoffman Selymes, M. D., Cleveland; Uni-
versity of Budapest Faculty of Medicine, 1914; aged
74; died May 24; member of the Ohio State Medical
Association and the American Medical Association.
Born and educated in Europe, Dr. Selymes came to
this country in the early 1920’s. He was a practi-
tioner of long standing in the Cleveland area. |
Jacob L. Tuechter, M. D., Cincinnati; Medical
College of Ohio, Cincinnati, 1906; aged 85; died
June 24; member of the Ohio State Medical Associa- a
tion, and the American Medical Association; Fellow
of the American College of Physicians; diplomate
of the American Board of Internal Medicine. A
physician in Cincinnati for some 55 years, Dr. Tue-
chter was a former president of the Daniel Drake
Medical Society and was associated with the Amefi-
can Therapeutics Society, the American Heart Asso-
ciation, and the American Diabetes Association. He
was on the faculty of the University of Cincinnati
College of Medicine for 20 years. Surviving are a
daughter and a sister.
"The Changing World of Medical Communica-
tion” will be the theme of the American Medical
Writers’ Association annual meeting at the Waldorf
Astoria, New York City, Thursday, September 29,
through Sunday, October 2. Physicians interested in
details on this professional organization are invited to
write to the national headquarters at 2000 P Street,
N. W., Washington, D. C. 20036.
The 12th annual meeting of the Flying Physicians
Association will be held at the Dunes Hotel, Las
Vegas, September 11-16. National offices of the or-
ganization are at 332 South Michigan Avenue, Chi-
cago, Illinois 60604. More than 70 flying physicians
in Ohio are associated with the group.
New Members . . .
Following are names of new members of the Ohio
State Medical Association certified to the Columbus
office during June. The list shows county in which
new member is practicing or temporary address in the
case of a physician taking graduate work.
Buder
J. Franklin Daugherty, Oxford
Ralph E. Kah, Middletown
Clark
Edwin J. Lilly, Springfield
Cuyahoga
Frank C. Flanders, Cleveland
C... Charles Welch, Cleveland
Franklin
.'4 Richard P. Dickey, Columbus
, A ' A ™
Prototype Refresher Course for
Women Physicians Studied
A pilot study designed to evaluate a re-entry into
medicine course for women physicians who have been
out of touch with the medical profession for ten or
more years is the purpose of a contract awarded to
the Presbyterian Medical Center, San Francisco, by
the U. S. Public Health Service’s Division of Com-
munity Health Services, Surgeon General William H.
Stewart announced.
"Approximately 16,000 female physicians are ac-
tive in the medical field,” Dr. Stewart said. "About
2,600 female physicians are either retired or no
longer in practice. Because of the need for more
physicians in many parts of this country, the Presby-
terian Medical Center study aims to produce a proto-
type program that can enable other medical centers
to set up re-entry courses for women physicians able
and desirous of returning to active practice.”
Dr. Wesley Furste, clinical assistant professor of
surgery in the Ohio State University College of Medi-
cine, participated in the International Conference on
Tetanus in Bern, Switzerland, July 15-19.
Gallia
Sam N. Rizkalla, Gallipolis
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for August, 1966
837
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initiating antibacterial measures. Generalized derma-
tological conditions may require systemic corticoster-
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cannot be expected to prevent recurrence. The use over
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permeable dressings, may result in systemic absorption.
Appropriate precautions should be taken. When occlu-
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atrophy and striae have been reported with the use of
steroids by the occlusive technique. When occlusive
nonpermeable dressings are used, the physician should
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T he Ohio State Medical Journal
Activities of County Societies . . .
BELMONT
The Belmont County Medical Society, with the
Auxiliary, met at the Belmont Hills Country Club
on June 16 for an afternoon program and dinner.
Hugh Hughes, of the Nationwide Insurance Com-
pany, Columbus, was the principal speaker for a dis-
cussion of Medicare.
COLUMBIANA
Dr. and Mrs. Chester Dewalt of Columbiana
shared their cmise around Africa with the Co-
lumbiana County Medical Society Tuesday evening
(June 21).
Approximately 25 couples attended the society’s
ladies night dinner at the Wick Hotel. Dr. Dewalt
showed slides taken on the cruise this year.
Dr. Edith Gilmore of East Liverpool, society presi-
dent, was in charge of business. The society’s next
meeting was announced for July 19 at the Wick
Hotel. — East Palestine Daily Leader.
CUYAHOGA
Photographs of officers, members of the Board of
Directors, officers and directors of the Woman’s Aux-
iliary, for Cuyahoga County are presented in the July
issue of The Bulletin of the Academy of Medicine
Cleveland.
JEFFERSON
Thirty members of the Jefferson County Medical
Society dined at the Steubenville Country Club on
June 28 and then held a business meeting, with Dr.
Jack R. Cohen presiding. Among the items con-
sidered were the following:
A Citizens’ Committee on Alcoholism suggested
the establishment of a facility for the treatment of the
acute alcoholic and the rehabilitation of the chronic
alcoholic patient.
The Jefferson County Academy of Pharmacy ex-
pressed appreciation of the Society on the coopera-
tion in the legislative campaign to control legend-
drug advertising in Ohio.
The Resolutions passed at the 1966 Annual Meet-
ing of the OSMA were discussed and explained by
Dr. Sanford Press, Chairman of the Legislative Com-
mittee and Delegate. Problems relating to Medicare
were explored.
In order to encourage physicians to practice in this
county, the president announced the appointment of
a Doctor Procurement Committee composed of Dr.
Lee A. Rosenblum, chairman, Dr. Sanford Press, and
Dr. Jonathan J. Yobbagy.
Dr. Jack R. Cohen was recommended as a member
of the Board of Directors of the Steubenville Child
Development Association.
Because of a recent feature story in Life magazine
that aroused much public comment, attention was
called to a ruling of the AMA Judicial Council by
Dr. Aniceto Carneiro, chairman of the Censor Com-
mittee, "that it is unethical for physicians to have a
financial interest in a drug repackaging company.”
By parliamentary action, the Society went on record as
condemning any financial return by physicians through
ownership of drug repackaging firms. — Irving Dre-
yer, M. D., Secretary-Treasurer.
MAHONING
The Mahoning County Medical Society has estab-
lished a trust fund for the purpose of providing
financial aid to medical and nursing students. The
trust will be known as "The Mahoning County Medi-
cal Society Foundation.” Basis of the fund is the
money left over from the polio campaigns conducted
by the Medical Society in 1961-62, which amounts
to $24,261. Officers of the Foundation are Dr. F.
A. Resch, president, Dr. G. W. Cook, Dr. Bertram
Katz, Dr. John J. McDonough, Dr. Raymond J.
Scheetz, Dr. Frederick L. Schellhase, and Dr. Joseph
W. Tandatnick. The Foundation will encourage tax-
free gifts from physicians, laymen, and organizations.
MONTGOMERY
Dr. Peter A. Granson, of 355 W. Whipp Rd., has
been elected to lead Montgomery County doctors in
1968 as president of the County Medical Society.
Results of the election were announced last night
(June 8) at the 117th annual meeting of the society
held at Wright-Patterson Air Force base.
Dr. Granson, a general surgeon, will serve as
president-elect next year, and become the 119th
president of the society when he takes office in 1968.
Other officers elected to serve next year include Dr.
Harvey J. Staton, vice president; Dr. Arthur E.
Fouke, secretary; Dr. Albert Hirsheimer, treasurer;
and Dr. Russell N. Brown, trustee for a three-year
term.
Dr. Frank L. Shively Jr. was elected to a five-year
term as delegate to the state group and Dr. John
Worthman was elected alternate delegate for the
same period. Named as senior member to the Clinic
committee was Dr. Marcus J. Freese while Dr. Clif-
ford E. Gerhart was named junior member.
The Montgomery County Medical Society president
in 1967 will be Dr. William J. Lewis who is now
president-elect. Dr. Charles E. O’Brien is the current
president. — Dayton Daily News.
for August, 1966
839
Law-Medicine Conference Scheduled
At Ohio State University
The College of Medicine of the Ohio State Uni-
versity and the Ohio Legal Center Institute have com-
bined their resources to present a special law-medicine
conference for Ohio’s physicians and lawyers.
The conference is entitled "The Medical Issue,”
and is directly to the development and presentation
of medical evidence in litigation. It affords the phy-
sician an opportunity to learn how one should prepare
with the lawyer for the giving of testimony. It covers
procedures which precede and follow the physician’s
appearance in court. The purpose and use of the
hypothetical questions is discussed in detail with
emphasis on the witness’ manner of testifying. In
this conference, the lawyer will develop an appreci-
ation of the physician’s utilization of the source mate-
rial which constitutes medical evidence and the
physician will learn the use the law makes of his
findings and opinions.
The program will be given in the 3500 seat Mer-
shon Auditorium on the Ohio State University cam-
pus. The dates are Friday, August 19, (9:00 A. M. -
5:15 p. M. EST) and Saturday, August 20, (9:00
A. M- 12:15 P. M. EST.) Only one presentation
is scheduled.
The enrollment fee is $40.00 which covers attend-
ance at all sessions, a copy of the extensive printed
reference manual prepared by the lecturers, a general
luncheon on Friday, and on-campus parking adjacent
to the Auditorium. (Those who can attend only se-
lected segments are welcome.)
Persons may enroll with either:
James L. Young, Director, Ohio Legal Center In-
stitute, P. O. Box 8220, Columbus, Ohio 43201; or
Dr. William V. Nick, Room 711, University Hospi-
tal, 410 West 10th Avenue, Columbus, Ohio 43210.
“Sudden Infant Death Syndrome”
Studied Through New Grant
A search for what causes the so-called "sudden
Infant Death Syndrome” has been launched under the
terms of a $165,300 contract let by the National In-
stitute of Child Health and Human Development,
Bethesda, Md., to the Children’s Hospital Research
Foundation of the District of Columbia.
The little understood medical entity causes the
deaths of approximately 10,000 to 20,000 American
babies annually, usually in the age group of two to
four months.
Dr. James Patrick, chief pathologist at Children’s
Hospital in the District of Columbia, will head the
six-physician team whose work is scheduled for about
a year.
. . . introduce your patient to
(BENZTHIAZIDE)
AQUATAG (Benzthiazide) is a potent, orally
active, nonmercurial, diuretic agent. It is effective
orally in producing diuresis in edema states,
where it is therapeutically comparable to mercu-
rials given parenterally. AQUATAG (Benzthia-
zide) is mildly antihypertensive in its own right
and enhances the action of other antihyperten-
sive drugs when used in combination.
DIURETIC ACTION: Clinically, the oral administration of AQUATAG (benzthiazide) re-
sults in diuretic activity within two hours with maximal natriuretic, chloruretic, and diuretic
effects occurring during the fourth, fifth and sixth hours. Maintenance of response con-
tinues for approximately 12 to 18 hours. Acidosis is an unlikely complication since thera-
peutic doses of AQUATAG (benzthiazide) do not appreciably increase bicarbonate
excretion. Edematous patients receiving 50 mg. of AQUATAG (benzthiazide) daily for
five days developed a maximal increase in the rate of sodium excretion on the first day,
and maintained this high rate until depletion of excessive body stores of sodium.
In congestive heart-failure patients, AQUATAG (benzthiazide) produced the same
weight loss, during a 48-hour treatment period as did a maximally effective dose of
hydrochlorothiazide.
DOSAGE: Diuresis, initially 50 to 200 mg.; maintenance 25 to 150 mg., daily. Hyper-
tension 50 to 100 mg. initially, adjusted to 50 mg. t.i.d. or downward to minimal effective
dosage level.
WARNINGS: Use with caution in the presence of renal disease as azotemia may be
precipitated or increased. In patients with advanced hepatic disease, electrolyte imbal-
ance may result in hepatic coma. Dosage of coadministered antihypertensive agents
should be reduced by at least 50%, In cases of suspected electrolyte imbalance, serum
electrolyte determinations.should be performed and imbalance, if any, corrected. Stenosis
or ulcer of small intestine have been reported with coated potassium formulas, and
surgery has been required and deaths have occurred. Based on surveys of both United
States and foreign physicians, incidence of these lesions is low and a causal relationship
in man has not been definitely established. Until further experience has been obtained,
the use of the drug in pregnant patients should be weighed against possible hazards
to the fetus.
CONTRAINDICATIONS: AQUATAG (benzthiazide) is contraindicated in progressive
renal disease or dysfunction including increasing oliguria and azotemia. Continued
administration of this drug is contraindicated in patients who show no response to its
diuretic or antihypertensive properties. Severe hepatic disease is a relative contra-
indication. (See "Warnings" above.)
PRECAUTIONS AND SIDE EFFECTS: Electrolyte imbalance with hypokalemia (digitalis
toxicity may be precipitated), hypochloremic alkalosis and hyponatremia may occur.
Patients with cirrhosis should be observed for impending hepatic coma and hypokalemia.
Other reactions may include blood dyscrasias, hyperuricemia and gout, nausea, jaundice,
anorexia, vomiting, diarrhea, dizziness, paresthesia, photosensitivity and headache.
Hepatic fetor, tremor, confusion and drowsiness are
signs of impending pre coma and coma in patients
with cirrhosis. Insulin requirements may be altered
in diabetes. AQUATAG (benzthiazide) should be
used with caution post-operatively as hypokalemia
isnotuncommon. Potassium supplementation maybe
advisable pre- and post-operatively. There have been
occasional reports of thrombocytopenia, leukopenia,
agranulocytosis, aplastic anemia and precipitation of
acute pancreatitis or jaundice.
Before prescribing or administering, read the pack-
age insert or file card available on request.
S.J.TUTAG
Available as 25 or 50 mg. scored tablets.
Request clinical samples and literature on your
letterhead.
& COMPANY
Detroit, Michigan-48234
840
The Ohio State Medical Journal
Lectures oil Human Reproduction
Are Scheduled in Cleveland
The Institute for the Study of Human Reproduc-
tion invites physicians to attend a non-tuition series
of courses scheduled in Cleveland under the title
"I. S. H. R. Reviews.” Programs are scheduled on
Wednesdays from 2 to 4 p. m. in the Conference
Room of Saint Ann Hospital, Cleveland.
The Institute, in association with The Saint Ann
Hospital, will present Lecture Series No. 5, en-
titled "New Horizons in Reproductive Physiology
and Pathology, November 7-9, in the Academy of
Medicine of Cleveland facilities, 10525 Carnegie
Avenue, from 5 to 8 p. m. on the three days.
Topics and speakers for the weekly series of pro-
grams in September are as follows:
September 7 - — - "The Cell as a Mirror of Dis-
ease,” James W. Reagan, M. D., professor of patho-
logy at Western Reserve University.
September 14 — "Prenatal Drug Effects on Off-
spring,” Joseph M. Ordy, Ph. D., instructor in sur-
gery at Western Reserve and research associate at
the Cleveland Psychiatric Institute.
September 21 — "Illegitimacy: A Socio-Psychiatric
Problem,” L. Douglas Lenkoski, M. D., acting direc-
tor of the Department of Psychiatry at Western
Reserve.
September 28 — "LSD and History,” Albert Sat-
tin, M. D., Departments of Pharmacology and Psy-
chiatry, Western Reserve.
Watch for additional information on these pro-
grams in coming issues of The Journal. Details may
be obtained from Miss Barbara A. Kasprow, Regis-
trar, Institute for the Study of Human Reproduction,
Saint Ann Hospital, 2475 East Blvd., Cleveland
44120.
Dr. William Herman was named Man of the Year
for his outstanding sendees to the community by
Gateway B’nai B’rith Lodge, Cleveland.
OSU Medical Education Network
Wins Top National Honors
The Ohio Medical Education Network has been
named first-prize winner for creativity by the Na-
tional University Extension Association’s division of
conferences and seminars.
Dr. William G. Pace is director of the Center for
Continuing Medical Education, which sponsors the
Ohio Medical Education Network. Robert Schwei-
kart, Ph. D., directs operations of the network. The
award was scheduled to be made at a dinner meeting
July 24 in Albuquerque, N. M.
The creativity award, given this year for the first
time, is to "encourage a deeper appreciation for
variety and form in conferences and institutes, as well
as to foster originality in programs for adults.
Via two-way radio and telephone, the Ohio Medi-
cal Education Network connects the College of Medi-
cine faculty with medical staffs of hospitals in Ohio
and West Virginia. More than 50 hospitals partici-
pated during the past year. The project began in
1962.
Dr. G. Robert Holsinger, dean of the Division of
Continuing Education, said: "Ohio State University
is especially pleased to receive the NUEA award
because of its emphasis upon the importance of
creativity and innovation in the continuing education
process.
"Dr. Pace and his staff are to be commended for
their development of the concept of the Ohio Medi-
cal Education Network, a dynamic illustration of the
use of broadcasting in extending the instructional
resources of the university far beyond campus limits
to meet professional needs.”
Dr. John W. Chrispin, of Rockford, has been ap-
pointed Mercer County health commissioner on a
part-time basis.
GROUP LIFE INSURANCE
Initiated and Sponsored by
Your OHIO STATE MEDICAL ASSOCIATION
For Information, Call Or Write
TURNER & SHEPARD, inc.
insurance
20 SOUTH THIRD STREET COLUMBUS, OHIO 43215 PHONE 228-6115 CODE 614
for August, 1966
845
State Association Officers and Committeemen
Headquarters Office: 17 S. High St. — Suite 500, Columbus 43215. Telephone: (61U) 228-6971
OFFICERS and COUNCILORS
Lawrence C. Meredith, M. D., President
205 Elyria Block, Elyria 44035
Robert E. Howard, M. D., President-Elect
2500 Central Trust Tower, Cincinnati 45202
Paul N. Ivins, M. D., First District
306 High Street, Hamilton 45011
Theodore L. Light, M. D., Second District
2670 Salem, Avenue, Dayton 45406
Frederick T. Merchant, M. D., Third District
1051 Harding Memorial Parkway,
Marion 43305
Robert N. Smith, M. D., Fourth District
3939 Monroe Street, Toledo 43606
P. John Robechek, M. D., Fifth District
10525 Carnegie Avenue, Cleveland 44106
Henry A. Crawford, M. D., Past President
1058 Hanna Bldg., Cleveland 44115
Philip B. Hardymon, M. D., Treasurer
350 East Broad St., Columbus 43215
Edwin R. Westbrook, M. D., Sixth District
438 North Park Avenue, Warren 44481
Sanford Press, M. D., Seventh District
525 N. Fourth Street, Steubenville 43952
Robert C. Beardsley, M. D., Eighth District
2236 Maple Avenue, Zanesville 43705
George N. Spears, M. D., Ninth District
2213 South Ninth Street, Ironton 45638
Richard L. Fulton, M. D., Tenth District
1211 Dublin Road, Columbus 43212
William R. Schultz, M. D., Eleventh District
1749 Cleveland Road, Wooster 44691
THE EXECUTIVE STAFF
Hart F. Page, Executive Secretary
Herbert E. Gillen, Administrative Assistant
W. Michael Traphagan, Administrative Assistant
Charles W. Edgar, Director of Public Relations
and Assistant Executive Secretary
Jerry J. Campbell, Administrative Assistant
R. Gordon Moore, Executive Editor
THE EDITOR: Perry R. Ayres, M. D.
COMMITTEES
Committee on Education — Thomas E. Rardin, Columbus, Chair-
man (1971) ; Clyde W. Muter, Warren (1970) ; Thomas S.
Brownell, Akron (1969) ; John G. Sholl, Cleveland (1968) ;
Elmer R. Maurer, Cincinnati (1967).
Judicial and Professional Relations Committee — Frank F. A.
Rawling, Toledo, Chairman (1968) ; Henry A. Crawford, Cleve-
land (1971) ; Homer A. Anderson, Columbus (1970) ; Chester H.
Allen, Portsmouth (1969) ; David Fishman, Cleveland (1967).
Committee on Public Relations and Economics — Frederick P.
Osgood, Toledo, Chairman (1969) ; Horace B. Davidson, Colum-
bus (1971) ; Luther W. High, Millersburg (1970) ; John H.
Budd, Cleveland (1968) ; John J. Cranley, Jr., Cincinnati
(1967).
Committee on Scientific Work — Samuel Saslaw, Columbus,
Chairman (1968); Jerry Hammon, West Milton (1971); Robert
E. Zipf, Dayton (1971) ; Jack Schreiber, Canfield (1970) ;
Walter J. Zeiter, Cleveland (1970) ; John D. Battle, Jr., Cleve-
land (1969) ; Harold J. Schneider, Cincinnati (1969) ; Isador
Miller, Urbana (1968); William Hamelberg, Columbus (1967);
F. A. Simeone, Cleveland (1967).
Committee on AMA-ERF — Robert S. Martin, Zanesville,
Chairman.
Committee on Auditing and Appropriations — William R.
Schultz, Wooster, Chairman ; Edwin R. Westbrook, Warren ;
George Newton Spears, Ironton.
Committee on Cancer — Arthur G. James, Columbus, Chair-
man ; Thomas D. Allison, Lima ; Andrew M. Barone, Lima ;
William F. Boukalik, Cleveland; William J. Flynn, Youngs-
town ; Douglas P. Graf, Cincinnati ; Stanley O. Hoerr, Cleve-
land; William A. Newton, Jr., Columbus; W. D. Nusbaum,
Lancaster ; Arthur E. Rappoport, Youngstown ; Carl A. Wilz-
bach, Cincinnati. , ,
Committee on Disaster Medical Care — Thomas D. Allison,
Lima, Chairman ; Thomas P. Bowlus, Toledo ; Nino M. Camardese,
Norwalk ; Drew L. Davies, Columbus ; John H. Davis, Cleveland ;
Gregory G. Floridis, Dayton ; Robert D. Gillette, Huron ; Robert
S. Heidt, Cincinnati ; Robert E. Holmberg, Cleveland ; N. J. M.
Klotz, Wadsworth; Thomas W. Morgan, Gallipolis ; Sterling
W. Obenour, Jr., Zanesville; Vol K. Philips, Columbus; Liaison
with the American Medical Association : Wendell A. Butcher,
Columbus.
Committee on Environmental Health — Rex H. Wilson, Akron,
Chairman ; William W. Davis, Columbus ; Larry L. Hipp, Gran-
846
ville; Robert C. Markey, Bowling Green; B. C. Myers, Lorain;
Tuathal P. O’Maille, Marietta ; Thomas N. Quilter, Marion ; I. C.
Riggin, Lorain ; Robert E. Schulz, Wooster ; Victor A. Simiele,
Lancaster ; John P. Storaasli, Cleveland ; Robert Vogel, Dayton ;
Robert C. Waltz, Cleveland ; Tennyson Williams, Delaware ;
John L. Zimmerman, Fremont.
Committee on Eye Care — Arthur D. Collins, Cleveland, Chair-
man ; Martin J. Cook, Springfield ; Thomas L. Edwards, Lima ;
Robert H. Magnuson, Columbus ; Russell J. Nicholl, Cleveland ;
Claude S. Perry, Columbus ; Norman W. Pinschmidt, Gallipolis ;
Barnet R. Sakler, Cincinnati ; Robert L. Willard, Toledo.
Committee on Government Medical Care Programs — H. Wil-
liam Porterfield, Columbus, Chairman ; James O. Barr, Chagrin
Falls; Dwight L. Becker, Lima; Robert A. Borden, Fremont;
Edwin W. Burnes, Van Wert; Philip T. Doughten, New Phila-
delphia ; Robert B. Elliott, Ada ; George T. Harding, Sr.,
Worthington ; Roger E. Heering, Columbus ; M. Robert Huston,
Millersburg ; Francis M. Lenhart, Defiance ; Harold E. Mc-
Donald, Elyria ; Elliott W. Schilke, Springfield ; Bernard A.
Schwartz, Cincinnati; Clarence V. Smith, Canton; Joseph B.
Stocklen, Cleveland; Don P. Van Dyke, Kent; William M.
Wells, Newark.
Committee on Hospital Relations — Robert M. Craig, Dayton,
Chairman ; L. Fred Bissell, Aurora ; L. A. Black, Kenton ;
Wendell T. Bucher, Akron ; Oscar W. Clarke, Gallipolis ; Henry
A. Crawford, Cleveland ; John V. Emery, Willard ; Harvey C.
Gunderson, Toledo ; Henry L. Hartman, Toledo ; E. R. Haynes,
Zanesville ; Middleton H. Lambright, Cleveland ; Lloyd E. Lar-
rick, Cincinnati ; James C. McLarnan, Mt. Vernon ; Ben V.
Myers, Elyria ; E. W. Schilke, Springfield ; Robert A. Tennant,
Middletown ; V. William Wagner, Port Clinton ; William A.
White, Canton.
Committee on Insurance — David A. Chambers, Cleveland,
Chairman ; William F. Bradley, Columbus ; Walter A. Daniel,
Tiffin ; Chester R. Jablonoski, Cleveland ; William A. Knapp,
Zanesville ; Marvin R. McClellan, Cincinnati ; William Neal,
Archbold ; Oliver E. Todd, Toledo ; Robert E. Tschantz, Canton ;
Allan L. Wasserman, Dayton; John W. Wherry, Elyria; Wil-
liam A. White, Canton.
Committee on Laboratory Medicine — Horace B. Davidson,
Columbus, Chairman ; William H. Benham, Columbus ; John B.
Hazard, Cleveland ; Melvin Oosting, Dayton ; Arthur E. Rappo-
port, Youngstown ; William Sinclair, Cleveland ; Gilbert B.
Stansell, Toledo; Philip B. Wasserman, Cincinnati.
The Ohio State Medical Journal
State Association Officers and Committeemen (Continued)
Committee on Legislation — James T. Stephens, Oberlin, Chair-
man ; Chester H. Allen, Portsmouth; Donald R. Brumley, Find-
lay; Jonathan G. Busby, Columbus; George D. J. Griffin, Cin-
cinnati; Jack L. Kraker, Lancaster ; William J. Lewis, Dayton;
Maurice F. Lieber, Canton ; James C. McLarnan, Mt. Vernon ;
Wesley J. Pignolet, Willoughby ; Marvin J. Rassell, Hamilton ;
Theodore E. Richards, Urbana ; Robert E. Rinderknecht, Dover ;
John H. Sanders, Cleveland; William W. Trostel, Piqua.
Committee on Maternal Health — Anthony Ruppersberg, Colum-
bus, Chairman ; Otis G. Austin, Medina ; Raymond E. Barker,
Columbus; William D. Beasley, Springfield; Keith R. Brande-
berry, Gallipolis ; Thomas E. Byrne, Mentor ; Mel A. Davis,
Columbus; Marion F. Detrick, Jr., Findlay; John P. Garvin,
Columbus ; Richard P. Glove, Cleveland ; Robert A. Heilman,
Columbus; John F. Hillabrand, Toledo; Robert E. Johnstone,
Cincinnati; Albert A. Kunnen, Dayton; James F. Morton,
Zanesville ; Ralph K. Ramsayer, Canton ; Robert E. Swank,
Chillicothe ; Densmore Thomas, Warren ; Robert S. VanDervort,
Elyria.
Committee on Medicine and Religion — Charles A. Sebastian,
Cincinnati, Chairman; John D. Albertson, Lima; Eugene F.
Damstra, Dayton ; Francis M. Lenhart, Defiance ; Ralph W.
Lewis, Portsmouth ; George W. Petznick, Cleveland ; J. Kenneth
Potter, Cleveland; John R. Seesholtz, Canton; William B.
Smith, Zanesville; James T. Stephens, Oberlin; Donald J.
Vincent, Columbus ; Don G. Warren, West Lafayette.
Committee on Mental Health — -Wendell A. Butcher, Columbus,
Chairman ; Homer A. Anderson, Columbus ; Robert D. Eppley,
Elyria; Max D. Graves, Springfield; Richard G. Griffin, Worth-
ington ; Warren G. Harding, Columbus ; Edward O. Harper,
Cleveland ; Henry L. Hartman, Toledo ; William H. Holloway,
Akron ; C. Eric Johnston, Columbus ; Robert E. Reiheld, Orr-
ville ; Philip C. Rond, Columbus ; W. Donald Ross, Cincinnati ;
Viola V. Startzman, Wooster; Victor M. Victoroff, Cleveland.
Military Advisory Committee — Drew L. Davies, Columbus,
Chairman ; Ralph G. Carothers, Cincinnati ; Homer D. Cassel,
Dayton ; Henry A. Crawford, Cleveland ; Walter L. Cruise,
Zanesville ; Charles R. Keller, Mansfield ; Ralph W. Lewis,
Portsmouth ; Edward L. Montgomery, Circleville ; Frank T.
Moore, Akron ; Frederick P. Osgood, Toledo ; Earl Rosenblum,
Steubenville ; Richard G. Weber, Marion.
Committee on Rural Health — Robert E. Reiheld, Orrville,
Chairman ; Chester J. Brian, Eaton ; Robert R. C. Buchan,
Troy; J. Martin Byers, Greenfield; Walter A. Campbell, Co-
shocton ; E. Joel Davis, East Canton ; Victor R. Frederick,
Urbana ; Benjamin W. Gilliotte, Zanesville ; Jerry L. Hammon,
West Milton ; Jasper M. Hedges, Circleville ; Luther W. High,
Millersburg ; E. D. Mattmiller, Athens ; John R. Polsley, North
Lewisburg ; Leonard S. Pritchard, Columbiana ; Harold C.
Smith, Van Wert ; Kenneth W. Taylor, Pickerington.
OSMA Advisory Committee to the Ohio State Society of
Medical Assistants — Richard L. Fulton, Columbus, Chairman ;
George Newton Spears, Ironton.
Committee on School Health — Charles H. McMullen, Loudon-
ville. Chairman; Walter Felson, Greenfield; Howard H. Hop-
wood, Cleveland ; Dale A. Hudson, Piqua ; Howard J. Ickes,
Canton ; Charles L. Kagay, Dayton ; Thomas E. Wilson, Warren ;
Robert C. Markey, Bowling Green ; Robert J. Murphy, Colum-
bus; Carey B. Paul, Jr., Columbus; Carl L. Petersilge, Newark;
William H. Rower, Ashland ; Thomas E. Shaffer, Columbus ;
Aubrey L. Sparks, Warren ; Homer B. Thomas, Gallipolis.
OSMA Members of the Joint Committee on School Bus Driver
Examinations — Carey B. Paul, Jr., Columbus ; Thomas N.
Quilter, Marion ; Drew L. Davies, Columbus.
OSMA Members of the Joint Advisory Committee on Athletic
Injuries — Walter A. Hoyt, Jr., Akron; John R. Jones, Toledo;
Don A. Kelly, Cleveland; Sol Maggied, West Jefferson; Marvin
R. McClellan, Cincinnati ; Robert P. McFarland, Oberlin ;
Charles H. McMullen, Loudonville ; Robert J. Murphy, Colum-
bus; Carey B. Paul, Jr., Columbus; Thomas E. Shaffer,
Columbus.
Committee on Workmen’s Compensation — H. P. Worstell,
Columbus, Chairman ; A. L. Berndt, Portsmouth ; Thomas H.
Brown, Jr., Toledo; Charles A. Browning, Jr., Bellefontaine ;
Oscar W. Clarke, Gallipolis ; Frederick A. Flory, Columbus ;
Lawrence T. Hadbavny, Cleveland ; Clyde O. Hurst, Ports-
mouth; Edmund F. Ley, Tiffin; Joseph Lindner, Sr., Cincinnati;
John D. Osmond, Jr., Cleveland; James G. Roberts, Akron;
George L. Sackett, Sr., Painesville ; William V. Trowbridge,
Cleveland ; Rex H. Wilson, Akron ; James N. Wychgel, Cleve-
land ; Joseph H. Shepard, Columbus; Frederick A. Wolf,
Cincinnati.
Woman’s Auxiliary Advisory Committee — Robert C. Beard-
sley, Zanesville, Chairman ; Theodore L. Light, Dayton ; Fred-
erick T. Merchant, Marion.
Ohio Medical Indemnity Liaison Committee — Robert E.
Tschantz, Canton, Chairman ; Henry A. Crawford, Cleveland ;
Lawrence C. Meredith, Elyria ; Mr. Hart F. Page, Executive
Secretary, OSMA, Columbus.
DELEGATES AND ALTERNATES
Delegates and Alternates to the American Medical Association
— George W. Petznick, Cleveland ; H. T. Pease, Wadsworth, alter-
nate ; Carl A. Lincke, Carrollton ; Robert S. Martin, Zanesville,
alternate ; Theodore L. Light, Dayton ; Kenneth D. Arn, Dayton,
alternate; Edmond K. Yantes, Wilmington; Harry K. Hines,
Cincinnati, alternate; John H. Budd, Cleveland; P. John Robe-
chek, Cleveland, alternate ; Richard L. Meiling, Columbus ;
Frank F. A. Rawling, Toledo, alternate ; Frederick P. Osgood,
Toledo ; Robert N. Smith, Toledo, alternate ; Charles A. Sebas-
tian, Cincinnati ; J. Robert Hudson, Cincinnati, alternate ; Ed-
win H. Artman, Chillicothe ; Philip B. Hardymon, Columbus,
alternate ; Robert E. Tschantz, Canton ; Henry A. Crawford,
Cleveland, alternate.
County Societies’ Officers and Meeting Dates
First District
Councilor; Paul N. Ivins, Hamilton 45011
306 High Street
ADAMS — Gary J. Greenlee, President, Manchester 45144 ; Stan-
ley H. Title, Secretary, Manchester 45144.
BROWN — Charles H. Maly, President, Sardinia 45171 ; Charles
W. Hannah, Secretary, Sardinia 45171. 1st Monday monthly.
BUTLER — Robert Johnson, President, 500 S. Breiel Boulevard,
Middletown 45042 ; Mr. Charles G. Greig, Executive Secretary,
110 North Third Street, Hamilton 45011. 4th Wednesday
monthly.
CLERMONT— Cecil F. Barber, President, State Route 133, Feli-
city 45120 ; Phillips F. Greene, Secretary, Route 1, Box 509,
New Richmond 45157. 3rd Wednesday monthly, except July
and August.
CLINTON — Richard R. Buchanan, President, 115 West Main,
Wilmington 45177 ; Mary Ranz Boyd, Secretary, Box 629,
Wilmington 45177. 4th Tuesday monthly.
HAMILTON — Robert M. Woolford, President, 320 Broadway,
Cincinnati 45202 ; Mr. Edward F. Willenborg, Executive
Secretary, 320 Broadway, Cincinnati 45202. Monthly meet-
ing dates, 1st Tuesday ; Academy, 3rd Tuesday, except June,
July and August.
HIGHLAND — Thomas L. Jones, President, 528 South St., Green-
field 45123 ; Walter Felson, Secretary, 357 South St., Greenfield
45123. 3rd Tuesday bimonthly.
WARREN — O. Williard Hoffman, President, 20 East Fourth
Street, Franklin 45005 ; Ray E. Simendinger, Secretary, 901
North Broadway Street, Lebanon 45036. 2nd Tuesday monthly.
Second District
Councilor: Theodore L. Light, Dayton 45406
2670 Salem Ave.
CHAMPAIGN — Myron J. Towle, President, 848 Scioto Street,
Urbana 43078 ; Fred R. Denkewalter, Secretary, 848 Scioto
Street, Urbana 43078. 2nd Wednesday monthly.
CLARK — Henry M. Tardif, President, 2608 E. High Street,
Springfield 45505 ; Mrs. Marion L. Wilcoxson, Executive
Secretary, Hotel Shawnee, Room 207, Springfield 44501. 3rd
Monday monthly, except June, July and August.
DARKE — William A. Browne, President, 722 Sweitzer St.,
Greenville 45331 ; Delbert D. Blickenstaff, Secretary, 552 S.
West St., Versailles 45380. 3rd Tuesday monthly.
GREENE — Clement G. Austria, President, 1142 North Monroe
Drive, Xenia 45385 ; Mrs. C. K. Elliott, Executive Secretary,
225 Pleasant Street, Xenia 45385. 2nd Thursday monthly
except July and August.
MIAMI — David Brown, President, 1060 North Market Street,
Troy 45373 : Jack P. Steinhilber, Secretary, 145 Sunset Drive,
Piqua 45356. 1st Tuesday monthly.
MONTGOMERY — Charles E. O’Brien, President, 600 Fidelity
Building, Dayton 45402 ; Mr. Robert F. Freeman, Executive
Secretary, 280 Fidelity Medical Building, Dayton 45402. 1st
Friday monthly October through May — 1st Wednesday June.
PREBLE — John D. Darrow, President, 228 N. Barron St., Eaton
45320 ; Willard C. Clark, Jr., Secretary, 228 N. Barron, Eaton
45320. Irregular meetings.
SHELBY — George J. Schroer, President, 322 Second Ave., Sidney
45365 ; Alfonsas Kisielius, Secretary, Ohio Bldg., Sidney 45365.
for August, 1966
847
County Societies’ Officers and Meeting Dates (Continued)
Third District
Council : Frederick T. Merchant, Marion 43305
1051 Harding Memorial Pky.
ALLEN — Carl H. Zinsmeister, President, 729 W. Market Street,
Lima 45801 ; Thomas D. Allison, Secretary, 401 Metropolitan
Bank Building, Lima 45801. 3rd Tuesday monthly.
AUGLAIZE — Robert Sobocinski, President, 75 Blackhoof Street,
Wapakoneta 45895 ; J. F. Bowling, Secretary, 319 West Spring
Street, St. Marys 45885. 1st Thursday monthly except July.
CRAWFORD — Don E. Ingham, President, 201 N. Market Street,
Galion 44833 ; Johnson H. Chow, Secretary, 1040 Devonwood
Drive, Galion 44833. Called meetings.
HANCOCK — Raymond J. Tille, President, 801 S. Main St., Find-
lay 45840 ; Herbert L. Queen, Secretary, 828 Woodworth Dr.,
Findlay 45840.
HARDIN — William D. Dewar, President, 405 North Main Street,
Kenton 43326 ; John J. Roget, Secretary, Belle Center 43310.
2nd Tuesday monthly.
LOGAN — Thomas Seitz, President, 223 E. Columbus Street,
Bellefontaine 43311 ; Glen Miller, Secretary, R. D. 2, West
Liberty 43357. 1st Friday monthly.
MARION — Ransome Williams, President, 1035 Harding Me-
morial Parkway, Marion 43302 ; Alice Fisher, Secretary, 1040
Delaware Avenue, Marion 43302. 1st Tuesday monthly.
MERCER — R. Duane Bradrick, President, Rockford 45882 ; R. L.
Dobbins, Secretary, 5402 State Route 29 East, Celina. 3rd
Thursday, monthly.
SENECA — Olgierd C. Garlo, President, 53 Clay Street, Tiffin
^4883 : Leonard M. Gaydos, Secretary, 233 South Monroe
Street, Tiffin 44883. 3rd Tuesday monthly.
VAN WERT — Norman L. Marxen, President, Medical Arts Bldg.,
Fox Road, Van Wert 45891 ; W. L. Iler, Secretary, Medical
Arts Bldg., Fox Road, Van Wert 45891. 4th Friday monthly.
WYANDOT — Herschel A. Rhodes, President, 777 N. Sandusky
Ave., Upper Sandusky 43351 ; J. J. Browne, Secretary, 777 N.
Sandusky Ave., Upper Sandusky 43351. 2nd Tuesday monthly.
Fourth District
Councilor; Robert N. Smith, Toledo 43606
3939 Monroe St.
DEFIANCE — L. F. Berry, Jr., President, 1400 East Second
Street, Defiance 43512 ; W. S. Busteed, Secretary, Box 218,
Defiance 43512.
FULTON — B. H. Reed, Jr., President, Delta 43515 ; R. L. Davis,
Secretary, Wauseon 43567. 2nd Tuesday quarterly March,
June, September, December.
HENRY — J. J. Harrison, President, 113 East Clinton Street,
Napoleon 43545 ; Gamble S. Hall, Secretary, 834 Strong
Street, Napoleon 43545. 1st Tuesday monthly.
LUCAS — E. L. Doermann, President, 2001 Collingwood Blvd.,
Toledo 43620 ; Mr. Robert W. Elwell, Executive Secretary, 3101
Collingwood Blvd., Toledo 43610. 3rd Tuesday monthly except
July and August.
OTTAWA — V. Wm. Wagner, President, 122 East Perry, Port
Clinton 43452 ; William Coon, Secretary, 120 East Perry, Port
Clinton 43452. 2nd Thursday monthly.
PAULDING — Roy R. Miller, President, 220 W. Perry, Paulding
45879 ; D. Paul Ward, Secretary, Box 416, Oakwood 45873.
Meetings called.
PUTNAM — Arthur P. Daniel, President, 144 N. Walnut, Ottawa
45875 ; Oliver N. Lugibihl, Secretary, Pandora 45877. 1st
Tuesday monthly.
SANDUSKY — J. L. Zimmerman, President, Memorial Hospital
of Sandusky County, Fremont 43420 ; Mrs. Patsy J. Askins.
Executive Secretary, Memorial Hospital of Sandusky County,
Fremont 43420. 3rd Wednesday monthly.
WILLIAMS — John E. Moats, President, Central Drive, Bryan
43506 ; Neil T. Levenson, Secretary, 907 Noble Drive, Bryan
43506. 2nd Tuesday monthly.
WOOD — Roger A. Peatee. President, 140 S. Prospect Street,
Bowling Green 43402 ; Douglas Hess, Secretary, 920 North
Main St., Bowling Green, Ohio 43402. 3rd Thursday monthly.
Fifth District
Councilor: P. John Robechelc, Cleveland 44106
10525 Carnegie Ave.
ASHTABULA — J. R. Nolan, President, 2736 Lake Avenue, Ash-
tabula 44004 ; Richard Millberg, Secretary, 430 West 25th
Street, Ashtabula 44004. 2nd Tuesday monthly.
CUYAHOGA — David Fishman, President, Room 404, 10515 Car-
negie Avenue, Cleveland 44106 ; Mr. Robert A. Lang, Executive
Secretary, 10525 Carnegie Avenue, Cleveland 44106.
GEAUGA — Bruce F. Andreas, President, 400 Downing Drive,
Chardon 44024 ; Arturo J. Dimaculangan, Secretary, 8400 May-
field Road, P. O. Box 277, Chesterland 44026. 2nd Friday
monthly.
LAKE — Robert W. Colopy, President, 89 E. High Street, Paines-
ville 44077 ; Mrs. Owen A. McLaren, Executive Secretary,
7408 Cadle Avenue, Mentor 44060. 4th Wednesday evening
monthly, January, May, March, September and November
unless otherwise ordered by Council.
Sixth District
Councilor: Edwin R. Westbrook, Warren 44481
438 North Park Ave.
COLUMBIANA — Edith S. Gilmore, President, 432 W. 5th St.,
E. Liverpool 43920 ; Fraser Jackson, Secretary, 205 W. 6th
St. 3rd Tuesday monthly.
MAHONING — F. A. Resch, President, Doctors Park, Canfield
44406 ; Mr. Howard C. Rempes, Jr., Executive Secretai’y, 245
Bel-Park Building, 1005 Belmont Avenue, Youngstown 44504.
3rd Tuesday monthly except July and August.
PORTAGE — David Palmstrom, President, 124 North Prospect
Street, Ravenna 44266 ; William R. Brinker, Secretary, 141
East Main Street, Kent 44240. 3rd Tuesday monthly.
STARK — A. R. Furnas, Jr., President, 420 Lake Avenue, N. E.,
Massillon 44646 ; Mr. John H. Austin, Executive Secretary,
405 4th Street, N. W., Canton 44702. 2nd Thursday monthly.
SUMMIT — James G. Roberts, President, 655 West Market Street,
Akron 44303 ; Mr. Sidney H. Mountcastle, Executive Secretary,
437 Second National Building, 159 South Main Street, Akron
44308. 1st Tuesday monthly.
TRUMBULL — John F. McGreevey, President, 297 Hawthorne
Lane N. E., Warren 44484 ; Mrs. Kay Ticknor, Executive
Secretary, 280 North Park Avenue, Warren 44481. 3rd
Wednesday monthly September through May.
Seventh District
Councilor: Sanford Press, Steubenville 43952
525 North Fourth Street
BELMONT — James Sutherland, President, 9 North 4th Street,
Martins Ferry 43935 ; Bertha M. Joseph, Secretary, 100 South
4th Street, Martins Ferry 43935. 3rd Thursday of February,
March, April, June, September, October, November and
December.
CARROLL — Glen C. Dowell, President, 207 West Main, Car-
rollton 44615 ; Thomas J. Atchison, Secretary, 292 East
Main, Carrollton 44615. 1st Thursday monthly.
COSHOCTON — Don Warren, President, 600 East Main Street,
West Lafayette 43845 ; Harold Lear, Secretary, 133 South
Fourth Street, Coshocton 43812. 2nd Tuesday monthly.
HARRISON — Charles D. Evans, President, 159 South Main
Street, Cadiz 43907 ; G. E. Vorhies, Secretary, Scio 43988,
Quarterly.
JEFFERSON — Jacob R. Cohen, President, 341 Market Street,
Steubenville 43952 ; Irving Dreyer, Secretary, Ohio Valley
Hospital, Steubenville 43952. 4th Tuesday monthly except
December, January, February.
MONROE — Byron Gillespie, Secretary, Woodsfield 43793.
TUSCARAWAS — Robert J. Kuba, President, 319 Grant St., Den-
nison 44621 ; Thomas E. Ogden, Secretary, 138 E. Main St.,
Gnadenhutten. 2nd Thursday monthly.
Eighth District
Councilor: Robert C. Beardsley, Zanesville 43705
2236 Maple Ave.
ATHENS — D. R. Johnson, President, 52 West Washington
Street, Nelsonville 45764 ; L. A. Hamilton, Secretary, 400 East
State Street, Athens 45701. 2nd Tuesday monthly except July
and August.
FAIRFIELD — George W. LeSar, President, 216 Harmon Avenue.
Lancaster 43130 ; Stephen R. Hodsden, Secretary, 1423 West
Market Street, Baltimore 43105. 2nd Tuesday monthly.
GUERNSEY — A. C. Smith, President, 1115 Clark Street, Cam-
bridge 43725 ; Dayle O. Snyder, Secretary, 840 Wheeling
Avenue, Cambridge 43725. 1st Tuesday monthly.
LICKING — Carl L. Petersilge, President, 104 Hudson Avenue,
Newark 43065 ; Robert P. Raker, Secretary, 317 N. Granger
Street, Granville 43023. 4th Tuesday monthly.
MORGAN — A. H. Whitacre, President, Chesterhill 43728 ; Henry
Bachman, Secretary, Box 199, Malta 43758.
MUSKINGUM — Paul A. Jones, President, 838 Market Street,
Zanesville 43701 ; Myron Powelson, Secretary, 2825 Maple
Avenue, Zanesville 43705. 2nd Tuesday monthly.
NOBLE — Frederick M. Cox, President, Caldwell 43724 ; Edward
G. Ditch, Secretary, 415 Main Street, Caldwell 43724. 1st
Tuesday monthly.
PERRY — Charles B. McDougal, President, 319 High St., New
Lexington 43764; Michael P. Clouse, Secretary, West Main St.,
Somerset 43783.
WASHINGTON — Mary L. Whitacre, President, Rt. 6, Marietta
45750 ; G. E. Huston, Secretary, 328 Fourth St., Marietta
45750. 2nd Wednesday monthly.
848
The Ohio State Medical Journal
County Societies’ Officers and Meeting Dates (Continued)
Ninth District
Councilor: George N. Spears, Ironton 45688
2213 S. 9th St.
GALLIA — Quentin Korfhage, President, Gallipolis Clinic, Gal-
lipolis 45631 ; John Groth, Secretary, Holzer Clinic, Gallipolis
45631. Monthly meetings at called times.
HOCKING — Jan S. Matthews, President, 9 East Second Street,
Logan 43138 : H. M. Boocks, Secretary, Route 3, Logan 43138.
2nd Tuesday monthly.
JACKSON — John M. Cook, President, Box 316, Oak Hill 45656 :
Earl J. Levine, Secretary, 120 N. Ohio Ave., Wellston 45692.
LAWRENCE — Frank W. Crowe, President, 2110 South 9th
Street, Ironton 45638 ; George Newton Spears, Secretary, 2213
South Ninth Street, Ironton 45638. Quarterly at called times.
MEIGS — Charles J. Mullen, President, 210 VG E. Main St., Pome-
roy 45769 ; Edmund Butrimas, Secretary, 204 E. Main St.,
Pomeroy 45769.
PIKE — Robert T. Leever, President, 100 East Third St., Waverly
45690 ; Albert M. Shrader, Secretary, East Water St., Waverly
45690. 1st Tuesday monthly.
SCIOTO — Chester H. Allen, President, 1405 Offnere Street,
Portsmouth 45662 ; Erich Spiro, Secretary, 1735 Waller Street,
Portsmouth 45662. 2nd Monday in February, April and Octo-
ber; December meeting and summer meeting decided by the
Council and members notified one month in advance.
VINTON — Richard E. Bullock, President, 203 South Market St.,
McArthur 45651.
Tenth District
Councilor: Richard L. Fulton, Columbus 43812
1211 Dublin Rd.
DELAWARE — Don K. Michel, President, 98 W. William, Dela-
ware 43015 ; Tennyson Williams, Secretary, Box 265, Delaware
43015. 3rd Tuesday monthly.
FAYETTE — R. D. ■ Woodmansee, President, 403 East Market
Street, Washington C. H. 43160; M. H. Roszmann, Secretary,
1005 East Temple Street, Washington C. H. 43160. 2nd
Friday monthly
FRANKLIN — Joseph A. Bonta, President, 3100 Olentangy River
Road, Columbus 43202 ; Mr. W. “Bill” Webb, Jr., Executive
Secretary, 79 East State Street, Room 601, Columbus 43215.
3rd Tuesday monthly.
KNOX — Richard L. Smythe, President, 812 Coshocton Road,
Mt. Vernon 43050 ; Robert E. Sooy, Secretary, Box 470, Mt.
Vernon 43050. 1st Wednesday evening monthly.
MADISON — Sol Maggied, President, 15 East Pearl Street, West
Jefferson 43162 ; Michael Meftah, Secretary, 11 East 2nd
Street, London 43140. 1st Wednesday monthly.
MORROW — Francis W. Kubb, President, 140 North Main, Mt.
Gilead 43338 ; William S. Deffinger, Secretary, Box 8, Marengo
43334. 1st Tuesday monthly.
PICKAWAY — V. D. Kerns, President, 143 E. Main Street,
Circleville 43113; Carlos Alvarez, Secretary, 147 Pinckney
Street, Circleville 43113. 1st Friday evening monthly, except
months of July and August.
ROSS — Joseph McKell, President, 174 W. Main Street, Chilli-
cothe 45601; Lowell O. Smith, Secretary, 217 Delano Avenue,
Chillicothe 45602. 1st Thursday evening monthly.
UNION — Malcolm Maelvor, President, 110 N. Court St., Marys-
ville 43040 ; May B. Zaugg, Secretary, 225 Stockdale Drive,
Marysville 43040. 1st Tuesday, February, April, October,
December.
Eleventh District
Councilor: William R. Schultz, Wooster 44691
1749 Cleveland Road
ASHLAND — Henry C. Chalfant, President, 309 Arthur Street,
Ashland 44805 ; H. W. Smith, Secretary, 414 Samaritan Ave-
nue, Ashland 44805. 1st Thursday monthly.
ERIE — Clinton F. Lavender, President, 1218 Cleveland Road,
Sandusky 44870 ; Mrs. Bertha Wolpert, Executive Secretary,
1205 Tyler Street, Sandusky 44870.
HOLMES — Charles H. Hart, President, 109 South Clay Street,
Millersburg 44654 ; William A. Powell, Secretary, 8 West
Adams Street, Millersburg 44654. 3rd Thursday monthly.
HURON — W. R. Graham, President, 15 Main Street, Wakeman
44889 ; E. R. McLoney, Secretary, 257 Benedict Avenue, Nor-
walk 44857. 2nd Wednesday of February, April, June, Au-
gust, October, and December.
LORAIN — Joseph A. Cicerrella, President, 209 6th Street, Lorain
44052 ; Mrs. Gladys Davidson, Executive Secretary, 428 West
Avenue, Elyria 44035. 2nd Tuesday monthly except June,
July and August.
MEDINA — Myrl A. Nafziger, President, Albrecht Building,
Wadsworth 44281 ; Mr. A. Dana Whipple, Executive Secretary,
320 East Liberty Street, Medina, Ohio 44256. 3rd Thursday
monthly.
RICHLAND — C. J. Shamess, President, 74 Wood Street, Mans-
field 44903 ; Harold F. Mills, Secretary, 70 Madison Road,
Mansfield 44905. 3rd Thursday monthly except June, July and
August.
WAYNE — Howard MacMillan, President, 1740 Cleveland Road,
Wooster 44691 ; R. J. Watkins, Secretary, 1736 Beall Avenue,
Wooster 44691. 2nd Wednesday monthly, January, February,
April, September. November and December.
Ohio Association of Blood Banks
Announces List of Officers
Following a meeting held during the Annual
Meeting of the Ohio State Medical Association in
Cleveland, announcement was made that the Ohio
Association of Blood Banks has been formed.
The President is Ludolph H. van der Hoeven,
M. D., of Dayton, and the secretary-treasurer is C.
R. Macpherson, M. D., Ohio State University Hos-
pitals, Columbus.
Members of the Board of Governors are: Jeanne
Burson, M. T., Sandusky; Warren Nordin, M. D.,
Toledo; Arthur E. Rappoport, M. D., Youngstown;
Hazel Suessenguth, M. T., Cleveland; Delores Kreis,
M. T., Cincinnati; Robert P. Carson, M. D., Middle-
town; Maty M. Kastetter, M. T., Columbus; and
Donald Walz, M. D., Mt. Vernon.
The University of Cincinnati Medical Center’s
research program on dmg action and efficacy in
treatment of man’s diseases has received a $10,000
boost from the Eli Lilly Co. of Indianapolis. The
division, now 3 Yj years old, is a joint effort of the
university’s Departments of Pharmacology and In-
ternal Medicine.
THE WOMAN’S AUXILIARY TO THE OHIO STATE MEDICAL ASSOCIATION
President: Mrs. James N. Wychgel
3320 Dorchester Rd., Cleveland 44120
Vice-Presidents: 1. Mrs. Malachi W. Sloan, II
415 Towerview Rd., Dayton 45429
2. Mrs. Carl F. Goll
1001 Granard Pkwy., Steubenville 43952
3. Mrs. Edward L. Doerman
3605 Laskey Rd., Toledo 43623
Past President and Nominating Chairman :
Mrs. Herbert F. Van Epps
425 E. 15th St., Dover 44622
President-Elect : Mrs. Paul Sauvageot
2443 Ridgewood Rd., Akron 44313
Recording Secretary : Mrs. James W. Loney
15450 Hemlock Point Rd., Chagrin Falls
Corresponding Secretary : Mrs. Vincent T. Kaval
19201 VanAken Blvd., Cleveland 44122
Treasurer : Mrs. Russell L. Wiessinger
2280 West Wayne St., Lima 45805
for August, 1966
849
JOURNAL ADVERTISERS
Advertisers in The journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The journal,
and help make it a quality publication. Tn return we
place their messages on the desks of Ohio’s physicians.
Please familiarize yourself with their services and pro-
ducts. and let them know that you see their advertising
in The journal.
I n This Issue :
Abbott Laboratories 771-772-773-774
Allergy Laboratories of Ohio, Inc 759
Ames Company, Inc 758
Appalachian Hall 778
Ayerst Laboratories 768-769
Blessings, Inc 837
The Brown Pharmaceutical Co 775
Burroughs Wellcome & Co. (USA) Inc 776
The Coca-Cola Company 77 6
Daniels-Head & Associates, Inc 834
Data Corporation 819
Dorsey Laboratories, a Division of the
Wander Company 841-842-843-844
Elder, Paul B., Company 852
Geigy Pharmaceuticals, Division of
Geigy Chemical Corporation Inside Back Cover
Hynson, Westcott & Dunning, Inc 753
The Kendall Company 760
Lederle Laboratories, A Division of American
Cyanamid Company .... 756-757, 764-765,
788, .' , 838
Lilly, Eli, and Company 793-794, 835
Loma Linda Foods, Medical
Products Division 781
The Medical Protective Company 775
Neisler Laboratories, Inc., Subsidiary of
Union Carbide Corporation 766-767
Parke, Davis & Company Inside Front Cover
Pharmaceutical Manufacturers
Association 770, 792
Philips Roxane Laboratories 783-784
Roche Laboratories, Division of
Hoffmann-La Roche Inc Back Cover
Searle, G. D., & Company 820-821
Smith, Kline & French Laboratories 780
Squibb, E. R., & Sons 786
Syntex Laboratories Inc 761-762-763
Turner & Shepard, Inc 845
Tutag, S. J., & Co 840
Wallace Laboratories 779, 787
The Wendt-Bristol Company 834
West-ward, Inc 789
Windsor Hospital 791
Winthrop Laboratories 754, 777, 790
Wyeth Laboratories 831-832
Table of Contents
(Continued From Page 755)
Page
764 October 16-22 Designated as Community
Health Week
778 Ohio Physician as Film Participant Discusses
the "Flabby” Male
778 Ohio State University Offers Courses for
Physicians
791 OSMA Executive Secretary Is Named on Two
National Committees
791 Blue Shield Symbol Protected by Appeals
Court Decision
791 Life Insurance Medical Research Fund Sponsors
Grants and Fellowships
827 Technicians Receive Certificates in Laboratory
Animal Care
836 Obituaries
837 New Members of the Association
837 Prototype Refresher Course for Women
Physicians Studied
839 Activities of County Medical Societies
840 Law-Medicine Conference Scheduled at Ohio
State University
840 Sudden Infant Death Syndrome
845 Lectures on Human Reproduction
845 OSU Medical Education Network Wins
National Honors
846 Roster of State Association Officers and
Committeemen
847 Roster of County Medical Society Officers and
Meeting Dates
849 Ohio Association of Blood Banks Organized
849 Roster of State Auxiliary Officers
850 The Journal’s Advertisers in This Issue
851 Classified Advertisements
851 Disaster Medical Care Proceedings Published
851 Ohio Corporation Gets Contract for Artificial
Heart Research
Eye Research at Three Colleges
Promoted by Ohio Lions
The Ohio Lions Eye Research Foundation has
awarded $24,000 to three groups on the Ohio State
University campus, according to Everett R. Steece,
general manager.
The College of Medicine, department of ophthal-
mology; the Institute for Research in Vision, and the
School of Optometry will share equally in the funds
to support research in diseases of the eye.
Steece, in making the presentation, said the Ohio
Lions Eye Research Foundation gives approximately
$65,000 annually for research at Ohio State Uni-
versity, the University of Cincinnati and Western
Reserve University.
850
The Ohio State Medical Journal
Classified Advertisements
Rates: 50 cents per line. Minimum charge of $1.00 for each insertion. Prices cover the cost of remailing
answers. Forms close 15th of the month preceding publication. To assure prompt delivery, when reply-
ing to an advertisement over a Journal box number, address letters as follows:
Box (insert number), c/o The Ohio State Medical Journal,
17 South High Street, Suite 500, Columbus, Ohio 43215
Physicians seeking locations in Ohio are invited to contact
the Physicians’ Placement Service in the executive offices of
the Ohio State Medical Association, 79 E. State St., Colum-
bus, Ohio 43215. Through this medium efforts are made to
establish communications between physicians seeking loca-
tions and communities where physicians are needed, or other
physicians who are in need of associates.
GENERAL PRACTITIONER. Available immediately position for
young G. P. in group practice. Group consists of two G. P.’s, an
Internist and an American Board Surgeon, in new medical building
with complete laboratory service and close to local hospital. Salary
first year leading to partnership, no investment. Rural community,
well located in northeast Ohio, excellent school system. Housing
available. Reply Box 422, Ohio State Medical Journal.
SPACE AVAILABLE — The Twinsburg Professional Center, on
State Route 14, across from the new TWINSBURG PLAZA shop-
ping center, in fast growing Twinsburg village. Air Conditioned,
ground floor space available, plenty of parking and good lighting.
Western Reserve design. This building is in a five mile radius of
Ford Motor Co., General Motors Corp., and Chrysler Corp., and is
surrounded by public and parochial schools, churches and approxi-
mately 5000 new homes. Eight interchanges in Twinsburg. A dire
need for physicians or surgeons in this area due to the expanding
population. Mr. Antonucci will make special arrangements for a
physician or a surgeon to help them get started and will also ar-
range housing facilities. A CHANCE OF A LIFETIME. For fur-
ther information call or write: Mr. Joseph Antonucci, 10570 Ravenna
Road, Twinsburg, Ohio. Twinsburg line 425-7141, Cleveland Line
421-7988. For particulars on business conditions contact Philip
Johnson, D. D. S., same address, Twinsburg line 425-2220.
ANESTHESIOLOGIST, 41, married, university trained, board
eligible wishes to relocate in Ohio. Box 473, c/o Ohio State Medical
Journal.
GENERAL PRACTITIONER with ten years experience in active
partnership practice desires to relocate in Northern Ohio community.
Either association or solo type arrangement would be considered.
Will gladly send resume and exchange references. Box 479, c/o
Ohio State Medical Journal.
FOR RENT: Office suite. New Medical Bldg. Modern; on one
floor; parking space; air conditioned. Call 442-0106 (Cleveland).
OB-GYN man looking for clinic association or good location for
private practice. Box 477, c/o Ohio State Medical Journal.
WANTED: Physician; male, under 50, in good health. New
Industrial Clinic in Cincinnati. No evening hours. Should have
fulfilled or be exempt from military obligation. Attractive remuner-
ation. Frederick A. Wolf, M. D., 911 West Eighth St., Cincin-
nati, Ohio 45203; Telephone 241-4135.
EXCELLENT OPPORTUNITY for GENERAL PRACTITIONER,
INTERNIST and PEDIATRICIAN, with nine-man group now prac-
ticing in a rapidly growing suburban community, 18 miles east of
Cleveland. Available immediately or will wait for right man. Sal-
ary open, leading to partnership. Specialists board certified. Box
475, c/o Ohio State Medical Journal.
FOR SALE: One Burdick Electrocardiograph with portable stand
and pro-amp sound projector, new $1200 for $800; 1 vitolator,
automatic $132 new for $80; 1 centrifuge, aloe, $98 new for $50;
1 oxygen unit $62.50 new for $30; 1 Health-O-Meter scales $56 new
for $25; 1 incubator and counting chamber $42 new for $25; 2
Hamilton cabinet exam tables $100; 1 autoclave sterilizer $25; T.
Laurel!, M. D., 242 Granville Street, Newark, Ohio. Phone 323-0581.
Anesthesiology — 2-year career residency now available; $10,000
yr. salary; Ann Arbor Veteran’s Administration Hospital. Integral
part of University of Michigan Anesthesiology Department. Write to
Dr. R. B. Sweet, Dept, of Anesthesiology, University Medical Center,
Ann Arbor, Michigan 48104.
FOR SALE: Estate sale of otorhinolaryngologist; treatment room
equipment; instruments — almost new plastic & stapes; Miller Electric
Scalpel; Medical books. Mrs. Morris Hyman, 305 Doctors Bldg.,
Cincinnati, Ohio 45202.
PRACTICE AVAILABLE in prosperous Central Ohio county seat,
due to sudden death of physician; 4-room office, furnished, x-ray and
other equipment; records; on rental basis; no investment necessary.
Box 481, c/o The Ohio State Medical Journal.
PUBLIC HEALTH PHYSICIAN to assume the duties of Health
Commissioner for well established County Health Department. Locale
Wood County, Ohio, population 80,000. Headquarters Bowling
Green, Ohio, home of the Bowling Green State Univeisity. Must
be eligible to practice in Ohio, salary open, retirement and fringe
benefits. For information contact Louis P. Baldoni, M. D., c/o
Wood County General Health District, 541 W. Wooster St., Bowling
Green, Ohio 43402.
WANTED: PHYSICIANS INTERESTED IN EMERGENCY
ROOM coverage on a fee for service basis. Excellent potential
based on approximately 25,000 visits per year. Write: Director,
Aultman Hospital, Canton, Ohio 44710.
Conference on Disaster Medical Care
Proceedings are Published
Recently released is a 67-page booklet entitled
"Summary of Proceedings, 16th National Conference
on Diaster Medical Care,” being summaries of papers
presented at the conference held in Chicago, Octo-
ber 30-31, 1965.
The booklet was prepared and published by the
Department of Governmental Medical Services, Di-
vision of Socio-Economic Activities, American Medi-
cal Association.
Among summaries are those of the following
Ohioans who spoke at the conference:
"Resuscitation,” by Dr. David S. Leighninger, as-
sistant professor of surgery, Western Reserve Univer-
sity School of Medicine.
"Treating the Radiation Casualty,” by Dr. Eugene
L. Saenger, professor of radiology, University of Cin-
cinnati College of Medicine.
Ohio Corporation Gets Contract for
Artificial-Heart Research
The Monsanto Research Corporation, Dayton, has
been awarded a $101,000 contract by the National
Heart Institute for research seeking materials that
provide the combination of physical and chemical
properties most desirable for artificial heart construc-
tion.
The contract is one of seven similar awards placed
with research organizations, and the corporation is
one of 12 institutions for research which received
research contracts aimed at the solution of specific
problems in artificial heart development.
The National Heart Institute has invested a total
of $3,090,284 in the research program, according to
an announcement from the U. S. Public Health Service.
Dr. Fiorindo S. Simeone, director of surgery at
Western Reserve University School of Medicine, has
been named to the President’s commission to study
the nation’s draft laws.
for August, 1966
851
To lighten and clear blemished skin—
without overbleaching or reactivity
Freckling, pigmented blemishes and skin discolor-
ations gently fade away with Eldoquin. This ex-
clusive new cream goes directly to the source of
common skin blemishes. Applied one or two times
daily, Eldoquin gradually lightens these areas to
blend uniformly with the surrounding skin.
Eldoquin is mild: 2% Hydroquinone proved to
be a remarkably safe bleaching agent during use
tests on 380 patients . . no case of sensitization
developed (in these tests).”1
Overbleaching is never a problem. Due to the
transient action of Eldoquin, bleaching is gradual.
Treatment can be easily adjusted to maintain a
blemish-free complexion with uniform skin tone.
Contraindications: Do not apply to skin which is
affected by prickly heat, sunburn, depilatory appli-
cation, or is otherwise irritated. Do not use near
eyes or open cuts.
Precautions: Before initiating treatment, sensitivity
tests should be made, as follows: Apply cream to
an area about the size of a quarter on inside of
upper arm and rub in well. Allow to remain for 24
hours. If no redness or itching develops, proceed
with the treatment. Do not expose treated area to
sunlight for extended periods.
Supplied: V2 oz. tube.
References: 1. Spencer, Malcolm C. and
Becker, S. W., Jr.: A Hydroquinone Effect,
Clinical Medicine 70:6 (June) 1963. 2. Spencer,
Malcolm C: Hydroquinone Bleaching, AMA
Archives of Dermatology 84:131 (July) 1961.
PAUL B. ELDER COMPANY, Bryan, Ohio
.
852
The Ohio State Medical Journal
^ ke
OHIO STATE MEDICAL
journal
OSMA OFFICERS J|
President
Lawrence C. Meredith, M. D.
20.") Elyria Block, Elyria 44035 ij
President-Elect HI
Robert E. Howard, M.D. §1
2500 Central Trust Tower, j||
Cincinnati 45202 g
Past President =
Henry A. Crawford, M. D. ■
1058 Hanna Bldg., Cleveland 44115 m
Treasurer =
Philip B. Hardymon, M. D. g
350 E. Broad St., Columbus 43215 =
EDITORIAL STAFF
Editor
Perry R. Ayres, M. D.
Managing Editor and
Business Manager
Hart F. Pace
Executive Editor and
Executive Business Manager
R. Gordon Moore
OSMA EXECUTIVE STAFF gg
Executive Secretary =
Hart F. Page |j
Director of Public Relations and g
Assistant Executive Secretary HI
Charles W. Edgar B
Administrative Assistants g
W. Michael Traphagan U
Herbert E. Gillen B
Jerry J. Campbell H
Address All Correspondence: II
The Ohio State Medical Journal
17 South High Street, Suite 500 g
Columbus, Ohio 43215 H§
Published monthly under the direction of the |=
Council for and by members of The Ohio State
Medical Association, 17 South High Street, Suite ^
500, Columbus, Ohio 43215, a scientific society,
nonprofit organization, with a definite member- =
ship for scientific and educational purposes.
Subscription, $6.00 per year to non-members; gs
single copy, 50 cents (outside Continental U.S., |||§
$7.50 and 75 cents). -
Entered as second class matter July 5, 1905, at ==
the Postoffice at Columbus, Ohio, under the Act =
of Congress of March 3, 1879; Acceptance for
mailing at special rate of postage provided for in
Section 1103, Act of Oct. 3, 1917. Authority
July 10, 1918.
Hie Journal does not assume responsibility for §es
opinions expressed by the essayists. Advertisers s|f
must conform to policies and regulations estab- Igj
lished by The Council of the Ohio State Medical §gj
Association. §=
Table of Contents
Page Scientific Section
897 Computers in Cardiology. A Look Toward the Future.
G. Douglas Talbott, M. D., Kettering.
905 Resuscitation After Cardiac Arrest. Case Report of Two
Successful Resuscitations Four Years Apart. A. Ian
G. Davidson, M. B., Ch. M., F.R.C.S. (E), Foresterhill,
Aberdeen, Scotland, and David S. Leighninger, M. D.,
Cleveland.
907 The Runaway Artificial Pacemaker. Report of a Case.
Herman K. Hellerstein, M. D., Tom R. Hornsten,
M. D., and Jay L. Ankeney, M. D., Cleveland.
912 Suprapubic Catheterization. Preliminary Report of a
New Postoperative Technic. Donald W. Shanabrook,
M. D., Tiffin.
915 Hemophilus Influenza Meningitis. Report of a Case
Complicated by Subdural Empyema. C. Norman
Shealy, M. D., Cleveland.
916 A Clinicopathological Conference from The Ohio State
University Hospital, Columbus, Ohio.
921 Clinical Note: Cornpicker’s Pupil. Mydriasis from Jim-
son Weed Dust (Stramonium). James A. Goldey,
M. D., Dover A. Dick, M. D., and William L. Porter,
M. D., Oxford.
880 The Historian’s Notebook: Health Officers of Cincin-
nati, Ohio, and the Problems of Their Day — 1900
to I960. (Part III.) Kenneth I. E. Macleod, M. D.,
Cincinnati.
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
Items of Special Interest
860 Query: Is Shingles Contagious?
877 Editorial: Cornpicker’s Pupil
906 Letter to the Editor: Regarding Medical Travelogue
News and Organization Section
922 Proceedings of The Council
936 AMA Takes Firm Stand at Convention
Ohioans Take Leading Roles
Notes on Installation of Dr. Hudson as
President of AMA (page 939)
Physician’s Role in Medicare (page 940)
942 Outstanding Scientific Exhibits at OSMA Annual
Meeting
948 Are You Registered to Vote?
952 Ohio Voices Objections to HEW
( Continued on Page 973)
STONEMAN PRESS, COLUMBUS, OHIO
[PRINTED 1
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of endometrial changes.1-3'7'16 With
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have been reported to date when used
as directed.
inhibition of ovulation by means of
2 time-proved hormonal agents
production of a cervical mucus hostile to
sperm motility and vitality
creation of an endometrium unreceptive
to egg implantation
856
The Ohio State Medical Journal
what
time
For the past
two years
there’s been
one new case
of active tuberculosis
reported for every
four thousand
of U.S. population.
ife time
to tine.
Tuberculin,
LEDERLE LABORATORIES, A Division of American Cyanamid Company, Pearl River, New York
414-6—4046
for September, 1966
859
Is Shingles Contagious?
LONG" CREDIT...
You and your business do not
deserve the loss of time and
money (profits!) which go with
over-extension of credit. The
debtor, too, would be far better
served, as would your fellow
businessmen, were you to say
“Sorry”.
But how to know when to say
“Sorry” or “Gladly”? . . . Simply
through membership in your
local Credit Bureau. Other mer-
chants and professionals are
“banking” debtor information
there daily. The complete and
up-to-date debtor histories are
available to all members — even
the histories of newcomer
families can be had, because
the records of 86 credit bureaus
in Ohio are available to yours,
also such histories from more
than 2000 bureaus in the U.S.
What better “good business”
insurance?
ASSOCIATED
CREDIT BUREAUS
OF OHIO
P. 0. Box 1114, Lima, Ohio 45802
Query
Editor
The Ohio State Medical Journal
Dear Sir:
Last winter, a nonagenarian patient developed a sev-
ere case of herpes zoster. A devoted niece volun-
teered to care for him; but she wished reassurance on
the danger of contagion. I assured her she ran no
risk, and that in fifty-seven years of practice I had
never seen two cases in the same household. For-
tunately, I advised her to consult her own physician.
He gave her the conventional answer.
In about six weeks she developed herpes. In an-
other six weeks, I had an unpleasant case, from
which I am just recovering. Does this prove that
the vimses are getting the jump on us?
In a somewhat puzzled way,
( Signed ) Mark Houston, M. D.
321 North Main
Urbana, Ohio 43078
June 25, 1966.
* * *
Comment: Chickenpox and shingles (herpes
zoster) are caused by the same viral agent. The dis-
ease which results is generally believed to depend
on the immune status of the patient. Chickenpox oc-
curs with initial infection, whereas herpes zoster is
the manifestation in a person who has ''partial im-
munity” from a previous encounter with the virus.
Chickenpox is highly contagious for a day or so
before the appearance of rash and several days there-
after. Herpes zoster is less contagious possibly be-
cause the virus is less widely disseminated. There
is none in the respiratory secretions and the localized
skin lesions are few in number and usually covered
by clothing.
An experience such as that recorded by Dr. Hou-
ston has convinced many of us that herpes zoster is
contagious or maybe, as Dr. Houston suggests, vir-
uses these days just don't behave like they used to.
The foregoing comment was solicited by the Editor from
Dr. Eli Gold, Associate Professor of Pediatrics and Assistant
Professor of Microbiology, Western Reserve University, at
Cleveland Metropolitan General Hospital, Cleveland, Ohio.
Ohioans on Texas Gyn Program
Dr. Nichols Vorys and Dr. Paige K. Besch, mem-
bers of the faculty at Ohio State University College
of Medicine, will particiate in a Texas program this
fall. The University of Texas Graduate School of
Biomedical Sciences at Houston, Division of Con-
tinuing Education, announced the two-day intensive
short course entitled, ''Gynecological Endocrinology.”
The dates are November 16 and 17 and the place is
the Texas Medical Center in Houston.
860
The Ohio State Medical Journal
Americans Are Highly Mobile
People, Report Shows
Americans are a highly mobile people. Each year
since 1948, about one fifth of the population changed
residence within the United States, according to sur-
veys by the Bureau of the Census. Between March
1964 and March 1965, the latest period for which
data are available, almost 38,000,000 persons 1 year
of age or older moved within the country, and an
additional 1,000,000 came into the country from
abroad.
Most of the moves in recent years did not involve
long distances; about two thirds did not cross county
lines, and many may even have been from one dwell-
ing to another in the same community. The movers
who crossed county boundaries were almost equally
divided between those who went to a new home
within the same State and those who took up resi-
dence in a different State.
Mobility rates vary markedly with age. As would
be expected, people in their early twenties have the
highest rates for both short- and long-distance
moves. In the year ended March 1965, 45 per cent
of the people at ages 20-24 and about 36 per cent
of those at ages 25-29 changed residence.
Moreover, unlike the experience for the other age
groups, more people in their twenties moved from
one State to another than to a different county in
the same State. Among the factors contributing to
the high mobility of young adults are employment
away from home, service with the Armed Forces,
marriage, and the expanding needs of a growing
family. — Metropolitan Life.
Cincinnati Physician Is Recipient
Of National Pediatrics Award
A. Ashley Weech, M. D., Cincinnati, is 1966-67
recipient of the Abraham Jacobi Award in Pediatrics.
The Jacobi Award of one thousand dollars and a
certificate is given by the Section on Pediatrics of
the American Medical Association. Established in
1962, it was created in tribute to Abraham Jacob',
founder of the first American pediatric clinic in I860
and often called the father of pediatrics in this
country. The award is made possible by a grant from
the Gerber Baby Fund of Fremont, Michigan.
Dr. Weech will receive the award and present
the Abraham Jacobi Award Address before the Sec-
tion on Pediatrics at the AMA Annual Convention
in Atlantic City, June, 1967.
Dr. Weech is currently B. K. Rachford Emeritus
professor of pediatrics, University of Cincinnati.
Since 1963, he has been editor-in-chief of the
American Journal of Diseases of Children, a specialty
journal published by the AMA.
Harding Hospital
(Formerly Harding Sanitarium)
WORTHINGTON, OHIO
For the Diagnosis and Treatment of Psychiatric Disorders
and with
Limited Facilities for the Aging
GEORGE T. HARDING, M. D. JAMES L. HAGLE, M. B. A.
Medical Director Administrator
Phone: Columbus 885 - 5381
(Area Code: 614)
for September, 1966
865
What'll we do
to help you plan
and implement
an acute coronary ward?
Everything but build the equipment.
We're consultants, not a manufac-
turer. We'll analyze both your
present and long range technical
and economic requirements for
automation. We'll impartially report
on bio-engineering instrumentation,
diagnostic tools and other equip-
ment. If you already have proposals
from computer system manufac-
turers, we'll gladly evaluate them
7500 Old
objectively and offer our recom-
mendations.
Then, at your request, we'll de-
sign an intensive care unit or acute
coronary ward that precisely
matches your needs. We'll even
work with the architect to be sure
the system is expandable at mini-
mum expense. And then we'll direct
its installation.
Xenia Pike/Dayton,
Finally, we'll work very closely
with your personnel. Train them
in proper procedure for flawless
operation of the system. For more
information, contact Mr. B. A. Fried-
man, Manager, Information Systems.
Ask for a copy of “The Physician's
Logical Approach to Acute Coronary
Wards."
Ohio 45432/Phone 513-426-3111
/ Data\
1 corporation /
866
The Ohio State Medical Journal
Establish and
maintain early,
more decisive
control of
blood pressure
DIITTENSEN:B
Cryptenamine 1.0 mg.* Methyclothiazide 2.5 mg. Reserpine 0.1 mg.
When blood pressure won’t stay down despite initial therapy—
when complaints of headache, fatigue or dizziness are often voiced—
it may be time for a change to Diutensen-R.
Diutensen-R is thiazide and reserpine plus cryptenamine— a rational,
comprehensive therapy to help establish and maintain early,
more decisive control of blood pressure.
The cryptenamine in Diutensen-R helps improve normal vasodilating
reflexes while the thiazide and reserpine components maintain
vasorelaxant, sedative, and saluretic benefits. Cryptenamine lowers
pressoreceptor reflex thresholds (which may be abnormally high in
hypertension)— “resets" pressoreceptors to function at more nearly
normotensive levels.
Early, more decisive control with Diutensen-R helps secure
continuing benefits — may reduce or even obviate the need for poorly
tolerated drugs later in therapy.
"...quite apart from the problem of vascular damage, there
arises a possibility of virtual ‘cure’ or remission of hypertension
when treatment is early, i.e., before too many other secondary
pressor systems have entered into the disequilibrium of pressor con-
trol, and when it is adequately suppressive.”
Corcoran, A. C.: The choice of drugs in the treatment of hypertension. In: Drugs
of Choice 1966-67, W. Modell, Ed., St. Louis, C. V. Mosby Company, 1966, p. 417,
Indications: Diutensen-R may be employed in all grades of essential hypertension.
Dosages: Usual dose is 1 tablet twice daily, at morning and evening meals.
However, adjustment of dosage to suit individual circumstances may be
required. Please refer to package insert for full particulars. Side effects and
precautions: The side effects observed with patients on Diutensen-R have
been of a mild and nonlimiting nature. These include occasional urinary frequency,
nocturia, nasal congestion, muscle cramps, skin rash, joint pains due to gout
symptoms and nausea and dizziness which have been reported for the individual
components. Most of these symptoms disappear while the drug is continued at
the same or lower dosage level. The concomitant use of digitalis and Diutensen-R
may increase the possibility of digitalis-like intoxication. If there is
evidence of myocardial irritability (extrasystoles, bigeminy or AV block), dosage
of Diutensen-R should be reduced or discontinued. Nocturia in patients
with marginal cardiac status and salt and fluid retention can be effectively
controlled by limiting the time of administration to early afternoon.
Diutensen-R should not be used in patients with a known intolerance to reserpine.
Package inserts furnish a complete summary of recommended cautions related to
each of the ingredients of Diutensen-R.
*As tannate salts equivalent to 130 Carotid Sinus Reflex Units.
NEISLER HfpSI
NEISLER LABORATORIES, INC. • DECATUR, ILLINOIS
SUBSIDIARY OF UNION CARBIDE CORPORATION
Current Comments in the Field
Of the Drug Manufacturers
The following excerpts of comments from various
sources are presented in behalf of the Pharmaceutical
Manufacturers Association and drug manufacturing
firms in general.
* * *
Government, the physician, and the pharmaceutical
industry must join forces to reduce injury from ad-
verse drug reactions. It is industry’s responsibility to
continue with the development of safer and more ef-
fective drugs. It is the responsibility of the physi-
cian to use drugs with discretion and to abstain from
using potent and hazardous drugs for trivial condi-
tions. It is the government’s responsibility, with its
virtually unlimited funds and resources, to continu-
ously review and survey adverse experience gained
with drugs from all sources and to bring these facts
before physicians preferably through already organ-
ized channels of medical communication. The gov-
ernment further has a responsibility to remove overly
hazardous drugs from the market when usefulness
does not balance off against hazard, but it must not
use this authority in an arbitrary and capricious man-
ner. The evaluation of drugs for safety is a most
difficult and complex matter, and no simple formula
can be devised to arrive at a conclusive opinion. —
Joseph F. Sadusk, Jr., M. D., to American College
of Physicians, New York, April 19, 1966.
* * *
There is much to be gained in most instances by
labeling the nature of the medication. Patients are
bombarded on all sides by medical information; their
approach to medical care is much more sophisticated
than that of their parents. The growth of effective
pharmaceutical agents has been such that three or
four types of medication may be indicated for the
management of a single problem. Labeling pro-
motes better medical care rather than detracting from
it. Labeling also promotes more effective communi-
cation between the patient and the physician. — E.
Clinton Texter, Jr., M. D., Illinois Medical Journal.
* * *
The problems and responsibilities of government in
assuring the safe use of dmgs are indeed formidable.
. . . This brings up the whole questions of efficacy and
of relative efficacy; and who is going to dogmatize on
this ? Again, who is going to say that the occasional
fatal toxic reactions which may result, for instance,
from the use of psychotrophic drugs in depressive
illnesses are or are not greater than the danger of an
increased incidence of suicide if such drugs are for-
bidden. Doubtless a committee of experts will ad-
vise the appropriate Ministers, and if experts are oc-
casionally wrong they are less often wrong than non-
experts. Nevertheless, we interfere with the prescrib-
ing doctor’s final freedom of decision at our peril in a
free democracy. It is easy to set up a sort of ponti-
ficial therapeutic Establishment; but Establishments —
Aristotle and Galen, for instance — have not always
been in the van of progress. — Sir Derrick Dunlop,
M. D., in British Medical Journal.
Clevelander Heads Board of Regents
Of American Chest Physicians
Dr. Howard Van Ordstrand, Cleveland, was named
chairman of the Board of Regents of the American
College of Chest Physicians at the recent 32nd annual
meeting of the group in Chicago. Headquarters of
the organization is at 112 East Chestnut Street in
Chicago.
The following physicians of Ohio were admitted
as Fellows in the college:
Ray W. Gifford, Jr., Cleveland; Norman E. Goul-
der, Columbus; Deane Hillsman, Cleveland; Paul
Kezdi, Kettering; R. Gilbert Mannino, Newark;
Philip C. Pratt, Columbus; Elias Saadi, Youngstown;
G. Douglas Talbott, Kettering; and Glen B. Van
Atta, Kenton.
GROUP LIFE INSURANCE
Initiated and Sponsored by
Your OHIO STATE MEDICAL ASSOCIATION
For Information, Call Or Write
TURNER X SHEPARD, inc,
insurance
20 SOUTH THIRD STREET COLUMBUS, OHIO 43215 PHONE 228-6115 CODE 614
870
The Ohio State Medical Journal
The human spine is not engineered for
prolonged sitting at desks, pianos, type-
writers and drafting boards. The stresses
set up by the heavy, forward-tilted head
and trunk, balanced precariously on an
insufficient base, result in strain of the
dorsal musculature, particularly at the
low lumbar level.
The unusual muscle-relaxant and anal-
gesic properties of ' Soma ’ make it espe-
cially useful in the treatment of low back
sprains and strains. ‘Soma’ is widely
prescribed □ to relieve pain □ to relax
muscles □ to restore mobility.
Indications: ‘Soma’ is useful for management of
muscle spasm, pain, and stiffness in a variety of
inflammatory, traumatic, and degenerative muscu-
loskeletal conditions. It also may act to normalize
motor activity in certain neurologic disturbances.
Contraindications: Allergic or idiosyncratic reac-
tions to carisoprodol.
Precautions: ‘Soma’, like other central nervous
system depressants, should be used with caution
in patients with known propensity for taking ex-
cessive quantities of drugs and in patients with
known sensitivity to compounds of similar chemi-
cal structure, e.g., meprobamate.
Side Effects: The only side effect reported with any
frequency is sleepiness, usually on higher than
recommended doses. An occasional patient may
not tolerate carisoprodol because of an individual
reaction, such as a sensation of weakness. Other
rarely observed reactions have included dizziness,
ataxia, tremor, agitation, irritability, headache, in-
crease in eosinophil count, flushing of face, and
gastrointestinal symptoms.
One instance each of pancytopenia and leuko-
penia, occurring when carisoprodol was admin-
istered with other drugs, has been reported, as has
an instance of fixed drug eruption with carisoprodol
and subsequent cross reaction to meprobamate.
Rare allergic reactions, usually mild, have included
one case each of anaphylactoid reaction with mild
shock and angioneurotic edema with respiratory
difficulty, both reversed with appropriate therapy.
In cases of allergic or hypersensitivity reactions,
carisoprodol should be discontinued and appropri-
ate therapy initiated. Suicidal attempts may pro-
duce coma and/or mild shock and respiratory
depression.
Dosage: Usual adult dose is one 350 mg. tablet
three times daily and at bedtime.
Supplied: Two Strengths: 350 mg. white tablets
and 250 mg. orange, two-piece capsules.
Before prescribing, consult package circular.
for the relief
of low back
sprains and strains
SOMA
(CARISOPRODOL)
4$?> Wallace Laboratories, Cranbury, N.J.
AAr« 26soij
Related Factors in Increasing
Motorscooter Accidents
With more people being killed on motorcycles,
motorbikes, or motorscooters, statisticians of the Met-
ropolitan Life Insurance Company give some inter-
esting data on this subject.
Deaths rose from 700 in 1961 to more than 1,100
in 1964 — a 60 per cent increase.
In a substantial majority of the fatal accidents, the
operators were committing traffic violations. Reckless
driving is a major cause of accidents.
Nine tenths of the motorcycle, motorbike or motor-
scooter accidents occur when driving conditions are
termed "good.”
About one tenth of those killed in these accidents
are female.
The number of registered motor-driven cycles rose
from 596,000 in 1961 to 985,000 in 1964 to nearly
1,288,000 in 1965.
Overturning, running off the road, and other non-
collision accidents are responsible for nearly one third
of the cycle fatalities.
Deaths per 100,000 vehicles decreased from 118
to 115 between 1961 and 1964. The death toll
high for the past ten years was 162 per 100,000
in 1957.
New Members . . .
Following are names of new members of the Ohio
State Medical Association certified to the Headquar-
ters Office during July. List shows name of physi-
cian, county and city in which he is practicing, or
temporary addresses for those taking graduate work:
Cuyahoga
Bolivar Albainy, Cleveland
Leslie Yu-Lin Cheng,
Cleveland
Juan J. Cruz, Wickliffe
William S. Jana, Cleveland
Mario C. Jones, Cleveland
George Stan, Jr., Cleveland
Despina B. Vidalis, Cleveland
Robert S. Yurick, Cleveland
Defiance
Herman W. Reas, Defiance
Franklin
Richard E. Brashear,
Columbus
Kenneth N. Carpenter, Dublin
Robert Levine, Columbus
Lowell C. Meckler, Columbus
Stephen Miklosik, Grove City
George W. Waylonis,
Columbus
Hamilton
David S. Hill, Cincinnati
Harold B. Spitz, Cincinnati
Richard L. Swarm, Cincinnati
Jefferson
Patrick K. Arakawa,
Tiltonville
Fernando J. Manalac,
Steubenville
Paul N. Mastros, Amsterdam
Lucas
Pedro L. Jimenez, Toledo
Harris M. Kenner, Toledo
Muskingum
Richard K. Goodrich,
Zanesville
James I. Mackall, Zanesville
Summit
Thomas R. Hathaway, Akron
Clifford L. Kauffman, Akron
Luther H. Robinson, Jr.,
Akron
Constantine C. Roussi, Akron
Russell L. Thomas, Akron
The problems of the facially disfigured — psycho-
logical, social and economic, as well as physical ■ —
will be studied at the New York University Medical
Center under a Federal grant of $100,000.
Ohio Physicians Help Establish
Virus Classification System
Two Ohio State University College of Medicine
faculty members are part of a scientific team which
has advanced a new international system for classify-
ing rhinovimses.
Dr. Vincent Hamparian and Dr. Robert Conant,
both also on the staff of Children’s Flospital in
Columbus, are principal contractors in a program to
clarify the field for research projects involving the
rhinoviruses.
A worldwide invitation was issued in 1965 for
scientists to submit candidate strains to the typing
center in Columbus. Each of 69 strains entered in the
program was tested against antiserum. A Committee
from the National Institutes of Health reviewed and
accepted test data which established 55 distinct types
of rhinoviruses.
The classification system sponsored by the National
Institute of Allergy and Infectious Diseases, Vaccine
Development Branch, was scheduled to be considered
by the Ninth International Congress of Microbiology
held in Moscow, July 24-30.
VA Hospitals Are Now Providing
More Beds for Nursing Care
As of June 24 more than 2,000 nursing care beds
were available in 36 Veterans Administrations hos-
pitals in 27 states. A spokesman for the VA said
that the program would help relieve the problems
which have arisen because of the influx of older
veterans to VA hospitals.
The new program was approved by Congress in
August, 1964 with additional legislation passed in
1965 enabling the activation and operation of 4,000
nursing care beds. The entire 4,000 beds are ex-
pected to be in operation by June of 1967.
Since the beginning of the program in July, 1965,
the VA has admitted 2,372 patients and provided
them with more than 400,000 days of nursing care.
(These figures were given as of July, 1966.) The
turnover rate is seven per cent monthly. Other pro-
visions of the legislation enable senior veterans to
be assigned to approved private nursing homes for
extended care.
According to the announcement, two Ohio area
VA hospitals have been allocated nursing care beds:
84 beds for the Dayton hospital, and 201 beds for
the Fort Thomas, Ky., hospital in the Cincinnati
area.
"The Changing World of Medical Communica-
tion” will be the theme of the American Medical
Writers’ Association annual meeting at the Waldorf
Astoria, New York City, Thursday, September 29
through Sunday, October 2. Details may be obtained
from the national office, 2000 P Street, N. W.,
Washington, D. C. 20036.
874
The Ohio State Medical Journal
INDOCIN
INDOMETHACIN
Indications: Chronic and acute rheumatoid arthritis,
rheumatoid (ankylosing) spondylitis, degenerative
joint disease (osteoarthritis) of the hip, and gout.
Contraindications: Active peptic ulcer, gastritis,
regional enteritis, or ulcerative colitis. Safety in
pregnancy has not been established. Not recom-
mended for pediatric age groups.
Warning: Patients who experience dizziness, light-
headedness, or feelings of detachment on
INDOCIN should be cautioned against operating
motor vehicles, machinery, climbing ladders, etc.
Use cautiously in patients with psychiatric dis-
turbances, epilepsy, or parkinsonism.
Precautions and Adverse Reactions: Most com-
monly, headache, dizziness, lightheadedness, G.l.
disturbances. The C.N.S. effects are often tran-
sient and frequently disappear with continued
treatment or reduced dosage. The severity of these
effects may occasionally require cessation of
therapy. G.l. effects may be minimized by giving
the drug with food or with antacids or immedi-
ately after meals. Ulceration of the stomach, duo-
denum, or small intestine has been reported and,
in a few instances, severe bleeding with perfora-
tion and death. Gastrointestinal bleeding with no
obvious ulcer formation has also been noted;
INDOCIN should be discontinued if G.l. bleeding
occurs. As a result of G.l. bleeding, some patients
may manifest anemia, and for this reason periodic
hemoglobin determinations are recommended.
Rare reports of effects not definitely known to
be attributable to INDOCIN include bleeding from
the sigmoid colon (either from a diverticulum or
without a known previous pathologic condition),
perforation of preexisting sigmoid lesions (di-
verticulum, carcinoma), and hematuria. In other
rare cases, a diagnosis of gastritis has been made
while the drug was being given. One patient de-
veloped ulcerative colitis, and another, regional
ileitis, while receiving INDOCIN; when the drug
was given to patients with preexisting ulcerative
colitis, there was an increase in abdominal pain.
Infrequently observed side effects may include
drowsiness, tinnitus, mental confusion, depression
and other psychic disturbances, blurred vision,
stomatitis, pruritus, edema, and hypersensitivity
reactions. Slight BUN elevation, usually transient,
has been seen in some patients, although the pre-
ponderance of evidence indicates that INDOCIN
does not adversely affect renal function, even in
patients with preexisting renal disease. Neverthe-
less, renal function should be checked periodically
in patients on long-term therapy. Leukopenia has
been seen in a few patients. Transient elevations in
alkaline phosphatase, cephalin-cholesterol floccu-
lation, and thymol turbidity tests have been ob-
served in some patients and, rarely, elevations of
SGOT values; the relationship of these changes to
the drug, if any, has not been established. As with
any new drug, patients should be followed carefully
to detect unusual manifestations of drug sensitivity.
Before prescribing or administering, read prod-
uct circular with package or available on request.
for September , 1966
Editorial
Cornpicker’s Pupil
We all know that anticholinergics cause mydriasis,
most of us know that stramonium is an anticholiner-
gic, some of us know that jimson weed produces
stramonium, and a few of us know that cornfields
may contain jimson weed. Elsewhere in The Jour-
nal (page 921) is a short clinical note in which Drs.
James A. Goldey, Dover A. Dick, and William L.
Porter put all of these facts together to explain a
patient’s puzzling complaint. Following is additional
comment on this subject, which we solicited from
Dr. William H. Havener, Professor of Ophthal-
mology, Ohio State University.
"Cycloplegia from accidental ocular contamination
by parasympatholytic drugs may affect agricultural
workers, medical personnel, or individuals unsophis-
ticated enough to 'try a friend’s good eye drops.’ We
occasionally see it, for example, in nurses, who con-
taminate their eyes after handling atropine.
"The differential diagnosis from neurologic dis-
orders causing dilatation of the pupil should not be
difficult. The presenting complaint of the cyclo-
plegic patients is visual difficulty of sudden onset,
specifically inability to read. Ordinarily the dilated
pupil of a neurologic patient is an asymptomatic
physical finding rather than a complaint. Further-
more, other evidence of third nerve paresis or cranial
nerve disorders will ordinarily accompany neuropar-
alytic mydriasis. The clue, then, is that the cyclo-
plegic patient notices the dilated pupil and complains
about it, while the neurologic patient usually does not.
"Some general observations may be appropriate.
The possibility of medical or toxic origin of symp-
toms or physical findings should be seriously con-
sidered in differential diagnosis. Basic pharmacologic
knowledge will immediately indicate what categories
of drugs might cause given symptoms. Embarking
upon extensive and expensive examinations on the
basis of an isolated and relatively minor finding of
acute and short duration is unwise. Many such prob-
lems vanish with a few days’ wait, without explan-
ation and never return. Should consultation be
desirable, an appropriate specialist should be chosen.
Primarily ocular complaints are more likely to indicate
ophthalmologic evaluation and care than neurosurgical.
"The authors of 'Cornpicker’s Pupil’ are to be
commended for presenting a succinct, dramatic, con-
vincing, and definitive article.”
The Ohio State University College of Medicine
has been awarded a $49,322 grant from the U. S.
Public Health Service, Bureau of State Services, to
support a one-year project of identifying nursing ac-
tion in the care of postoperative cardiac patients.
877
new from Ames
5 basic uro-analytical
£ facts in 30 seconds
ill
Labstix I
BRAND REAGENT STRIPS
...broadest urine screening possible from
a single reagent strip
Urine test results with Labstix Reagent Strips can represent
significant guides to differential diagnosis or therapy in many
conditions. An unexpected “positive” may enable you to detect
hidden pathology — long before more recognizable symptoms
become evident. Negative results, which permit you to rule out
abnormalities in a broad clinical range, can serve as baseline
values for reference in future examinations. The 5 colorimetric
test areas encompassed on Labstix Reagent Strips are:
pH —values are read numerically in the essential range
of pH 5 to pH 9.
Protein— results are read either in the “plus” system or in
mg. % in amounts approximating “trace,” 30, 100, 300, and over
1000 mg. %.
Glucose — provides a “Yes-or-No” answer for urine “sugar spill.”
Ketones— detects ketone bodies in urine — both acetoacetic
acid and acetone. Reacts with as little as 5 to 10 mg. %
of acetoacetic acid.
Occult Blood— specific test for intact red cells, hemoglobin or
myoglobin. Results are read as negative, small, moderate or large
amounts.
Now a Clear Reagent Strip of Firm Construction
...facilitates handling during testing procedure. Excellent color
contrast made possible by the clear plastic strip, together with the
clearly defined color charts provided, permits precise, reproducible
colorimetric readings in all 5 test areas. A more definitive inter-
pretation of uro-analytical facts is made possible.
Available: Labstix Reagent Strips, bottles of 100
are supplied with each bottle).
Ames Company, Inc., Elkhart, Indiana
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(color charts
AMES
'
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incisive
A good way to describe ‘Stelazine’.
It’s different from the tranquilizers
that sedate and dull your anxious
patients. Its antianxiety effect is
direct. On ‘Stelazine’, your patients
can be calmed yet remain alert.
And ‘Stelazine’ offers additional bene-
fits. Dependence has not been re-
ported. At low doses, side effects are
minimal. Its b.i.d. dosage is con-
venient and economical.
Stelazine®
brand of trifluoperazine
The following is a brief precautionary statement. Before prescribing, the physician should be familiar with the complete
prescribing information in SK&F literature or PDR. Contraindications: Comatose or greatly depressed states due to C.N.S.
depressants and in cases of existing blood dyscrasias, bone marrow depression and liver damage. Precautions: Use with
caution in angina patients and in patients with impaired cardiovascular systems. Antiemetic effect may mask symptoms
of other disorders. An additive depressant effect is possible when used with other C.N.S. depressants. Prolonged adminis-
tration of high doses may result in accumulative effects with severe C.N.S. or vasomotor symptoms. Use in pregnant patients
only when necessary for the patient's welfare. Side Effects: Occasional cases of mild drowsiness, dizziness, mild skin
reactions, dry mouth, insomnia and amenorrhea. Neuromuscular (extrapyramidal) reactions (motor restlessness, dystonias,
pseudo-parkinsonism) may occur and, in rare instances, may persist. In addition, muscular weakness, anorexia, rash,
lactation, hypotension, and blurred vision have been observed. Blood dyscrasias and cholestatic jaundice have been
extremely rare.
For a comprehensive presentation of 'Stelazine' prescribing information and side effects reported with phenothiazine
derivatives, please refer to SK&F literature or PDR.
Smith Kline & French Laboratories, Philadelphia
September, 1966
879
The Historian’s Notebook
Health Officers of Cincinnati, Ohio
And the Problems of Their Day
1900 to 1960
KENNETH I. E. MACLEOD, M. D., M. P. H.*
PART III
( Continued From August Issue )
School Health: 1913
THERE were 112 public and parochial schools
served by the school health service which was
staffed by the Chief School Medical Officer with
two district physicians employed full time, and five
part-time physicians. A Chief Dental Inspector was
also employed full time, four dentists part-time, and
two full-time dental assistants. There were 14 school
nurses with an average of 2,400 pupils per nurse. The
Free Dental Clinic was operated at a cost of $4,500
in salaries. The money for equipment ($1,690) was
obtained privately.
1914
In 1914 the population of the city was 402,175
and the total deaths numbered 6,429 (mortality
rate 15.98). The infant death rate under one year
was 92.6 per thousand births reported and was
stated as "one of the lowest in the country.” Also,
"our diarrheal death rate in infants under two years
of age has fallen from 103 per 100,000 population
in 1910 to 54 in 1914 and is one of the lowest in
the country.”
But the tuberculosis problem was still significant
with a death rate at ”278 per 100,000 for the five-
year period preceding 1910; and for the five years
following 1910 — 254. During 1914 it was 240.”
Disease Prevention
But on the credit side of the ledger, Dr. Landis
notes that
Cincinnati’s low death rate from typhoid fever since the
completion of the filtration plant late in 1907, has led to
a partial investigation of vital statistics for the purpose of
determining, if possible, the truth of Hazen’s Theorem.
Briefly this theorem is that one life saved from death by
typhoid through an improved water supply means the saving
of from two to five more from general causes.
Thus we note in the following tables these im-
provements :
1905-1907: Before filtration of Water Supply.
The death rate per 100,000 from diarrheal
*Dr. Macleod, Gncinnati, is Commissioner of Health, City of
Cincinnati.
Submitted March 16, 1966.
diseases in infants under two years, including
inanition and convulsions 133
1908-1910: After filtration 98
1911-1913: After efficient milk inspection 76
Health of Negroes
But Dr. Landis deplores the excessive mortality
among Negroes, which
in proportion to their population have three times as many
children stillborn, twice as many born alive die during the
first year of life, nearly five times as many die of tubercu-
losis, four and one-half times as many of syphilis, over twice
as many from alcoholism, etc. Their general death rate
(1913) is a little in excess of 1,005 greater than in the
white race. An investigation is now under way to deter-
mine, if possible, the reasons why this condition exists; to
include sanitary conditions in the home, character of em-
ployment, rate of wage, cost of rental, etc.
Sundry Items
The efficacy of terminal disinfection by fumigation
is now under suspicion and extensive experiments are
being carried on in New York City for the purpose
of determining definitely whether or not disinfection
by fumigation possesses any real value . . . (1914)
The work of the Cincinnati Dental Society in the tubercu-
losis hospital demonstrated that the nutrition of a large num-
ber of patients was seriously interfered with because of bad
conditions of their teeth. It is my belief that a nursing force
of 15 for work among our tuberculosis poor and provisions
for dental care would more than compensate for the addi-
tional outlay . . . (1914)
As a public health movement, the Better Babies Contest
held in Cincinnati on June 25 and 26 was eminently suc-
cessful. 320 babies were entered. (1914)
247 cases were referred to the nurse employed by the Cin-
cinnati Association for the Welfare of the Blind . . . (1914)
Education in Health and
Work Certificates
Forty-five students were enrolled in a course which in-
cludes practical experience in the field demonstrations and
routine work in the laboratory. The students were given
an opportunity to witness federal and municipal inspection
of animals slaughtered, etc.
Begun some six or seven years ago, school medical inspec-
tion met the hostility which seems to be everlying in wait
for anything in the way of departure from "custom and
tradition’s hopeless rut.” Opposition came from a few of
the older principals and teachers and from a limited num-
880
The Ohio State Medical Journal
ber of physicians and parents. With medical inspectors "on
full time” and not permitted to do a private business, the
chief objection from the medical profession has been elimi-
nated. The score of our work has been extended until now
it includes 115 public and parochial schools. 3,777 children
were inoculated against smallpox. Comprehensive exami-
nations of school children were conducted. 17,657 defects
were diagnosed. The number of children needing treatment
was 16,581 . . .
In accordance with Section 2766 (Laws of Ohio, 1913)
the district physicians examined 1,166 applicants for child
work certificates. Light work was recommended for six
children who were deformed or handicapped by organic
lesions . . .
In January the Department of Health undertook for the
Board of Education a course in elementary hygiene and the
care of the sick for A grade girls of the Woodward High
School. The 15 lessons took up 30 hours of school time
over a period of 19 weeks. The girls were taught how to
appoint a sickroom, etc.
Vital Statistics: 1915
The death rate in 1915 was 15.63 per 1,000 popu-
lation. The city’s population was 406,706. But the
death rate for the colored part of the population
(estimated to be 22,005) was 29.40. There were
7,804 births — a general birth rate of 19.19 per
1,000 population.
Tuberculosis Control
Dr. Landis writes with some satisfaction,
The intensive work of the past five years is having cumu-
lative effect enabling the city to break all previous records
along several lines, the lowest general death rate in history.
The tuberculosis death rate at the lowest point in many
years at 2.20 per 1,000 population. The infant mortality
down to 78 per 1,000 live births, and so on. The effect
of an improved milk supply on infant mortality (from 547
deaths in 1906 to 175 in 1915). Of course, in the interval
the population had risen from 345,230 to 406,706 persons.
In the laboratory over 1,000 more samples were examined.
The routine procedure for the diagnosis of diphtheria is
to make cultures on Loefler’s blood serum of the swabs
submitted. These cultures are incubated at 37.5 °C for from
8 to 16 hours. During the year 1,853 cultures were ex-
amined for diagnosis of diphtheria of which 458 were posi-
tive . . . Also, tubercle bacilli were found in 648 of 2,239
specimens of sputum examined. Some 900 agglutinations
were performed for Typhoid, Paratyphoid and Enteritis
infections ... 69 were positive, etc.
Dr. W. H. Peters: 1916-1934
In a "triennial” summary published in 1918, Dr.
Wm. H. Peters, the Health Commissioner writes:
In presenting a brief summary of the more important phases
of work performed under the leadership of the late lamented
Dr. Landis, we believe that the people of Cincinnati will
concur in our opinion that real progress has been made
commensurate with appropriations for public health pur-
poses. We regret that we have not been able because of
funds to publish annual reports for the last three years . . .
1. ... In discussing a program for the future, I should
like to stress particularly the need for increasing the medical
and nursing service so that we can furnish prenatal and
postnatal service and provide adequate dispensary service
for tuberculosis individuals and suspects, and give a little
more attention to the Negro health problem . . .
2. The number of inspectors in the division of Sanitation,
Food and Drugs should be increased and if we are to con-
tinue in the front rank, it is imperative that we create two
new divisions — one of Public Health Education and the
other of Industrial Hygiene and Occupational Diseases . . .
3. Needless to say that if we do these things there will
be a compensatory drop in the death rates . . .
4. There should be a well-organized campaign for the
control of cancer which is a common enemy of mankind.
Cure depends upon early diagnosis and treatment. One
woman out of every eight past the age of forty dies of
cancer. Drugs may relieve pain, but they do not remove
the cause. The only hope of cure lies in early surgical
removal.
5. The epidemic wave of infantile paralysis reached Cin-
cinnati in July, 1916, throwing the populace into a frenzy
of fear. It continued throughout the hot, dry and dusty
months. Children under 16 returning from infected centers
in the East were kept under observation. 10 sporadic
cases occurred in 1917 with no fatalities while 1918
showed an increase with 23 cases reported and 2 deaths.
6. Typhoid fever, with a death rate of 3.2 per 100,000
was the best record in the history of the Queen City.
7. We favor the more general application of the
Schick Test as an economic procedure in the control of
diphtheria . . .
8. The great prevalence and severity of whooping cough
in recent years led to the making of new quarantine regu-
lations requiring the placarding of homes and the wearing
of a band on the arm of the child afflicted . . .
9. The great white plague, tuberculosis, claimed in 1916
as its toll, 926 victims; in 1917, 952; and in 1918 there
were 940 fatalities.
The Influenza Pandemic
The great pandemic of influenza in its western flight
struck Cincinnati the last few days in September, 1918.
The first death occurred on October 1st. A most alarming
situation soon developed and became almost beyond control.
The Board of Health had wisely foreseen the gravity of
the epidemic and measures were promptly taken a week in
advance of other cities to combat the scourge. Being fore-
armed with a ban on all gatherings, the closing of theatres,
churches, schools, and the regulation and limitation of saloon
trade, the regulation of stores and shops for the prevention
of crowding, and variety of measures for the promotion of
individual and community hygiene, we were unquestion-
ably enabled to save many hundreds of lives. It is esti-
mated that there were about 100,000 cases with 1,688
deaths from October 1st to December 31st, 1918. In 1918
the mortality being 4.07 per 1000 population.
Gonorrheal Ophthalmia
160 cases of inflammation of the eyes of the newborn
were reported by midwives and physicians during the first
three years. Of this number 50 were pronounced "Gonor-
rheal Ophthalmia” ... In 18 no prophylactic had been
used at birth. Four children died under treatment. Loss
of the right eye in one case, left eye in two cases was
noted. 65 cases of trachoma, reported to the Department,
were followed up in order to instruct the patients as to
the proper prophylaxis in the home . . .
Child Hygiene
Under "child hygiene” in nine infant welfare centers milk
was provided for the poor through the Taft endowment
. . . A "Baby Week and Better Babies” contest was held
in 1916. The "Oyler Health Center” was the scene of
"intensive work” . . . notwithstanding the baleful influence
of the influenza epidemic which played such havoc in the
nineteenth ward.
(Continued in October Issue )
for September, 1966
883
C-14 AS MICROGRAMS NICOTINIC ACID PER LITER OF PLASMA
TIME AFTER ADMINISTRATION (Hours)
Human volunteer subjects were administered Geroni-
azol TT tablets with the nicotinic acid component
made radioactive with C-14. Plasma and urine sam-
ples were analyzed. (See Figures I and II) The radio-
active tracer study substantiated the previous clinical
evidence that the release of nicotinic acid from the
Geroniazol TT tablet produced a gradual rise in
plasma levels to a plateau for a total of 12 hours and
more.
Such proven sustained activity makes the manage-
ment of geriatric patients much easier by minimizing
the possibility of neglected doses through absent-
mindedness or senile confusion. Therapy can be con-
tinuous on a daily dose of only one Geroniazol TT tab-
let every 12 hours.
The gradual release of nicotinic acid in Geroniazol
TT will provide the well-known peripheral vasodilata-
tion needed in patients with deficient circulation and
with a minimum amount (if any) of “flushing.” Also,
cerebrovascular circulation is complemented by pen-
tylenetetrazol, long-established as a cerebral and res-
piratory stimulant.
Geroniazol TT improves the typical, unfortunate,
igns of senile confusion. Patients become more alert,
i
Ideal for geriatric patients
□ provides gentle, dependable overnight relief
□ offers aid in restoring normal bowel tonicity
and peristalsis
□ no griping or cramping; no added bulk
"In our experience, thiscombination/Modane/has been more
satisfactory in handling chronic constipation of senile
bedridden patients than most other laxatives ... a 93 per cent
response was obtained in a general hospital population.""
MODANE
the broad spectrum laxative
DANTHRON FOR RELIEF
Danthron in Modane acts selectively on the large bowel; its gentle
stimulation assures overnight relief of constipation.
PANTOTHENIC ACID FOR TONICITY AID
Pantothenic acid plays an important role in the formation of
acetylcholine. An adequate level of acetylcholine is necessary for
normal transmission of neural impulses to intestinal muscle.
one tablet daily with evening meal
Modane Tablets— 75 mg. danthron, 25 mg. d-calcium pantothenate.
Modane Mild Tablets— 37.5 mg. danthron, 12.5 mg. d calcium pantothenate.
Modane Liquid— 37.5 mg. danthron, 12.5 mg. d-calcium pantothenate per teaspoonful
(5 cc.). Dosage: One tablet, or palatable liquid dosage, with evening meal,
or as required by patients.
^Plotnick, M.: Int. Record of Med. 173:262, 1960.
WARREN-TEED PHARMACEUTICALS INC.
®COLUMBUS, OHIO 43215
SUBSIDIARY OF ROHM AND HAAS COMPANY
for September, 1966
887
What To Write For
Some booklets, pamphlets, and other published
materials available for the asking or at nominal ex-
pense and suitable for the physician’s office, library
or waiting room or for his personal information.
Report of the Committee on the Control of In-
fectious Diseases, or the "Red Book” of the Ameri-
can Academy of Pediatrics. This 15th edition of the
well-known report contains recommendations for im-
munization, and other procedures for infants and
children. $1.50 from the American Academy of
Pediatrics, 1801 Hinman Avenue, Evanston, Illinois
60204.
* * *
Current Procedual Terminology, 1st Edition; a
booklet containing a system of standard terms, pro-
visional eponyms, and descriptors developed for the
convenience of physicians and designated personnel
to expedite the reporting of therapeutic and diag-
nostic procedures of surgery and medicine. $2.00
in the U. S. Canada and Mexico; $1.50 for medical
students, interns and residents.
* * *
Identifying Problem Drinkers in a Household
Health Survey. Field procedures and analytical
techniques developed to measure the prevalence of
alcoholism. A good narrative description as well as
statistical data. USPHS Publication No. 1000 -
Series 2 - No. 16. For sale by the Superintendent of
Documents, U. S. Government Printing Office, Wash-
ington, D. C. 20402 — 35 cents.
* * ❖
Supply, Demand and Human Life. A leaflet di-
rected toward public support of the national cam-
paign to recruit additional volunteer blood donors,
in a joint effort supported by eight organizations in-
cluding the American Medical Association. Copies
available from the American Association of Blood
Banks, Central Office, Suite 1322, 30 North Michigan
Avenue, Chicago, Illinois 60602.
* * *
Nurse-Physician Collaboration Toward Improved
Patient Care. A report of the second national con-
ference of physicians and professional nurses held
September 30 - October 2, 1965, in Denver. Order
from Department of Nursing, American Medical
Association; $1.50 per copy.
* * *
A Doctor Talks to 5-to-8-Year-01ds. One of a
series of booklets to aid the physician in his talks
with patients. Write for list and details to the Bud-
long Press Company, 5428 N. Virginia Avenue,
Chicago, Illinois 60625.
For the treatment of
apathy
irritability
forgetfulness
confusion
in the aging patient
EACH CEREBRO-NICIN CAPSULE CONTAINS:
Pentamethylene Tetrazole 100 mg
Njcotinic Acid 100 mg
Ascorbic Acid 100 mg
Thiamine HCI . 25 mg
1-Glutamic Acid 50 mg
Niacinamide 5 mg
Riboflavin 2 mg
Pyridoxine 2 mg
DOSAGE: One capsule t.i.d. or as prescribed by physician
AVAILABLE: Bottles of 100, 500, 1000 capsules.
Also elixir pint bottles.
CONTRAINDICATIONS: There are no known contraindications
to Pentamethylene Tetrazole although caution should be exer-
cised when treating patients with a low convulsive threshold.
Most persons experience a flushing or tingling sensation
after taking a higher potency niacin-containing compound.
As a secondary reaction some will complain of nausea and
other sensations of discomfort. This reaction is transient and
is rarely a cause of discontinuance of the drug if the patient
forewarned to expect the reaction.
Federal law prohibits dispensing without a prescription.
CereAro-JiffcAr
A GENTLE CEREBRAL STIMULANT AND VASODILATOR
66% 66%
CEREBRO-NICIN® New double-blind study* shows how
effectively senility can be forestalled. Four times as
many aging patients showed striking improvement.
*A Double-Blind Study of Cerebro-Nicin, Therapy for the Geriatric Patient, R. Goldberg,
Jrnl. of the Amer. Ger. Soc., June, 1964.
Write for literature and samples . . .
THE BROWN PHARMACEUTICAL CO.
2500 W. Sixth Street,
Los Angeles, California 90057
REFER TO
888
The Ohio State Medical Journal
i
Butazolidiri alka
phenylbutazone, 100 mg.
dried aluminum hydroxide gel, 100 mg.
magnesium trisilicate, 150 mg.
homatropine methylbromide, 1.25 mg.
The trial period need not exceed 1 week. In
contrast, the recommended trial period for
indomethacin is at least 1 month.
That’s why it’s logical to start therapy with
Butazolidin alka— you’ll know quickly whether
or not it works. And usually, it will.
A large number of investigators have re-
ported major improvement in about 75% of
cases. Some patients have gone into remis-
sion. Relief of stiffness and pain may be
followed quickly by improved function and
resolution of other signs of inflammation. And
Butazolidin alka is well tolerated, especially
since it contains antacids and an antispas-
modic to minimize gastric upset.
Contraindications
Edema; danger of cardiac decompensation;
history or symptoms of peptic ulcer; renal,
hepatic or cardiac damage; history of drug
allergy; history of blood dyscrasia. Because
of the increased possibility of toxic reactions,
the drug should be used with greater care in
the elderly and should not be given when the
patient is senile or when other potent chemo-
therapeutic agents are given concurrently.
Large doses of Butazolidin alka are contra-
indicated in patients with glaucoma.
Warning
If coumarin-type anticoagulants are given
simultaneously, the physician should watch
for excessive increase in prothrombin time.
Usually works within 3 to 4 days
in osteoarthritis
Pyrazole compounds may potentiate the phar-
macologic action of sulfonylurea, sulfonamide-
type agents and insulin. Patients receiving
such concomitant therapy should be carefully
observed for this effect.
Use with caution in the first trimester of preg-
nancy.
Precautions
Before prescribing, the physician should ob-
tain a detailed history and perform a com-
plete physical and laboratory examination,
including a blood count. The patient should
be kept under close supervision and should
be warned to report immediately fever, sore
throat, or mouth lesions (symptoms of blood
dyscrasia); sudden weight gain (water re-
tention); skin reactions; black or tarry stools,
Regular blood counts should be made to
guard against blood dyscrasias.
Adverse Reactions
The most common adverse reactions are nau-
sea, edema and drug rash. Moderately lowered
red cell count may sometimes occur due to he-
modilution. The drug has been associated with
peptic ulcer and may reactivate a latent peptic
ulcer. Infrequently, agranulocytosis, exfoliative
dermatitis, Stevens-Johnson syndrome or a
generalized allergic reaction may occur and
require withdrawal of medication. Stomatitis,
salivary gland enlargement, vertigo or languor
may occur. Leukemia and leukemoid reactions
have been reported but cannot definitely be
attributed to the drug. Thrombocytopenic
purpura and aplastic anemia are also possible
side effects.
Confusional states, hyperglycemia, agitation,
headache, blurred vision, optic neuritis and
transient hearing loss have been reported, as
have hepatitis, jaundice and several cases of
anuria and hematuria. With long-term use,
reversible thyroid hyperplasia may occur
infrequently.
Dosage
The initial daily dosage in adults is 300-600
mg. daily in divided doses. In most instances,
400 mg. daily is sufficient. When improvement
occurs, dosage should be decreased to the
minimum effective level: this should not
exceed 400 mg. daily, and is often achieved
with only 100-200 mg. daily.
For complete details, please refer to full
prescribing information.
6509-V(B)
Also available: Butazolidin®, phenylbutazone
Tablets of 100 mg.
Geigy Pharmaceuticals
Division of Geigy Chemical Corporation
Ardsley, New York BU-3804R
Geigy
American College of Surgeons
To Convene on West Coast
The 52nd annual Clinical Congress of the Ameri-
can College of Surgeons, will be held in San Fran-
cisco, October 10-14.
Every phase of surgery will be presented during
the five-day program through 26 1 research-in-progress
reports, nine postgraduate courses, 42 panel discus-
sions in general surgery and surgical specialities, 107
medical films, 14 operative telecasts from Palo Alto-
Stanford Hospital, and 425 scientific and industrial
exhibits. Approximately 1,100 doctors will be partici-
pants in the program.
Details may be obtained from ACS at 55 E. Erie
St., Chicago, Illinois 606ll.
Malignant Tumors Studied
Dr. Dante G. Scarpelli, professor of pathology at
Ohio State University, is continuing an investigation
of aflatoxin and its relationship to cancer of the liver
in rainbow and brook trout, under a grant from the
National Institutes of Health.
Hatchery-raised rainbow trout have a high in-
cidence of liver tumors not ordinarily found in wild
trout. Grain is a component of the diet of hatchery-
raised fish, and aflatoxin is found in moldy grain.
Investigators Compile Collection
Of Papers on Berylliosis
An interesting collection of reprints of articles on
Beryllium poisoning by a Northern Ohio group of
investigators, has been bound in booklet form.
The original clinical research on the various acute
manifestations of Berylliosis was performed by the
group with a follow-up which has extended over 26
years. One of the investigators reports that the dis-
ease has been adequately controlled, but that the an-
swer has been elusive as to the method of its peculiar
selectivity and delayed manifestations, especially of
the chronic form.
Authors of the papers are: Morris G. Carmody,
M. D., medical director of Clifton Products, Paines-
ville; Joseph M. DeNardi, M. D., Lorain, senior in-
structor in Department of Medicine, Western Reserve
University; John Zielinski, f M. D., Lorain, medical
director of the Brush Beryllium Company; and the
following physicians of the Cleveland Clinic Educa-
tional Foundation: George Curtis, M. D., Department
of Dermatology; Robert Hughes, M. D., chief of the
Department of Radiology; Earl Netherton, M. D.,
emeritus consultant in dermatology; and H. S. Van-
Ordstrand, chairman of the Medical Division and
chief of the Department of Pulmonary Diseases.
Inquiries may be directed to Dr. DeNardi at 736
Broadway, Lorain.
tRecently Deceased
eruice
mam a
Professional Protection
since 7 899
Telephone: 513-751-0657
890
The Ohio State Medical Journal
American College of Physicians
Announces Regional Programs
The American College of Physicians has announced
its list of regional programs to be held in areas
throughout the nation from September through June
of 1967. Details about all of these meetings may be
obtained by writing the college at 4200 Pine Street,
Philadelphia, Pa. 19104.
Here are some of the programs in the immediate
vicinity of Ohio:
Regional meeting for Ohio, Western Pennsylvania,
and West Virginia; Morgantown, W. Va., January
20-21, 1967.
Michigan Regional meeting, Detroit, November
18-19.
In the category of postgraduate courses, the ACP
will sponsor a program at the University of Cincin-
nati College of Medicine, June 12-16, 1967, on the
topic, "Internal Medicine — Current Physiological
Concepts in Diagnosis and Treatment.’’
A course on "Fundamental Concepts of Gastro-
enterology” will be held at the University of Michi-
gan Medical Center, Ann Arbor, March 20-24.
A program on "Psychiatry for the Internist,” will
be given at Wayne State University School of Medi-
cine in Detroit, March 27-31.
Establish Training Program for
Obstetric Anesthesiology
What is reported to be the nation’s first regional
training center in obstetric anesthesiology is being
established at MacDonald House, maternity hospital
in Cleveland’s University Medical Center, it was an-
nounced by Dr. Douglas D. Bond, Dean of the
School of Medicine of Western Reserve University.
The program will be supported by a two and a
half year pilot training grant awarded to University
Hospitals of Cleveland and the WRU School of
Medicine by the Children’s Bureau of the Depart-
ment of Health, Education, and Welfare. Present
value of the grant is $234,000 through 1968, and
it is expected that the program will be extended
beyond that year.
The new center will provide physician specialists
six months of intensive training. An objective of
the program is to train at least eight physicians per
year to fill positions of directors of anesthesiology
for maternity hospitals.
The grant provides yearly stipends of $10,000 to
be paid to trainees who have had one or more years
of practice or postgraduate studies after residency.
Anesthesiologists or obstetricians who have completed
two years of residency will receive $8,000 per year.
Obstetric and anesthesiology centers of the United
States and Canada have been invited to nominate
trainees to the center.
31 w w ♦ Wfi* w w Established 1916
# Asheville, North Carolina
An institution for the diagnosis and treatment of psychiatric and neurological illnesses,
rest, convalescence, drug and alcohol habituation. There are ample facilities for classification
of patients
Insulin coma, electroshock, psychotherapy, occupational and recreational therapy are employed. The
hospital is equipped with complete laboratory facilities, including electroencephalography and x-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town in the beautiful Smoky
Mountain Range, an ideal location for rehabilitation.
WM. RAY GRIFFIN, Jr., M. D. MARK A. GRIFFIN, Sr., M. D.
ROBERT A. GRIFFIN, M. D. MARK A. GRIFFIN, Jr., M. D.
For rates and further information write APPALACHIAN HALL, Asheville, N. C.
for September, 1966
895
good reason
to select
Ilosone
Erythromycin Estolate
for bacterial
infections
two to four times
the therapeutic
activity of other
erythromycins
CONTRAINDICATIONS: Ilosone is contraindicated in patients with a known history of sensitivity
to this drug and in those with preexisting liver disease or dysfunction.
SIDE-EFFECTS: Even though Ilosone is the most active oral form of erythromycin, the incidence
of side-effects is low. Infrequent cases of drug idiosyncrasy, manifested by a form of intrahe-
patic cholestatic jaundice, have been reported. There have been no known fatal or definite resid-
ual effects. Gastro-intestinal disturbances not associated with hepatic effects are observed in a
small proportion of patients as a result of a local stimulating action of Ilosone on the alimentary
tract. Although allergic manifestations are uncommon with the use of erythromycin, there
have been occasional reports of urticaria, skin eruptions, and, on rare occasions, anaphylaxis.
DOSAGE: Children under 25 pounds— 5 mg. per pound of body weight every six hours. Children
25 to 50 pounds— 125 mg. every six hours. Adults and children over 50 pounds— 250 mg. every
six hours. For severe infections, these dosages may be doubled.
Available in Pulvules®, suspension, drops, and chewable tablets. Ilosone Chewable tablets
should be chewed or crushed and swallowed with water.
Additional information available to physicians upon request.
Eli Lilly and Company, Indianapolis, Indiana 46206.
600541
896
The Ohio State Medical Journal
Computers in Cardiology
A Look Toward the Future
G. DOUGLAS TALBOTT, M. D.
The Author
• Dr. Talbott, Kettering, is a Clinical Assistant
Professor of Medicine at the Ohio State University
and at the University of Indiana, a consultant in
medicine at the Veterans Administration Hospital,
and is on the staff of local hospitals.
THE roles of computers are assuming an increas-
ing importance in medicine and particularly
this seems to be true in the broad field of cardi-
ology. As one views numerous medical installations
of various disciplines and regards the world cardi-
ological literature, the roles of computers appear to
categorize themselves into patient care, basic research,
teaching, literature storage and retrieval, nutritional
research, and administration.
Monitoring
Patient care, as it pertains to cardiology, concerns
itself mainly with the monitoring of the acute medical
or surgical patient, although some emphasis should
be placed on the diagnostic and therapeutic implica-
tions of computers.
Substantial gains are being made in the moni-
toring field, which offer tremendous potential in the
care of the acute patient.1-7 While the author’s main
experience has been with the care of coronary patients,
there have been excellent facilities constructed and
substantial progress made with the postoperative pa-
tient undergoing surgery for vascular, congenital,
and degenerative disease.8-10
Whether the patient be medical or surgical, the
basic principles involved in monitoring are similar.
Heretofore measurements, whether physiological, bio-
chemical, electrophysiological, or hematological, have
From the Cox Coronary Heart Institute, 352 5 Southern Boulevard,
Kettering, Ohio.
Submitted January 3, 19 66.
been intermittent and sometimes random: blood pres-
sures read at intervals of 15 minutes to four hours,
blood counts once or twice a day, electrocardiograms
every 24 hours, pulses, temperature, and respiratory
rates every four hours, lactates and pyruvates once
daily, are time intervals commonly observed in daily
practice. Such procedures lead to empiric character-
ization, not only of the disease in general but also
of the particular stage of disease with which the
physician is currently dealing.
All physicians are aware that any acute cardiology
patient presents a swiftly changing condition, one
which may alter appreciably from minute to minute,
and certainly belies conclusions drawn from either
random or intermittent measurements. However, it is
manifestly impossible to take readings by conventional
methods on all the pertinent variables at intervals
frequent enough to delineate the successive steps in
a continuously dynamic state. If enough hands and
eyes could by some miracle be available to accomplish
that purpose, then the time required to record and
correlate the data would nullify the effort, insofar as
897
treatment is concerned. Fortunately, to free us from
such a dilemma, computers now exist. Microsecond
measurements of multiple variables can be made on
a continuous basis by process-control computer. Such
a computer confers three distinct benefits.
First, instantaneous information is available as
to the real-time or current status of the patient.11* 12
Such information can be displayed digitally, by
means of analogue-to-digital conversion, at the bed-
side (See Fig. 1). Thus it becomes possible to stand
at the foot of a patient’s bed and view readings of
his blood pressure, pulse, temperature, and respira-
tion as of the moment of observation. This informa-
tion is delivered through body and catheter sensors
in digital form (Fig. 2), and can be transmitted to
automatic typewriters to provide both permanent
nursing records and material for subsequent medical
study. Intermittent but frequent blood chemistry
studies and other physiological observations can al-
ready be made of blood withdrawn through arterial
and venous indwelling catheters. Eventually it will
be possible to do real-time monitoring of not only
the rate but also the rhythm and wave-form of the
heart’s activity. The point is that a process-control
computer allows both physician and nurse to have
precise knowledge of multiple physiological variables
in the acutely ill patient at any given moment. (See
Figs 3 and 4.)
The second major benefit of computer monitoring
is conferred by the double-checked alarm system.
A major source of difficulty in the mechanized unit
for intensive care, or in the coronary ward, is the
problem of false alarms. Time and again when a
very complex and expensive system is installed in a
coronary ward the alarm system virtually negates
the benefits of automation by its many false-positive
signals.
To interpose a process computer system between
the "stand alone” units and the patient provides two
advantageous checks : redundancy check and cross-
correlation check of multiple variables. An appar-
ently out-of-limit pulse rate, for example, would be
checked as follows. The pulse rate would be check-
ed repeatedly (redundantly) on a multisecond basis
to be sure that the alarm had not been actuated by
sensor stoppage, change in position, or such common
phenomena as coughing or sneezing. In our cur-
rently operating computer system at Cox Coronary
Heart Institute, where multiple measurements are
being made on many variables in normal subjects, at
4000 points an hour, we have found that false alarms
from such causes occur frequently, and can be com-
pensated for by redundancy checks. Cross-correla-
tion checks reveal the behavior of multiple physio-
logical variables, simultaneously. Such revelation al-
lows the physician to anticipate and possibly to
prevent cardiovascular disaster.13 Cross-correlation
checks are made on two bases: the on-line nursing
record shows simultaneous second-to-second varia-
tions in multiple variables, while the on-line graphs
reveal trends in the movement of those variables.
When a single variable, such as the pulse rate, is
out of bounds it is important to know what other
related variables are doing. If the pulse rate is
really out of limits, then other hemodynamic para-
meters should also be abnormal. A single variable
only briefly in alarm strongly suggests artifact. A
combination of variables out of limits generally her-
alds either shock, failure, or other cardiac catastrophe.
The sophistication of computer interface permits us
to make both repeated individual and multiple simul-
taneous observations so that we may more promptly
and accurately recognize true alarm and differentiate
it from false alarm.
The third benefit of computer monitoring lies in
the rapid accumulation and processing of massive data
from multiple measurements. Massive data has too
often been a curse rather than a blessing. A
thoughtful, well organized and sophisticated plan
pre-programmed for massive data processing must
first be formulated and propagated. If this is done,
one may pass from empiric characterization to gen-
eral and later to analytical characterization of a given
state, and thence into a quantitative description of
the disease entity. In our institution such a plan for
data processing has been evolved by our data team
over the last several years and thus far appears to be
satisfactory. Of course the latter steps in analytical
characterization are in their infancy, and require ad-
ditional time for their evaluation.
Diagnosis
The diagnostic use of computers in the interpreta-
tion of electrocardiograms has almost passed from
the research phase into the service phase, due to such
pioneers as Caceres, Pipberger, and others.14*28 Simi-
lar progress in routine and commonly used laboratory
studies has been accomplished by such workers as
Reeves, Ramelkamp, Maloney,29 and others.30 Pul-
monary function studies are already being computer-
ized by Graybiel’s group at Pensacola. While many
problems still need to be resolved, the future of com-
puters in interpretation of physiological measurements
seems assured.
More complex is the diagnostic use of computers
in the interpretation of such symptomology for the
identification of specific disease states, such as con-
genital heart disease.31- 33 Homer Warner’s early
work in this area has emphasized the importance and
potential of such an approach.34 Although its ini-
tial use may be in the field of teaching, eventually
a service function will be realized.
Therapy
Even more distant and perhaps more obscure are
the therapeutic implications of computers in cardiol-
ogy.35 Consider for example, the acute myocardial
infarction patient brought into the coronary ward in
898
The Ohio State Medical Journal
TEMP
TIME PAT 01 A SYS HR RR
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Fig.1. Automated nursing record.
for September, 1966
899
profound shock. Assuming that vasopressor agents
are the treatment of choice, most physicians have had
the experience of attempting to administer such
agents manually. The nurse taking frequent time-
logged cuff measurements, and the physician adjust-
ing the stopcock on the I. V. bottle by guess as to
the appropriate drip rate, inevitably combine to pro-
duce the "ping-pong” phenomenon of pressure over-
shoot and undershoot with its obviously undesirable
effects. Yet it is quite possible, with indwelling
arterial-pressure transducer and a servomechanism
involving pressure feedings through the computer,
to use a graded pump system to administer a vaso-
pressor in a much more quantitative and real-time
related fashion.36’ 37 Such a system is now possible
in our laboratory and, in the author’s judgment, will
ultimately replace the present unsatisfactory manual
method by virtue of its precision and physiological
soundness.
So we see that the computer has already demon-
strated its usefulness in many areas of cardiological
patient care and promises to give us still newer vistas
of improved survival and recovery.
Modeling and Simulation
A very important area of application of com-
puters in cardiology is in the "modeling” of physi-
ological systems and processes. A model, in this
sense, could be loosely defined as any mathematical
or physical analogy that is used to describe the im-
portant aspects of a system and to demonstrate how
these aspects are interrelated. For example, hydraulic
system models can be built that serve as a physical
analogy of some aspects of the circulatory system,
and mathematical equations can be developed that
describe such things as the dye-dilution process used
for measuring the cardiac output.38-45
As more complex physiological processes are stud-
ied, the equations which define their mathematical
models become too complex to be solved by manual
methods. Such models can, however, be defined by
running their equations on a computer which pro-
vides both solutions and outputs, such as the time
variation of the variables considered in the model.
Developing a model whose output will truly represent
the known physiological system is, in most cases, a
long process with much trial and error and many
reiterations before an acceptable solution is obtained.
Here again the computer gives us the capability to
run a model over and over again while making com-
plete changes in its structure, or while varying para-
meters to optimize a solution.
In all of this, we must not lose sight of the pri-
mary purpose of developing a model, which is to ob-
tain insight into the physiological process. The use
of computers and mathematical modeling is a means
of discovering quantitative relationships. Such rela-
tionships provide much more information than the
mere qualitative cause-and-effect relationships which
are so commonly sought in medicine today.
Trying to develop a model forces a degree of dis-
cipline and provides a method of organization in the
study of complex systems where there are many in-
terrelating and related factors. It provides a method
for developing and testing hypotheses in ways that
would be impossible when working with the actual
living system. As with any powerful analytical
tool, the use of the computer imposes much more
stringent requirements upon the medical researcher,
and creates more potential pitfalls, than the use of
more conventional procedures. Measurements and
observations must be much more precise, mathemati-
cal techniques must be much more sophisticated. The
maximum effective use of the computer will require
considerably more education in the physical and math-
ematical sciences than is presently provided to most
physicians. However, it is our feeling that the
surface has just been scratched and that the rewards
will be commensurate with the effort expended by
those willing to learn to use computer techniques in
medical research.
Nutritional Research
Analysis of individual nutritional histories and
the formulation of diets has assumed increasing im-
portance paralleling increasing knowledge of satu-
rated fats, sodium, carbohydrates, and total calorie
intake as related to cardiovascular disorders. Several
studies have shown the merit of computer control
for such analysis and formulation.46’ 50 Though a
long and tedious programming effort is required,
computer systems are now capable of rapidly break-
ing down a detailed individual dietary record to
determine basic food elements, minerals, and caloric
content. Such a system will eventually lend itself
to inquiry from a practicing physician. By means of
a diet history sheet he may be able to find out what
undesirable dietary habits his cardiological patient
possesses, without the presence of highly trained and
skilled nutritionists and dietitians. He then can begin
to formulate a desirable diet. One of the major
benefits of such a system is the identification of
hidden dietary sources of saturated fats and sodium,
as well as the rapid and accurate formulation of de-
sirable diets.
Literature Storage and Retrieval
Temporal restrictions do not allow detailed dis-
cussions of the significant and growing role of com-
puters in cardiological world literature.51’ 54 Suffice
to say that by means of computer it is now possible
to store and to selectively retrieve an almost unlimited
number of abstracts dealing with specific problems of
the heart and blood vessels. One such specific in-
quiry system for coronary disease has been developed
at Cox Coronary Heart Institute, and is described
in detail elsewhere. But whether the subject be
900
The Ohio State Medical Journal
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Fig. 2. High-speed computer measurement of multiple physiological variable.
for September, 1966
901
PROBABILITY DENSITY FUNCT
0050464 $DATE
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1 $ SYS
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0 + + + +0.03 + + +0.06 + + +0.09 + + +0.12 + + +0.15 + + +0.18 + + +0.21 + + +0.24 + + +
0 + + + +0.03 + + +0.06 + + +0.09 + + +0.12 + + +0.15 + + +0.18 + + +0.21 + + +0.24 + + +
0000090
4.6511627-04
0000091
2.3255813-04
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6.9767441-04
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4.6511627-04
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6.9767441-04
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9.3023255-04
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2.7906976-03
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Fig. 3. On-line computer graphing of systolic blood pressure.
902
The Ohio State Medical Journal
PLOT OF MONITORED DATA
0050464 $DATE 0000011 $RUN
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,+ ...10
Fig. 4.
Thirty second multiple variable computer-recall
record.
for September, 1966
903
vascular degenerative disease, congenital heart disease,
acquired valvular disease, or any of a host of other
cardiological disorders, computer systems can now be
programmed to store and retrieve authors, key words,
abstracts, and even complete documents. Original
document storage by computer techniques today is
wasteful, but retrieval through microphotographic
methods such as PCMI offered by National Cash Reg-
ister, or through the microcard offered by IBM, of-
fers a partial solution.
Systems such as this permit not only specific inquiry,
ie, retrieval of a set of specific abstracts in response
to a specific question, but also offer the advantage of
remote inquiry. Inquiry can be made from a distance
by use of remote output devices such as automatic
typewriters, which have output speed of 180 lines
per minute, or by cathode ray tubes. Visualization
of the material requested may be forthcoming in a
few minutes, although the inquiring physician may be
hundreds of miles from the computer center. The
main limitation of such systems today is not the
technology of the computer but the lack of medical
data-basis with pertinent abstracts translatable into
machine language. The future of such literature
specific inquiry systems is bright indeed in its promise
to practitioner, medical student, research physician,
and consultant.
Other Computer Applications
In addition to those mentioned there are diverse
other applications of the computer in cardiology.
The potentials of computers in the teaching field
have already been indicated by such investigators as
Warren and associates. Because of the computer’s
vast memory capacity and its ability for cross-correla-
tion, it is probable that in the future the computer
will be queried with an almost infinite number of
questions relating to specific symptoms, disease en-
tities, and syndromes. Medicine is not unique in that
it must await advances in both computer technology
and education of the public to realize this goal.
Several major industries and the corporations are
devoting large sums of money and much time in ad-
vancing such technology and in hastening such edu-
cation, for industry is confident of the computer’s
future.
Sophisticated machine-teaching and learning meth-
ods have the distinct advantage of removing the
limitations of both time and teaching-manpower for
a given student.55 Machine-teaching allows great
flexibility in rate of individual student-learning, and
potentially represents a mass memory bank superior
to any given individual’s retention and recall. Con-
sequently, individual students may set their own learn-
ing pace with the computers. Obviously it would be
a tragedy of concept if such learning was not sub-
jugated to the human teacher, and secondary to his
influence and wisdom.56
Computers in cardiology will have broad admin-
istrative capabilities.57 An example is maintenance
of patient records.58 61 Today, in a short period
of time a patient may successively enter four or five
different hospitals in any given city. Each hospital
starts a new chart in which earlier and often valuable
information from other hospitals obviously is not
included, and the distance-time factor does not allow
the current attending physician to be privy to such
material. At some future time, centralized computer
patient-record banks will be used with automatic
peripheral output devices at the individual hospitals.
Uniform record forms will be used in all member
hospitals. All of the accumulated medical informa-
tion on any given patient will be available to the
current physician. Before this can be realized many
problems must be solved: privileged communication,
doctor education, layman acceptance, and medical
agreement on a standardized record. Despite these
multiple difficulties, such central computer record-
control will eventually be available not only for
cardiological patients but for patients of nearly every
category.
Another example is in computerized drug control.
The manual stocking and distribution of all kinds
of drugs and therapeutic agents are not only clumsy
but often wasteful procedures. Furthermore procure-
ment of vitally needed dmgs is often delayed be-
cause the dmg inventory is not up to date. The De-
partment of Defense, and industries such as those
which supply parts to the automobile and the air-
plane manufacturers, have already utilized computers
to solve these problems in logistics. Medicine will
do likewise.
A third administrative use of computer is for
bookkeeping. It has already been demonstrated that
financial and administrative bookkeeping in the hos-
pital can be done more efficiently and more quickly
by computers.
Summary
In the cardiology of tomorrow, computers will
play an increasing role. Their worth to the patient
suffering from degenerative vascular disease has al-
ready been proven in many of the areas discussed,
but their accomplishments are dwarfed by their poten-
tial. Despite the enormous and intriguing possi-
bilities offered by the technology of machines it is
still important to remember that the course and
survival of the cardiological patient will forever de-
pend fundamentally on the human factor. How-
ever, computer and automated systems offer the physi-
cian an opportunity for greater sophistication in diag-
nostic and therapeutic techniques. Inevitably, better
patient care and longer survival will result.
3525 Southern Boulevard, Kettering, Ohio 45429.
References
References are available from the author.
904
The Ohio State Medical Journal
Resuscitation After
Cardiac Arrest
Case Report of Two Successful Resuscitations Four Years Apart
A. IAN G. DAVIDSON, M. B., Ch.M., F.R.C.S.(E.), and DAVID S. LEIGHNIN GER, M. D.
FOLLOWING is the report of two fatal heart
attacks occurring in the same patient at ages
69 and 73 years.
Case Report
The patient, a 69 year old white man complaining of
persistent chest pain, was seen by a cardiologist on Decem-
ber 12, 1959. An electrocardiogram at this time revealed
an old posterior myocardial infarct and the presence of pos-
sible digitalis intoxication accompanied by runs of parox-
ysmal atrial tachycardia. It was decided that the patient
should be hospitalized but, while in the admitting office of
University Hospitals, he collapsed and was immediately
taken to the nearby emergency room. Occasional respirations
were noted but no pulse could be felt. Mouth-to-mouth
breathing was started. An emergency thoracotomy was done
to permit direct massage of the heart.
The interval between collapse and the start of massage
was estimated at three to four minutes. Ventricular fibrilla-
tion was present. After endotracheal intubation the patient
was ventilated with 100 per cent oxygen. Despite poor
myocardial tone, a good circulation was maintained by hand
pumping. The heart was defib rillated by two 110 volt shocks
(A.C.). The blood pressure was then 130/90 mm. Hg. The
electrocardiogram showed frequent runs of ventricular tachy-
cardia. Procaine amide 300 mg. was given intravenously but
ventricular fibrillation recurred. This was reversed by another
countershock (110V) after a short period of hand pumping.
The heart beat then remained stable and the blood pressure
was satisfactory.
During the next few days, the patient gradually improved.
Mild left heart failure responded to therapy, and he was
discharged home five weeks after admission. He continued
to take digitalis, quinidine, and a low salt diet.
During the next four years, he remained well and fully
mobile. At no time was he in cardiac failure nor did he
complain of anginal pain. When seen by his practitioner in
January 1964, he had no complaints and was enjoying his
retirement. Electrocardiogram revealed evidence of old an-
terior and posterior myocardial infarction and left ventricular
strain. Blood pressure was 130/70 mm. Hg.
On February 27, 1964, while in a taxicab, the patient
collapsed without warning. His wife urged the taxi driver
to go to the nearest hospital as quickly as possible. She
started mouth-to-mouth breathing. Several spontaneous respi-
rations were noted during the three to four minutes it took
the taxi to reach the Emergency Room of The University
Hospitals. External cardiac massage was started immediately.
Oxygen was given first by face mask and then by endotrach-
eal tube. A good carotid pulse was felt as soon as external
massage was started. The pupils were initially large and
From the Western Reserve University, University Hospitals, Cleve-
land, Ohio.
Submitted November 22, 1965.
The Authors
• Mr. Davidson, Foresterhill, Aberdeen, Scotland,
formerly Research Fellow, Department of Cardio-
vascular Surgery, Western Reserve University,
Cleveland, presently is Registrar in Surgery, Aber-
deen Royal Infirmary, and Lecturer in Surgery,
University of Aberdeen, Scotland.
• Dr. Leighninger, Cleveland, is Assistant Sur-
geon, Lakeside Hospital; Assistant Professor of
Surgery, Western Reserve University School of
Medicine.
unresponsive to light but quickly came down to normal size.
The electrocardiogram showed ventricular fibrillation. Within
minutes an intravenous infusion was started and metarominol
given by this route. Three ampules of sodium bicarbonate
(3x44.4 mEqs) were given intravenously at this time.
The patient was moved to a Beck-Rand machine1 for
external cardiac massage. Systolic blood pressure readings
at this time varied from 140 to 170 mm. Hg. After nine
external shocks (480 volts, A. C.) the heart remained de-
fibrillated, the last shock being given 28 minutes after the
patient was admitted. An arterial blood sample taken 10
minutes later showed the pH to be 7.35, pC02 49 mm. Hg,
and the CO2 content 26.7 mEq/ liter. The patient was then
transferred to the intensive care unit.
During the next 24 hours, his condition slowly improved.
Blood pressure was maintained with minimal doses of met-
araminol. Urine output was adequate. Electrocardiogram
suggested recent anterior myocardial infarction. Procaine
amide was given in regular doses because of occasional pre-
mature ventricular beats. The patient was wide awake at this
time, although confused and irrational.
Over the next few days his cerebral status improved. He
had periods of complete lucidity, being able to converse with
his wife and cooperate with nursing and medical staff. Be-
cause of secretion retention and inability to cough adequately,
a tracheostomy was done to permit tracheal suction and as-
sisted ventilation. Postural drainage and antibiotics had
been started on the day of admission.
Seventeen days after admission, the patient’s condition
began to deteriorate. He developed signs of spreading bron-
chopneumonia and, despite vigorous therapy, died on March
9, 1964, three weeks after his second cardiac arrest.
The immediate cause of death was confluent bronchopneu-
monia involving most of the left lung. Examination of the
coronary vessels showed severe atherosclerosis. There was
aneurysmal dilatation of the apex of the left ventricle with
scarring of anterior, posterior, and lateral walls. Recent ex-
for September, 1966
905
tension of the anterior infaxct was present. A mural throm-
bus was found adherent to the underlying endocardium.
Pathologic changes were not identified in the brain.
Comment
This is probably the first occasion when successful
defibrillation was carried out on two separate occa-
sions on the same patient, with such a long time
interval. The fact that the patient was near the hos-
pital at the time of his second attack was undoubtedly
important as regards his immediate survival. Despite
severe myocardial damage, it is significant that de-
fibrillation was accomplished with restoration of an
adequate heart beat.
The complications which followed, rather than
any failure of the resuscitation procedure, were the
factors which caused this patient’s death and serve
to emphasize the importance of vigorous and detailed
medical care right from the time of arrest. The rel-
atively advanced age of the patient must also have
weighed heavily against his long term survival. The
heart was severely damaged by old and recent in-
farcts. In spite of severe damage it was possible to
defibrillate the heart and restore a coordinate beat to
virtually provide this patient with his third life.
Reference
1. Leighninger, D. S.: Closed Chest Resuscitation. An Experi-
mental Study. Amer. J. Cardiology, 14:193, 1964.
Letter To The Editor
Perry R. Ayres, M. D., Editor
The Ohio State Medical Journal
Dear Dr. Ayres:
When I discussed my experiences in Paris in my
"Medical Travelogue,’’ [The Journal, pp. 323-328,
April 1966], I erroneously said that the non-identical
twin recipient of a transplanted kidney was the long-
est surviving in the world. The Parisian, of course,
has every reason to be happy about the fact that he
is now going for so many years. But, to put the rec-
ord straight there is another non-identical twin trans-
plant which was done by the group in Boston at
Peter Bent Brigham Hospital, and whose transplant
is approximately six months older than the Parisian’s.
I assume that it is well known that the group at
the Peter Bent Brigham Hospital are indeed the pio-
neers of kidney transplantation in man. In that
group were Doctors Murray, Merrill, Hume and
many others.
The readers will perhaps forgive my error when
they realize that it was made in Paris.
Sincerely yours,
W. J. Kolff, M. D., Head
Department of Artificial Organs
Cleveland Clinic Foundation
Cleveland, Ohio 44106
July 12, 1966.
SPECIALIZATION IN MEDICINE was inevitable when the horizon of
medical knowledge became too broad for the comprehension of one person.
As time moves on, this tendency will increase with a continued fractionation of
the broad spectrum of medical disciplines. Certainly this changing pattern makes
available highly specialized and efficient techniques of medical diagnosis and
therapy, but all too frequently, the focus of attention narrows upon a fragment
of the whole person. No one bemoans the passing of the horse and buggy
doctor with his well-intentioned but far too often inadequate therapeutic and
prophylactic efforts, and yet, this dignified and respected man of medicine dis-
pensed a compassion of human understanding so essential to the healing of the
whole body. Too often today we find this compassion lacking in the technically
efficient but impersonal mechanics of modern medicine. — Melvin A. Casberg,
M. D., Long Beach, (From an address at the installation of Granger E. Westberg
as the first Dean of the Institute of Religion, Texas Medical Center, Houston,
Texas, April 2, 1965), California Medicine, 104:381-386, May 1966.
906
The Ohio State Medical ]our7ial
The Runaway Artificial Pacemaker
Report of a Case
HERMAN K. HELLERSTEIN, M. D., TOM R. HORNSTEN, M. D.,
and JAY L. ANKENEY, M. D.
T
~^HE advent of the artificial internal cardiac
pacemaker1 is but one of the myriad of ex-
amples of the modern application of electronic
engineering to clinical medicine. The use of this in-
strument now permits previously incapacitated pa-
tients with refractory heart block to lead relatively
normal lives. In the early years of the use of artifi-
cial pacemaking devices, major difficulties were en-
countered. Better engineering has since eliminated
or at least anticipated many of these difficulties, but
some problems still remain. Some of the difficulties
which have developed in one patient are illustrated
by the case presented below.
Case Report
This 38 year old white woman was admitted to Univer-
sity Hospitals of Cleveland for the 11th time on May 13,
1962, with the chief complaint, "My pacemaker isn’t work-
ing.” This patient had been in her usual state of good
health until 1954 when, six weeks postpartum, she first
developed syncopal attacks. In July, 1956, convulsions oc-
curred concomitant with syncope, and the patient’s physician
referred her to University Hospitals of Cleveland for fur-
ther study. During the next four years she was hospitalized
on 10 occasions because of syncopal episodes concomitant
with complete heart block and recurrent ventricular asystole.
Various modes of therapy were instituted but were unsuc-
cessful, viz, Isuprel®, ephedrine, atropine, Thorazine®,
salt restriction, prednisone, deep sleep therapy, and bilateral
vagotomy. In October, I960 the patient was admitted to
another medical center for study and treatment. During
seven months hospitalization, studies were singularly nega-
tive and an internal electrical pacemaker was implanted in
three stages on December 15, I960, April 18, 1961, and
May 12, 1961.
The patient was asymptomatic until November, 1961,
when the electrical pacemaker ceased functioning. She re-
turned to the same medical center where the pacemaker had
been implanted. It was found that a soldered joint con-
necting an electrode wire to the lead from the pacemaker
had come apart and that the insulating plastic covering
the junction had leaked. The connection was re-established
and the pacemaker resumed control of the heart beat.
For the following six months, there were no syncopal
episodes. However, on Sunday morning, May 13, 1962, the
patient noted the sudden onset of tachycardia, which was
accompanied by nausea, vomiting, and dyspnea. She was
transported 125 miles by ambulance and was admitted to
the University Hospitals of Cleveland. The temperature
was 37.4 degrees C.; pulse rate, 190; blood pressure, 80/50
mm Hg. The neck veins were distended to the angle of the
The Authors
• Dr. Hellerstein, Cleveland, is Associate Physi-
cian, University Hospitals of Cleveland; Associate
Professor of Medicine, Western Reserve Univer-
sity School of Medicine.
• Dr. Hornsten, Cleveland, is Assistant Physician,
Outpatient Department, University Hospitals of
Cleveland; Research Associate, Department of
Medicine, Western Reserve University.
• Dr. Ankeney, Cleveland, is Associate Thoracic
Surgeon, University Hospitals of Cleveland; As-
sociate Professor of Thoracic Surgery, Western Re-
serve University School of Medicine.
jaw, when the patient was in a semi-Fowler’s position.
The left border of cardiac dullness was in the anterior axil-
lary line in the fifth intercostal space. All peripheral pulses
were poorly palpable. She was in circulatory failure.
The electrocardiogram revealed a heart rate of 190 cor-
responding to the electrical pacemaker stimulation (Fig. l).
It was thought that the batteries driving the patient’s elec-
trical pacemaker mechanism were failing, and as a result,
the timing mechanism was causing the pacemaker to in-
crease in rate. The patient presented a most difficult ther-
apeutic problem, and one for which we were unprepared
at the time (1962). We possessed neither definite informa-
tion as to the exact type of the pacemaker nor wiring cir-
cuits of the most commonly used pacemakers. She did not
possess a wiring diagram describing the circuitry of the
pacemaker mechanism, and a case such as hers had not
been encountered previously. This was the first documented
case of ventricular tachycardia due to failure of an arti-
ficial pacemaker with 1:1 conduction. One of us (HKH)
later learned of a case of battery failure resulting in 2:1 con-
duction, but we were not aware of this incident at that time.
In fact, we had been favorably impressed by the reported
success of the application of pacemakers. An advertisement
of one company manufacturing a pacemaker had stated:
"Three million transistor hours have been accumulated in
patients without a single failure.”2
With a sense of urgency, steps were taken to solve this
problem.* In general, the object was to disconnect the
intracardiac electrodes from the internal electrical pace-
maker and to connect them instead to an external stimulat-
ing device. The possibility of the need for such an emer-
gency transfer had been considered by most manufacturers
of pacemakers. The runaway device was equipped with a
safety extension or "pigtail” which contained circuitry
From the Departments of Medicine and Surgery, University Hos-
pitals of Cleveland, Ohio, and the School <3 Medicine, Western
Reserve University, Cleveland, Ohio. Submitted January 27, 1966.
Supported in part by a grant from the Harry Sacks Memorial Fund.
*We are indebted to the interns, nurses, orderlies, x-ray techni-
cians, and telephone operators whose services were so willing and
capably mobilized.
for September, 1966
907
A
B
Fig. 1. V entricular tachycardia due to failure of implanted
artificial pacemaker, with 1:1 conduction at a rate of 190
per minute. Electrocardiogram on admission to the Univer-
sity Hospitals of Cleveland. (Row A): Lead aVR, paper
speed 25 millimeters per second, standardized 1 millivolt =
10 millimeters deflection. Note 1 millisecond pacemaker
signal (P. S.) preceding each QRS complex. (Row B):
Lead aVR, paper speed 50 millimeters per second, standard-
ized 1 millivolt — 10 millimeters deflection.
through which the pacemaker might be "shorted out’’ and
an external stimulator attached. The first step was to locate
the pigtail. It was easily palpable in its subcutaneous posi-
tion. An emergency x-ray confirmed the exact location of
the pigtail (Fig. 2). Once the pigtail was located, how-
Fig. 2. Roentgenogram showing bipolar patch electrodes in
left ventricular wall, pigtail in subcutaneous tissue of left
abdominal wall, and subcutaneously implanted pacemaker,
(at the loiver right corner).
ever , the most important question still remained, ie, exactly
what to do with it.
Emergency telephone calls to three widely dispersed cities
were made on this late Sunday afternoon: (1) to the other
medical center which kindly scoured the neighboring sub-
urban areas to locate the surgeon who had implanted the
pacemaker and who identified for us the manufacturer and
provided details of the implantation of the pacemaker; (2)
to the manufacturing company; and (3) to Dr. William
Chardack at Buffalo, New York, the surgeon whose exten-
sive experience and leadership in the field of pacemaking
devices is widely recognized. We were informed that within
the pigtail there were three wires, two of which were con-
nected to the opposite ends of a resistor. One wire attached
to the resistor was to be cut and an external stimulator was
to be introduced into the circuit through connection with
the cut wire and the third wire.
Equipped with this knowledge we were ready to proceed.
The following events transpired in the patient’s hospital room.
An electrocardiographic monitor was connected to the pa-
tient’s chest so that the electrical complexes would be visual-
ized. Employing local anesthesia, one of us (J. A.) exter-
nalized and opened the pacemaker pigtail. It was found to
contain three extremely fragile wires as described, but there
was no color code or other type of coding to indicate which
end of the resistor was at the higher potential. Although
this information was described in the manufacturer’s in-
structions, these invaluable data were not available to us at
the time and it was necessary to know these facts if the wire
were to be cut in the proper place. A voltmeter was
needed post-haste. Therefore, an emergency triple page was
put out summoning the hospital electrician who, blue clad
and equipped with his voltmeter, attempted to ascertain
which end of the resistor was at the higher potential.
A decision concerning the circuitry was made, a wire was
cut, and two wires were attached to an external stimulator.!
To the relief of all, the patient’s heart contracted in response
to the new stimulus (Fig. 3). However, after the first
T
A
Fig. 3. (Row A): V entricular tachycardia due to runaway
pacemaker ceases abruptly when pigtail wire was severed
(arrow). V entricular asystole and somatic tremors due to
seizure develop in the subsequent 2.6 seconds before the
external stimulator was adjusted. (Row B): Immediately
after the above adjustment, negative pips of external stimu-
lator are followed by ventricular responses. Positive pips of
internal pacemaker continue to occur. See Fig. 4 for ex-
planation.
sighs of relief, it was noted that, although the heart was
responding to the new stimulator, the internal pacemaker
was still firing off impulses to which the heart did not
respond. The resultant electrocardiogram produced a record
of dissociation with "block” between two artificial pace-
makers (Fig. 4). Although this was an interesting electro-
cardiographic phenomenon, it did not appear to be signifi-
Fig. 4. Electrocardiogram showing dissociation with "block”
between two artificial pacemakers. The positive pips (of
the subcutaneous runaway pacemaker) have a rate of 190
per minute and do not influence the basic ventricular rate
of 55 produced by the external pacemaker. The failure of
the internal pacemaker to capture control of the heart is in-
terpreted to be due either to "block” at the site of myocar-
dial electrode(s) or to inadequate strength of the stimulating
signal secondary to battery failure. In either instance, the
dissociation between the two artificial pacemakers is due to
the equivalent of block and not of interference. There is
a third pacemaker, the patient’s own pacemaker, which is
subservient to the external pacemaker but still capable of
independent oscillation (See Fig. 6). Note fusion of the
pips of the internal and external pacemakers (F).
fit is now recognized that there is a potential hazard associated
with connecting a line powered pacemaker-monitor to a direct myo-
cardial electrode. Ventricular fibrillation may be produced if the
patient is not properly grounded. For this reason line powered
pacemaker-monitors should never be used in such circumstances. 3
908
The Ohio State Medical Journal
Fig. 5. (Row A): Effects of drying of electrode jelly of
chest electrode. Some of the stimuli of the external pace-
maker (E) do not produce a ventricular response. (Row
B): As the electrode jelly is replaced, amplitude of the pips
of the internal pacemaker (I) increases. (Row C): After
the electrode . jelly is completely replaced, impulses from
external stimulator are all followed by ventricular responses.
cant clinically. The patient felt well and was responding
well to the new stimulation.
As the hours progressed, however, a strange phenomenon
began to occur. It was noted that the signal of the external
stimulator was not always followed by a ventricular re-
sponse (Fig. 5), and the voltage had to be augmented
steadily in order to provide enough stimulation for 1 : 1
myocardial contraction. At the sixth hour, 40 volts were
required. It was not thought likely that this situation was
due to recent polarization of the implanted cardiac elec-
trodes. The cause was not immediately understood. A
major crisis developed, however, when an attempt was made
to change the position of the electrocardiographic monitor
electrodes on the patient’s chest to avoid local skin irrita-
tion. When the electrodes were removed from the patient’s
chest wall or when the patient cable was disconnected from
the monitor, asystole developed. Furthermore, when the
external pacemaker was disconnected, the internal pace-
maker also ceased functioning suggesting that the latter was
firing through the former (Fig. 6). It was evident that
Fig. 6. Electrocardiogram showing three pacemakers. (Row
A) : External pacemaker pips (down, E) control the ven-
tricles. Internal pacemaker pips (up, I) are blocked. (Row
B) : When the external stimulator was disconnected (ar-
row) both internal and external pips disappear indicating
that the internal pacemaker was firing through the external
stimulator. The patients physiologic pacemaker, ie, the
sino-atrial impulse (P) is blocked at the A-V node. (Row
C) : The external pacemaker is reconnected and resumes
control of the ventricles.
the external stimulator was not connected properly and that
it was attached to the wrong end of the cut pigtail wire.
In some strange way, the circuit was not being completed
through the internal wiring but rather through the chest
wall electrodes from the monitoring device. The electrode
jelly was drying out, and the resistance of the circuit was
increasing with the result that more voltage was necessary
if an adequate amount of current was to be maintained. It
was noted that the amplitude of the signal of the internal
pacemaker decreased as the electrode jelly dried and in-
creased when it was replaced (Fig. 5). (Later examina-
tion of the pigtail by Dr. William Chardack revealed that
one of the wires in the pigtail was broken, and this factor
probably contributed to the failure of the circuit to func-
tion in a proper manner.)4 Once the situation was at least
partially understood, the stimulator was re-attached to the
other pigtail wires. After this procedure was performed,
the internal pacemaker ceased oscillation, and the heart
responded to the external pacemaker stimulus (Fig. 7). It
was no longer necessary to increase the stimulator voltage,
Fig. 7. (Row A): When the external sti?nulator teas de-
tached from the indifferent wire, (black bar) ventricular
tachycardia of the implanted pacemaker temporarily returned.
Note the increase in the amplitude of the signal of the in-
ternal pacemaker. (Row B): When the external stimu-
lator was attached to the other end of the severed pigtail
wire ( arrow ),the internal pacemaker ceased firing and the
heart responded to the external pacemaker only.
and the monitor electrodes could be removed without dan-
ger of asystole.
On May 16, 1962, a new internal pacemaker was inserted.
The patient had occasional extrasystoles during the im-
mediate postoperative period, but following this she was
asymptomatic with a heart rate of 64. She was discharged
May 26, 1962, with the diagnosis, "dysfunction of an artifi-
cial cardiac pacemaker.”
The patient did well until December 22, 1962, at which
time she noted "irregularities” in her heart beat. Upon ad-
mission to the hospital, electrocardiographic tracings revealed
a regular pacemaker rate of 62, but there were frequent beats
during which the pacemaker failed to stimulate the ven-
tricles. It was thought that the difficulty lay in the end
plates of the electrodes implanted within the myocardium.
The whole unit, including both pacemaker and electrodes
was replaced, and regular rhythm was restored.
The patient again continued to be asymptomatic until
June 18, 1964, when she developed an episode of syncope.
She suffered five other syncopal attacks that day and again
reported to the hospital. This time electrocardiograms re-
vealed a pacemaker rate of 71, but there were occasional
episodes during which the pacemaker failed to fire once or
even twice in succession, causing periods of asystole. Fail-
ure of the timing circuit was considered to be the cause
of this most recent pacemaker dysfunction, and when the
pacemaker unit was replaced, the patient experienced no
further discomfort.
Discussion
Although the production of an electrocardiogram
such as the one described, revealing dissociation be-
tween two artificial pacemakers, may border on the
humorous, the situation which is illustrated by the
above case report is serious indeed. An electronic in-
strument responsible for a patient’s life had failed five
times. A soldered connection had once come apart;
a pigtail wire had broken; and the batteries, timing
circuit, and end plates each had failed. One to one
conduction with life threatening ventricular tachy-
cardia had developed.
The probability of occurrence of many of these
types of failure has decreased since 1962 because of
for September, 1966
909
better technical features in pacemakers now being
implanted. Two of the failures in the above de-
scribed case were due to breakdown of the electrodes,
■which were of inferior quality and had not been
constructed by the company which had manufactured
the pacemaker mechanism. Chard ack5' 6 reports that
the platinum coil electrode has virtually terminated
the problem of myocardial electrode failure. Changes
in the design of the safety pigtail have minimized
breakage of these extension wires. The problem
of the fast failure of a runaway pacemaker7* 8 has also
been alleviated.
The original fear with the use of internal pacemak-
ers was that there would occur a rise in threshold cur-
rent requirements secondary to increasing fibrosis
around the implanted electrodes. Because of this con-
cern, the original pacemakers were constructed with
10 battery cells capable of putting out a high current.
Only a few of these battery cells also contributed to
the timing circuit of the pacemaker. Originally, with
a 10 cell unit, it was thought that the failure of one
cell in the timing circuit would produce an increase
of 15 per cent in the heart rate. Should a second
battery fail, the pacemaker rate would again increase,
but the total output would then have dropped to
below threshold levels, thus preventing a 1:1 re-
sponse. However, it was found that increasing cur-
rent thresholds tended not to occur and that as a
result, although a cell in the timing circuit might fail,
the remaining cells would still provide enough output
to drive the heart at a higher rate.6 Chardack’s 12
cases of pacemaker failure secondary to battery de-
pletion in 60 patients with pacemakers were all in
units with 10 cells constructed as above.6
The pacemaker design was therefore changed so
that only five or six battery cells are present, all of
which drive both timing and output circuits. Loss of
up to three cells is estimated by Chardack to have
"very little" influence on the heart rate and loss of
a fourth cell would produce only a 10 per cent in-
crease in rate. However, by this time the output
of the unit will be below the myocardial threshold
to stimulation and fast failure will not occur.6 Ra-
ther, the heart will revert back to its previous state
of complete A-V block. Chardack reported no fail-
ures secondary to battery depletion in 17 patients
with this improved circuitry between April, 1962 and
August, 1963. 6
Although newer technology is helping to solve
pacemaker problems, the threat of pacemaker failure
still remains a constant danger. It should be men-
tioned that sudden return to complete A-V block is
in itself dangerous, and immediate death may follow
as is illustrated by the following case:
A 78 year old white man with complete heart block under-
went implantation of an artificial pacemaker manufactured
by the same company that produced the pacemaker involved
in the above described case. Three years after implantation,
the patient suddenly developed syncope and was brought
to University Hospitals of Cleveland, dead on arrival. An
electrocardiogram revealed no cardiac activity. An impulse
was present in a direct writer electrocardiograph which at
first blush appeared to be 60 cycle current. However, this
was demonstrated on oscilloscopic and photographic traces
as being the discharge of the pacemaker at a somewhat ir-
regular rate between 660 and 900. The pacemaker was
removed from the body and output voltage measured. It
was only 150 millivolts as compared with a usual output
near 8000 millivolts. The manufacturer examined the de-
fective pacemaker and ascribed its premature failure to the
failure of the oscillator transistor. The resistance in the col-
lector circuit of the oscillator transistor had increased and
caused significant rate changes in the oscillator circuit with
secondary rundown of the battery.
Autopsy examination revealed definite fibrosis around the
electrodes implanted within the myocardium. It is postu-
lated that with the fast, ineffective (low voltage) discharge
of the artificial pacemaker, the patient’s heart reverted to its
previous state of complete A-V block, whereupon an im-
mediate and fatal Stokes-Adams attack occurred.
Because of the gravity of the threat of pacemaker
failure, certain suggestions are proffered for the fur-
ther safe clinical use of internal pacemaking devices.
1 . All Patients with Internal Pacemakers Should
Carry Information Describing These Devices with
Them at All times. Such information should include
x-rays for the location of safety pigtail devices and
schematic wiring diagrams for interpretation of the
pacemaker circuitry. Without these precautions, the
dangers and difficulties involved in attempting to cor-
rect pacemaker failure are obviously increased. If
necessary, wiring diagrams could be copied on micro-
film and actually placed inside the body of the pace-
making device. Such diagrams might also contain
references to color codes which should be used on
wires, as well as detailed procedures for repair and
temporary substitution of malfunctioning pacemaking
devices.
2. Adequate Warning of Impending Pacemaker
Battery Failure Should Be Available. Changes in
the x-ray picture of the battery pack in situ have been
shown to reflect the state of its change. However,
measures should be available to indicate acute changes.
Pacemakers might be equipped with an audio signal,
which would produce a warning sound as soon as
one battery began to fail. This is especially im-
portant since, with the use of pacemakers now being
employed, the heart rate may neither increase nor de-
crease until at least three batteries fail. Patients
should be instructed, of course, in the routine taking
of pulses periodically during the day so as to note any
change in rate. They should be instructed to re-
port to their physicians at the earliest signs of pace-
maker failure.
3. An Attempt Should Be Made to Standardize
Pacemaker Design and Parts. Today, with many
different manufacturers designing and constructing
artificial pacemakers, small mechanical differences in
parts make it difficult to replace failing pacemaker
components. The patient may find it necessary to
return frequently to the original hospital where a
particular replacement part is available. With inter-
changeability of parts, most pacemaker components
could be stocked at major hospitals throughout the
910
The Ohio State Medical Journal
country, and time involved in treating life-threaten-
ing situations secondary to pacemaker dysfunction
might be minimized.
The runaway pacemaker is an interesting but in-
deed frightening complication of the application of
electronics to clinical medicine. Through both elec-
trical and clinical safeguards, however, its occurence
may be minimized.
Summary
A case is reported of artificial pacemaker in-
duced ventricular tachycardia with 1 : 1 conduction
at a rate of 190 beats per minute. Suggestions are
proffered for the further safe clinical use of artificial
cardiac pacemakers.
Acknowledgment: The authors are indebted to Doctor
Robert Rinderknecht, Dover, Ohio for the privilege of study-
ing this patient.
References
1. Chardack, W. M. ; Gage, A. A., and Greatbatch, W. : A
Transistorized Self-contained Implantable Pacemaker for the Long-
Term Correction of Complete Heart Block. Surgery, 48:643-654
(Oct.) I960.
2. Manufacturer’s Literature, Medtronic, Inc., Minneapolis,
Minnesota.
3. Chardack, W. M. : Personal Communication to H. K. Heller-
stein. September 4, 1964.
4. Chardack, W. M. : Personal Communication to H. K. Heller-
stein. September 20, 1962.
5. Chardack, W. M.; Gage, A. A.; Frederico, A. J.; Schimert,
G., and Greatbatch, W.: Clinical Experience With an Implantable
Pacemaker. Ann. N. Y. Acad. Set., 111:1075-1092 (June 11) 1964.
6. Chardack, W. M. : Heart Block Treated With an ImDlantable
Pacemaker — Past Experience and Current Developments. Progr. in
Cardiov. Dis., 6:507-537 (May) 1964.
7. Applebaum, I. L. ; Parsonnet, V.; Gilbert, L.; Levine, B., and
Zucker, I. R.: Complications of an Implantable Cardiac Pacemaker.
/. Newark Beth Israel Hosp., 13:166-174 (July) 1962.
8. Harris, R. S., Jr.; Becker, D. J.; Rodensky, P. L.; Wolcott,
W.; Dick, M. M., and Wasserman, F.: Symptomatic Paroxysmal
Pacemaker-Induced Ventricular Tachycardia., Amer. f. Cardiol.,
11:403-408 (Mar.) 1963.
PACEMAKER PROBLEMS. — Thirty-eight implantable pacemakers have
been inserted in 29 patients at the University of Florida Hospital during the
past three and one-half years. A total of 15 complications occurred. There are
22 survivors; three of the seven deaths were unrelated to the pacemaker. Two
deaths were due to infection as a complication of the insertion of the pacemaker.
One death occurred because of unrecognized electrode failure, and one death oc-
curred on the fifth postoperative day, possibly as a result of ventricular fibrillation
secondary to competition for ventricular stimulation by the myocardial versus the
electronic pacemaker.
Of the 16 patients operated upon in the last 18 months only two have had to
be reoperated upon, one because of electrode wire breakage and one because of
infection.
Of nine survivors living 18 months or more after the original pacemaker
implantation, only four have not had to have operation for replacement of the
pulse generator unit. Battery failure can be held accountable for the need for
reoperation in three patients and wire problems in two.
On the basis of our experience, we believe that the intravenous right ven-
tricular electrode with an external power source should be used from the time of
admission to the hospital until the patient is in optimum condition for operation.
In very elderly, feeble or infected patients, the right ventricular electrode with an
implanted pulse stimulator seems most desirable at present. For complete heart
block the fixed rate pacemaker has been reasonably satisfactory. The atrially
activated pacemaker is used in patients with intermittent episodes of complete
heart block associated with symptoms of cerebral ischemia.
Wire failure is handled by grounding first one wire and then the other
in the subcutaneous tissue. If this fails to achieve a ventricular response, both
wires are attached to an external power source. If this fails, a general anesthetic
is given and a completely new unit implanted. — Thomas D. Bartley, M. D., and
Myron W. Wheat, Jr., M. D., University of Florida, Gainesville: The Journal of
the Florida Medical Association, 53:498-503, June 1966.
I or September, 1966
911
Suprapubic Catheterization
Preliminary Report of a New Postoperative Technic
DONALD W. SHANABROOK, M. D.
URINARY TRACT infection in Obstetrics and
Gynecology is a problem of serious propor-
tions and, to date, of partially unknown con-
sequences.1’2 It is not at all uncommon, especially
in the course of pregnancy and gynecologic surgery.
Many physicians3-6 have studied the problem in an
effort to elucidate the etiology and pathogenesis of
urinary tract infections and in order to prevent acute
and chronic urinary problems.
In this study, our primary effort has been to in-
vestigate an uncomplicated and practical method of
bladder drainage that would prevent or minimize
urinary tract infection, with special reference to gyne-
cologic surgery. This method was in part suggested
by British authors7"10 who employed a suprapubic
puncture for the relief of acute urinary retention or
for bladder drainage. We reasoned this would elimi-
nate the pericatheter route of infection suggested by
some physicians as important with indwelling ure-
thral catheterizations.11
Methods and Material
Bladder drainage in the postoperative gynecologic
patient can be achieved by inserting a 5 FCG (French
Catheter Gauge) polyethylene tube into the bladder.
The equipment required for this type of drainage
is shown in Fig. 1. This is accomplished following
the surgical procedure by filling the bladder, via a
urethral catheter, with approximately 300 cc. of nor-
mal saline to which 1 cc. of methylene blue is added
as shown in Fig. 2. Percutaneous puncture of the
bladder is made in the midline, 2l/2 cm. above the
symphysis with a 13 gauge 31/2 inch needle, and free
flow of the blue colored saline signals entrance into
the bladder as shown in Fig. 3. At this point, the
catheter is inserted through the needle into the blad-
der. Then, the needle is withdrawn, as shown in
Fig. 4. The catheter is connected to an intravenous
tubing for constant open drainage, and the poly-
ethylene tube and the first portion of the collecting
tube are taped securely to the anterior abdominal wall
in order to prevent inadvertent removal of the cath-
eter, as shown in Fig. 5. The methylene blue saline^
solution is drained through the urethral catheter,
Submitted December 20, 1965.
The Author
• Dr. Shanabrook, Tiffin, former Resident in
Obstetrics and Gynecology, St. Luke’s Hospital,
Cleveland, presently is staff member. Woman’s
Clinic, Tiffin, and Associate Staff member, Mercy
Hospital in Tiffin.
which is then removed. An attempt was made to
obtain a preoperative and 24 hour post-catheteriza-
tion urinalysis, culture, and colony count in each case,
to evaluate the efficacy of the procedure.
Results
The procedure was done in 20 patients, 15 of
whom had anterior and posterior colporrhaphy, and
usually a vaginal hysterectomy. Total abdominal
hysterectomy was done on the remaining five patients.
A number of clinical observations became readily ap-
parent almost at the onset of the study. This method
of catheterization is without discomfort to the patient.
There is no sensation of urgency as is frequently ex-
perienced with urethral catheters, and no pain or dis-
comfort were noted on catheter removal. Further-
more, patients were not aware of the presence of the
catheter. The catheter maintained constant bladder
drainage despite its narrow lumen. Blockage of the
catheter was noted on only one occasion, caused by a
small blood clot. This was easily removed with
normal saline irrigation, without recurrence of the
obstruction. Bacteriuria was noted in eight cases,
using a baseline of 100,000 bacterial colonies per
cc. of urine. However, none of these patients had
symptoms of urinary infection. Antibiotic therapy
was used in three of these patients, and all eight of
these had negative urine cultures three to four days
after treatment.
Our original purpose was to develop a method of
catheter drainage which would eliminate bacteriuria.
This may yet be the case with continued experience
with this procedure. We have considered using a
somewhat larger catheter to maintain even greater
bladder drainage and rest, precluding any increased
muscle tension or residual urine in the bladder. The
catheter is removed, following spontaneous urination
912
The Ohio State Medical Journal
via the urethra, which usually occurs in four to five
days in cases of extensive surgery. Bladder decom-
pression was adequately maintained, and no instances
of overdistention were noted, despite the small lumen
of the tubing.
Fig. 1. The equipment required for this procedure is readily
available.
Fig. 2. A urethral catheter is inserted following the oper-
ative procedure and the bladder is filled with 300 cc of nor-
mal saline to which 1 cc of methylene blue is added for easy
visualization.
Fig. 3. A percutaneous puncture of the bladder is made
21/2 inches above the symphysis in the midline with a 13
gauge 31/2 inch needle, and the free flow of the blue colored
saline signals entrance into the bladder.
Comments
There are many methods available to prevent bac-
teriuria after gynecologic surgery and catheterization.
The use of clean, voided urinary specimens properly
obtained and examined, has been demonstrated to be
an accurate method of evaluating the urinary tract of
the patient without catheterization.12 Antibiotic oint-
ments can be used for lubrication during urethral
catheterization, to reduce bacteriuria.13’ 14 Many
obstetric and gynecologic procedures can be done
without urethral catheterization, or with catheteriza-
tion for only 24 hours or less; ie, routine deliveries,
cesarean sections, abdominal hysterectomy, and ad-
nexal surgery.15 This can be done without an in-
crease in morbidity from urinary tract infection.
At the present time, it is impossible to prevent all
cases of bacteriuria and urinary tract infections, since
we are frequently operating in close proximity to a
urinary tract which is either infected or has weakened
Fig. 4. The polyethylene tube is inserted through the needle
into the bladder, then the needle is withdrawn, leaving the
polyethylene tube in place.
Fig. 5. The catheter is then connected to a constant drain-
age system.
for September, 1966
913
bacteriostatic mechanisms. A recent study by Cox
and Hinman16 has uniquely demonstrated inherent bac-
teriostatic properties of the bladder. Our aim has been
to enhance and protect this mechanism by procedures
such as suprapubic catheterization and drainage.
Summary
A new procedure has been presented, which can
maintain urinary asepsis and bladder drainage, avoid-
ing urethral catheterization, which almost certainly
results in significant bacteriuria after 48 hours. Al-
though this procedure requires more evaluation, it
does offer a method of postoperative bladder drain-
age, which is comfortable for the patient and helpful
to the physician, without cumbersome equipment or
time consuming procedures.
References
1. Beeson, P. B.: Case Against the Catheter. (Editorial),
Amer. J. Med., 24:1-3 (Jan.) 1958.
2. Kass, E. H. : Bacteriuria and the Pathogenesis of Pyelone-
phritis. Lab. Invest., 9:110-116 (Jan. -Feb. ) I960.
3. Lich, R., Jr., and Howerton, L. W.: Clinical Evaluation of
the Urethral Catheter. J. A. M. A., 180:813-815 (June 9) 1962.
4. Ansell, J. : Some Observations on Catheter Care. /. Chronic
Dis., 15:675-682 (July) 1962.
5. Slotnick, I. J., and Prystowsky, H.: Microbiology of the
Female Genital Tract. Amer. J. Obstet. Gynec., 83:1102-1111 (April
15) 1962.
6. Prather, G. C., and Sears, B. R.: Pyelonephritis: In Defense
of the Urethral Catheter. J. LJrol., 83:337-344 (April) I960.
7. Riches, E. W. : Suprapubic Catheterization for Paralysis of
Bladder in Spinal Injury. Lancet, 2:128-130 (July 31) 1943.
8. Hey, H. W. : Asepsis in Prostatectomy. Brit. J. Surg., 33:
41-46 (July) 1945.
9. Buchanan, J. M.: Emergency Suprapubic Catheterization.
Brit. Med. J., 5363:1000-1001 (Oct. 19) 1963.
10. Gleeson, L. N. : Emergency Suprapubic Catheterization. Brit.
Med J., 5372:1589 (Dec.21) 1963.
11. Kass, E. H., and Sossen, H. S.: Prevention of Infection of
Urinary Tract in Presence of indwelling Catheters. J. A. AI. A.,
169:1181-1183 (Mar. 14) 1959.
12. Hart, E. L., and Magee, M. J. : Collecting Urine Speci-
mens. Amer. J. Nurs., 57:1323-1324 (Oct.) 1957.
13. Hildebrandt, R. J., et al. : Relationship Between Acquired
Bacteriuria, the Foley and Robinson Catheters, and Mycitracin
Ointment. Surg., Gynec, Obstet, 114:341-344 (March) 1962.
14. McLeod, J. W., et al.: Prophylactic Control of Infection of
the Urinary Tract Consequent on Catheterization. Lancet, 1:292-
295 (Feb. 9) 1963.
15. McGowan, L.: Omission of Bladder Catheterization with
Gynecological Operations. Obstet. Gynec., 22:256-257 (Aug.) 1963.
16. Cox, C. E., and Hinman, Frank F., Jr.: Retention Catheter-
ization and the Bladder Defense Mechanism. J. A. M. A., 191:171-
174 (Jan. 18) 1965.
HODGKIN S DISEASE AND LYMPHOSARCOMA. — The cooperation
of physicians is requested in a study of Hodgkin’s disease and lymphosar-
coma being conducted by the National Cancer Institute at the Clinical Center,
National Institutes of Health, Bethesda, Maryland.
Particularly desired are patients who have had no previous treatment or
minimal prior treatment. All clinical stages of biopsy-proven disease are accept-
able. The major purpose of the study is to determine the curative potential of
intensive radiotherapy in localized cases and to evaluate combination chemotherapy
and x-irradiation in patients with generalized involvement.
Physicians interested in having their patients considered for the study may
phone or write to: Paul P. Carbone, M. D., The Clinical Center, National Institutes
of Health, Building 10, Room 12-N-228, Bethesda, Maryland 20014; Telephone:
656-4000, Ext. 64251. — Announcement, Clinical Center, NIH, April 1966.
HYPER- OR HYPOPARATHYROIDISM.— The cooperation of physicians
is requested in a study of patients with either hyper- or hypoparathyroidism
in conjunction with developing a practicable immunoassay for parathyroid hormone
being conducted by the Metabolic Diseases Branch of the National Institute of
Arthritis and Metabolic Diseases at the Clinical Center, National Institutes of
Health, Bethesda, Maryland.
Of interest for this study are patients with kidney stones and/or bone demin-
eralization in association with high serum calcium and/or low semm phosphate.
Patients with hypoparathyroidism (congenital or following extensive thyroid sur-
gery) having low blood calcium and high serum phosphorous are also needed.
Physicians interested in having their patients considered for the study may
write or telephone: Gerald D. Aurbach, M. D., Clinical Center, Room 9-D-14,
National Institutes of Health, Bethesda, Maryland 20014; Telephone: 656-4000,
Ext. 65051. — Announcement, Clinical Center, NIH, April 1966.
914
The Ohio State Medical Journal
Hemophilus Influenza Meningitis
Report of a Case Complicated by Subdural Empyema
C. NORMAN SHEALY, M. D.
The Author
• Dr. Shealy, Cleveland, is Assistant Neurosur-
geon, University Hospitals of Cleveland; Attending
Neurosurgeon, Cleveland Veterans Administration
Hospital; Assistant Neurosurgeon, Highland View
Hospital; Assistant Professor of Neurosurgery,
Western Reserve University School of Medicine.
SUBDURAL effusions are frequent complications
of infant meningitis, which usually resolve with
repeated subdural taps. Some of these infants
will then develop hydrocephalus as meningeal thick-
ening blocks either the arachnoidal villae or the basi-
lar cisterns. This report concerns an unusual instance
of thick empyema following hemophilus influenza
meningitis.
Case Report
This 3 month old male child was admitted to University
Hospitals October 20, 1963, with a five-day history of fever
and lethargy. Past history was not remarkable.
Physical examination: Temperature was 40.4 degrees
C (rectal); pulse, 180 per minute; respirations, 48 per
minute. The patient was acutely ill and moderately leth-
argic. Head circumference was 44.2 cm. with a bulging,
tense fontanelle. There was generalized decreased muscle tone
and poor reactivity. Deep tendon reflexes were hyperactive.
Laboratory Data: Hemoglobin was 9-6 Gm. per 100 ml.
and white blood cell count, 17,000 with a shift to the left.
Lumbar puncture yielded cloudy fluid with 1000 WBC/
cu.mm, and a protein of 28 mg./ 100 ml. Cultures grew
Hemophilus influenzae.
Hospital Course: The patient wTas begun on treatment
with penicillin, Chloromycetin® and Gantrisin®. He im-
proved somewhat but continued to spike a fever. Six days
after admission neurosurgical consultation was obtained,
and bilateral subdural taps yielded thick, grossly purulent
material. Twenty cc. of this material was withdrawn from
each side without total evacuation. Cultures were sterile,
and repeated taps yielded similar results. Consequently,
on October 29, 1963, large bilateral frontal craniectomies
were performed. A small amount of subdural liquid pus
was found bilaterally. In addition, there w^as a thick col-
lection of semi-inspissated pus (Fig. 1), having the con-
moderate blood vessels floated on the surface of the gelatin-
ous, suggesting that portions were subarachnoid. In fact,
it was impossible to distinguish subarachnoid from subdural
space. The pus was removed by suction and debridement
and the bone flaps were left out. Cultures remained sterile.
Postoperatively the patient did exceedingly well and re-
mained afebrile. Antibiotics were continued for three weeks.
Two weeks after surgery, however, the craniectomy sites re-
mained slightly tense. A ventriculogram revealed moderate
communicating hydrocephalus. On November 19, 1963, a
lumbar subarachnoid peritoneal shunt was done with im-
mediate softening of the decompression sites. Two months
later the shunt blocked and a ventriculojugular shunt was
done without incident. The child continues to develop nor-
mally, walked at 1 year of age, and seems bright. The right
craniectomy site has ossified and the left has almost closed.
Discussion
From 30 to 50 per cent of infants with influenza
meningitis develop subdural effusions.1 In no recent
article or textbook has post-meningitis subdural em-
pyema been reported. Dandy mentions subarachnoid
abscess as one of many complications of meningitis,2
but no case report has been located.
It seems unlikely that the thick pus found at sur-
gery would have reabsorbed without considerable
scarring; furthermore, despite the fact that no or-
ganisms were grown from the pus, fever continued
until surgical drainage. Undoubtedly development
of such pus is a rare occurrence since the advent of
antibiotics, which were successful in halting the prog-
ress of the meningitis but apparently did not prevent
progressive formation of pus. It is not surprising that
hydrocephalus would develop in such a situation.
Summary
This is the first known case report of a 1 to 4
cm. thick inspissated subdural and/or subarachnoid
empyema developing from hemophilus influenza
meningitis.
References
1. Ingraham, Franc D.. and Matson, Donald D.: Neurosurgery
of Infancy and Childhood, Springfield, 111.: Charles C. Thomas, Pub-
lisher, 1954.
2. Dandy, Walter: ’’The Brain,” in Lewis, Deal (ed. ) : Practice
of Surgery, Hagerstown, Md.: W. F. Prior Company, 1932, pp.
354-355.
Fig. 1. The left frontal area showing extensive collection
of subdural and subarachnoid pus.
sistency of mayonnaise. This extended from frontal tip
to midparietal area and across the Sylvian fissures; it ranged
from 1 to 4 cm. in thickness. In some areas small to
From the Division of Neurosurgery, Western Reserve University
School of Medicine and University Hospitals, Cleveland, Ohio.
Submitted December 22, 1965.
for September, 1966
915
A Clinicopathological Conference
From The Ohio State University Hospital, Columbus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
J. B. McMILLAN, M. B., Ch. B., President
PRESENTATION OF CASE
First Admission: This white male barber, aged
46, was well until approximately one year prior
to his first admission to Ohio State University
Hospital. At that time he noted reddening and in-
flammation of his left eye. The inflammation cleared
spontaneously except for an occasional light spot that
appeared in the central vision of the left eye and was
episodic in nature. After an examination by an
optometrist, the patient received glasses. He was
then symptom-free until four weeks prior to the
admission when he noted a rapid decrease in the
visual acuity of the left eye and mild left frontotem-
poral headache. The visual acuity worsened over
the next two weeks until he had complete loss of
vision in the left eye.
On admission to the hospital the physical exami-
nation revealed blindness in the left eye. The left
pupil did not react to light but reacted to accom-
modation, and the left optic disk appeared slightly
paler than the right. The skin over his entire body
was moderately dry and scaly. The physical find-
ings were otherwise normal.
The admission laboratory studies, which included
urinalysis, blood urea nitrogen (BUN), fasting blood
sugar, blood count, and serologic tests for syphilis,
as well as the electrocardiogram, were reported as
within normal limits. The chest x-ray was not re-
markable. Skull x-rays showed suggestive erosion
of one anterior clinoid. The optic foramina and
paranasal sinuses were normal. The electroencephal-
ogram was abnormal with 5-6 second slowing over
the left temporal, frontal and central areas. The
spinal fluid showed two red cells, no white cells,
protein 86 mg., sugar 50 mg., and chlorides 730 mg.
per 100 ml. The opening pressure was 270 mm.
and the closing pressure 190 mm.
A left carotid angiogram on the fifth hospital day
showed some elevation of the middle cerebral artery
and its ascending frontoparietal branch with a shift
of the anterior cerebral artery toward the right. There
was some elevation of the proximal portion of the
anterior cerebral artery. A right transbrachial car-
Submitted June 18, 1966.
Presented by
• William E. Hunt, M. D., Columbus, and
• Leopold Liss, M. D., Columbus;
Edited by Dr. Liss.
otid- vertebral angiogram also showed a shift of
the anterior cerebral artery to the right, elevation
and posterior displacement of the first portion of the
anterior cerebral artery. A pneumoencephalogram
done at the same time showed a mass lesion of the
left side bulging into the third ventricle. Spinal fluid
from the pneumoencephalogram showed 1 red cell,
3 white cells, 74 mg. of protein, and 52 mg. of
sugar.
On the 15 th hospital day the patient underwent a
left frontotemporal craniotomy with exploration. A
dense arachnoid reaction was found at the base of the
brain, around the optic chiasm and optic nerves. The
left optic nerve was enlarged to four or five times the
size of the right. No mass was found. The left
carotid artery was closely adhered to the optic nerve
in what appeared to be an inflammatory reaction.
The inferior surface of the frontal lobe was also
densely adherent to the optic nerve and chiasm on
the left. Biopsy of the arachnoid was done. Because
of the possibility of inflammatory disease, biopsy of
the optic nerve was not performed.
Postoperatively the patient recuperated fairly well.
The visual fields continued to show blindness in the
left eye and a temporal hemianopsia in the right
eye. The postoperative period was complicated by
urinary infection which responded quite well to ap-
propriate antibiotic therapy. He was discharged after
six weeks in the hospital.
Second Admission
The patient was readmitted approximately one
month after his discharge. He had done poorly and
had become progressively confused and lethargic.
The blindness continued and increasingly progres-
sive right-sided weakness was noted.
Examination at this time showed a lethargic, stu-
porous patient who was unable to communicate. He
916
The Ohio State Medical Journal
had a right central facial paralysis and a right hemi-
paresis. The right fundus showed papilledema with
flame-shaped hemorrhages surrounding the optic disk.
No papilledema was noted on the left.
The admission laboratory work showed a hemo-
globin of 15.1 Gm., hematocrit 45 per cent, leu-
kocytes 25,500 with 89 per cent neutrophils. The
BUN was 10 mg. per 100 ml. The urine was not
remarkable.
A left carotid angiogram showed a marked shift
of the anterior cerebral artery to the right. A defi-
nite tumor was noted in the area of the hypothal-
amus. The patient became gradually unresponsive
and died on his fourth hospital day.
CLINICAL DISCUSSION
Dr. Hunt: We are presented with a middle-
aged barber who was well until about a year prior
to his first admission to the hospital, at which time
he had noticed redness and inflammation of the left
eye. He was treated with glasses. The inflamma-
tion cleared, the protocol states, spontaneously, except
for an occasional light spot which appeared in the
central vision of the left eye and was episodic in
nature. So we are talking in two different contexts:
one is the signs of inflammation in the globe and
the other is the sign of impairment of vision, and
these are of greatly differing significance. In fact,
as the history develops, I would almost be inclined
to say that the redness and inflammation of the eye
had nothing whatever to do with the case. How-
ever, we should keep in mind the possibility that the
subsequent events here may have been the result of
inflammation. If they were, this inflammation in-
volved the eye as well as the intracranial contents,
because of subsequent fatal brain involvement. So
we have to keep in mind the differential diagnosis
of inflammatory disorders.
Progressive Unilateral Blindness
In any event, these things happened to him a year
prior to admission, and then he did quite well until
about four weeks prior to admission when he rapidly
started to become blind in the left eye, and you
wonder if this is a natural extension of this inflam-
matory condition or whether something new is hap-
pening. He had a little left-sided frontotemporal
headache. This is of considerable importance be-
cause headache comes from a limited number of
sources, such as traction or dilatation of blood ves-
sels, or inflammation of blood vessels or meninges in
locations where sensory fibers are passing through the
dura. The concept of inflammation includes blood in
the subarachnoid space as well as infections and
periarteritic and collagen-like disorders, and mechani-
cal distortion. The degenerative diseases of the ner-
vous system that make one blind, such as multiple
sclerosis, are ordinarily not painful.
The patient went rather rapidly blind in the left
eye. On examination the left pupil did not react to
light. The reaction to accommodation meant that the
fibers of the efferent side of the reflex that constrict the
pupil were intact, because it could be fixed by accom-
modation but not by light. There was moderate dry-
ness and scaliness of the skin covering his entire body.
It makes us think of neuro-endocrine disturbances.
We are already thinking about intracranial lesions that
involve the optic nerve, which is in the vicinity of the
chiasm and the pituitary. So there is a natural chain re-
action in the neurologist’s thinking. When he sees
somebody coming in with blindness he gets interested
in his potency, his skin, what her menstmal period is
like, and the weight change and the urinary patterns.
You never think of the chiasm without thinking of
the endocrine system.
So we proceed then to his admission laboratory work,
and his urine, BUN, fasting blood sugar, hemoglo-
bin, hematocrit, leukocyte count, and serology were
all normal, as were his electrocardiogram and his
chest x-ray. Any time you think of intracranial dis-
ease you think of the chest since many intracranial
disorders spread from the chest. I don’t know
whether or not the pituitary was involved. I do
know that the optic nerve on the left side was
involved in some pathological process behind the
globe which did not interfere with the flow of its
parasympathetic and sympathetic fibers to the globe.
The skull x-rays showed suggestive erosion of one
anterior clinoid; this is not firm enough for conclu-
sions. The optic foramina, however, were not en-
larged and this tells me that there was no tumor within
the substance of the optic nerve inside the optic
foramen. There was no tumor within the substance
of the optic nerve inside the orbit since no description
of proptosis was made. Therefore, if the process
was neoplastic, it was intracranial, and if it was in-
flammatory, it was along the course of the optic nerve,
and it is unlikely to have been degenerative because
there was pain. Of course, as we read on, the course
looks very much like a neoplasm or some savage,
inexorable inflammatory process.
Frontal Lobe Lesion?
Then we get our first "curve” here. Here was a
man who was normal except for his optic nerve, but
we find that there was a 5-6 second slowing over
the left temporofrontal and central areas, and this
makes you take notice immediately. Are we dealing
with secondary involvement of the optic nerve by a
lesion in the silent frontal lobes of the brain? Lum-
bar puncture was done and he had increased intra-
cranial pressure, if this recording is correct. It doesn’t
specify whether the patient was sitting or lying down,
whether or not he was properly relaxed. It is pos-
sible that the examiner may have been paying too
little attention to some of the things that will give you
a false high.
Let’s say that this means something, and when I
find in addition a protein of 86 mg. in an otherwise
normal spinal fluid I am taking very sharp notice of
for September, 1966
917
what’s going on. It means that he had organic dis-
ease of the nervous system. Elevated protein occurs
also in myxedema and this feeds us back to the
dry, scaly skin. Also the breakdown of the blood-
brain barrier in inflammatory disease and in neoplastic
disease will let plasma protein find its way in in-
creased amounts into the spinal fluid. We know
then that we are not dealing with any neat, encap-
sulated lesion like a pituitary adenoma or a cranio-
pharyngioma or an optic nerve glioma. Whatever
this was was big enough, inflammatory enough, ne-
crotic enough, producing stasis, degeneration, to cause
increase in CSF pressure, an EEG focus, and elevated
protein. None of these would happen in retrobulbar
neuritis that involves the optic nerve on one side.
When he was hospitalized, he was subjected to
angiography and they found evidence of a mass,
which confirms our original presumptions here.
Pneumoencephalogram also showed a mass bulging
into the third ventricle. The elevated protein was
confirmed, and he was subsequently subjected to
craniotomy, exploration, and biopsy. May we see
the x-rays at this point?
Discussion of X-Ray Findings
Dr. Dunbar: In the initial lateral skull film
the paranasal sinuses appeared normal. There is some
erosion of the anterior clinoid, which is not a firm,
solid diagnosis when the sella itself is normal, and
the posterior clinoids don’t show any evidence of
demineralization. In the initial left carotid arteri-
ogram the a.-p. projection shows slight pulling of the
anterior from left to right and slight elevation of the
initial part of the anterior cerebral. The middle
cerebral on this projection is essentially normal.
Dr. Hunt: I would call that a little more than
slight, just in the interests of future discussion, be-
cause ordinarily the anterior communicating lies on
the level of the bifurcation of the internal carotid,
doesn’t it?
Dr. Dunbar: Yes, I don’t think there is any
question that the elevation is definite.
Dr. Hunt: So we’ve got some mass on both
sides of the artery.
Dr. Dunbar: There is a mass both under the
initial portion and also on the left side. The lateral
view shows an elevated portion of the anterior cere-
bral artery and a hint of elevation of the middle
group. I will go back to the initial arteriogram and
show that the mass above the sella is the major con-
crete finding on this initial arteriogram. On pneu-
moencephalography in the occipital projection the
filling of the ventricle is not good, but this is most
likely the anterior third ventricle, shifted from left to
right, and there probably is evidence of a mass lesion
projecting back of the suprasellar area and displac-
ing the anterior third ventricle from left to right.
From these initial studies I would have to say that
there was evidence of a suprasellar mass, but I would
be unsure of the temporal component — whether
there was a mass beneath the middle cerebral artery
or not.
Dr. Hunt: Is this mass entirely extracerebral
or is it intracerebral?
Dr. Dunbar: Such an extensive lesion, going
back along the third ventricle, would make me feel
that it was within the brain probably.
Dr. Hamwi : Do you see any pineal calcifications ?
Dr. Dunbar: No, and also no definite shift.
Dr. Hunt: The critical points Dr. Dunbar has
touched on indicate that there was a mass. Many of
the benign lesions, like suprasellar adenomas, don’t
elevate the protein, don’t increase intracranial pres-
sure, don’t produce electroencephalographic foci, but
will elevate the anterior cerebral just as this mass did.
But this mass also shifted the anterior across the mid-
line and it also produced a bend in the third ventricle
that suggests, as Dr. Dunbar pointed out, that this may
have a significant intracerebral component.
An extracerebral exploration was done first. The
left optic nerve was said to have been enlarged. "No
mass was found.’’ This is the statement of the pro-
tocol. I would have to say that an optic nerve four
to five times the size of a normal optic nerve is a
mass. This is too big for about anything I know
of but tumor. I am sure this refers to the fact that
no other mass was found. There obviously also was
inflammatory reaction, possibly secondary to neoplasia.
The arachnoid was biopsied. The patient recuperated.
I presume we will be told what the biopsy showed.
Dr. Liss: The submitted specimen of arachnoid
from the optic nerve and from the frontal lobe
showed reactive fibrosis and no neoplastic elements.
Dr. Hunt: Very good. Postoperatively, he had
a minor urinary infection. He developed some new
visual field loss but recuperated fairly well. When
he was admitted again, a month after his first dis-
charge, he had done poorly; he showed progressive
confusion and lethargy, the blindness continued, and
he started to get weak on the right side. So here
was a man who was showing progressive damage
to his left cerebral hemisphere with hemiparesis,
confusion, lethargy, and drowsiness. Are we missing
a major endocrine disorder to account for his leth-
argy, etc ? Probably not, because he had a progressive
focal neurological sign referable to the area of the
brain that we have already been looking at closely.
What sorts of inflammatory disease have this in-
exorable steady progression ? Really none that I
know of. The arteritic phenomena look like vascular
syndromes, but they can also be excluded. An oc-
casional parasitic infestation ? When I’m looking for
something unlikely to bring up in the presence of an
intracerebral mass I think of a case of schistosomiasis
of the brain in a man who had been swimming in
918
T he Ohio State Medical Journal
fresh water in Leyte, but I don’t expect that to crop
up more times in my life. So I think it unlikely
that we have a case for inflammatory disease.
So he was lethargic, stuporous, and he had papil-
ledema. His increased pressure had progressed. He
had a right hemiparesis, and on the left side he
had no choked disk or optic atrophy.- This is the
Foster Kennedy syndrome, which is supposed to be
a sign of tumor that compresses one optic nerve and
produces increased intracranial pressure that chokes
the other optic nerve. This confirms my impression
that we are dealing with a brain tumor. The carotid
arteriogram shows that he had a tumor as predicted.
Four Brain Tumors
I would like to emphasize that the neurosurgeon
thinks of there being four brain tumors: neoplasm,
hematoma, abscess, and brain swelling from whatever
cause. Now this patient had a tumor, and since he
had a "definite tumor in the area of,” I wonder if
they mean that they saw a vascular stain that makes
it neoplasm, or do they simply mean that they found
an extension of what we thought was a mass in the
first place? If there was no tumor stain, with this
progression, I would rule out tumor due to bra;n
swelling alone. I would mle out hematoma because
of onset and progression. I would think that abscess
was a distinct possibility because of the inflammatory
reaction, and I would think avascular neoplasm,
purely for statistical reasons, was the most likely
diagnosis. And if there was a tumor stain, a
vascular stain, I would say vascular neoplasm. Ob-
viously, a vascular neoplasm in the context that I
am using the word is not any basic classification.
Dr. Dunbar: In the left carotid arteriogram
the displacement from left to right is greatly increased
over the previous examination. The elevation of the
proximal portion of the anterior cerebral retains its
relatively normal course. The mass lies between the
anterior and middle cerebral arteries. The lateral
projection shows markedly abnormal vascularity
throughout a very large area. It demonstrates clearly
a large malignant neoplastic stain throughout this
region. The malignant lesion is both suprasellar and
deep in the thalamic and the junction of the temporal
and frontal lobe areas. I presume it’s a cerebral
tumor such as a glioblastoma. From the stain it looks
a little like meningioma. It is rather homogeneous
and fleshy and must have stayed there for a long
period of time.
Diagnostic Criteria
Dr. Hunt: Thank you, Dr. Dunbar. Then we
are down to a vascular neoplasm. The question of
malignancy, however, remains with us. The criteria
for the diagnosis of brain tumor are based upon the
rate of filling of the capillary bed of the tumor, the
rate of emptying, how early the veins appear, what
the pattern of the vascular change is, and what the
relationship of surrounding vessels is that may tell you
that this mass was intracerebral or extracerebral. On
purely statistical grounds glioblastoma multiforme
is the commonest, although of course there are various
sarcomas, metastatic neoplasms for which the primary
has not been found, and a variety of other malignant
tumors of brain substance that could be present. My
final diagnosis is tumor of the posteromedial frontal
lobe involving the lateral wall of the hypothalamus
and invading, if not originating in, the left optic
nerve — probably malignant glioma.
Dr. Meagher: Do you think his tumor was of
a year's duration? Do you think his initial symp-
toms in which he had apparently a scotoma were
related to his terminal illness?
Dr. Hunt: I think probably not. Certainly I
don’t think the red, inflamed eye was, because there
was never any recurrence of any signs of extracranial
inflammation. What this "occasional light spot” in
the central vision of the left eye really means, I
don’t know.
Dr. Meagher: Ordinarily, what do you think
of first in a patient with rapid loss of visual acuity
without pain?
Dr. Hunt: And with virtually no findings on
funduscopic examination? This is the classic syn-
drome of what the ophthalmologist refers to as
retrobulbar neuritis in which neither the patient nor
the doctor can see anything. It’s a dangerous diag-
nosis. In the first place, it ought to be translated
"retrobulbar neuropathy,” and a very common cause
of retrobulbar neuropathy is retrobulbar neuritis, but
another common cause of retrobulbar neuropathy is
pituitary adenoma, parasellar tumor. So the diag-
nosis can’t be taken lightly. The rapid onset, the
rapid progression and stabilization, however, fit this
general category of disorders until you begin to find,
as we said early, that there is more to it than this.
Dr. Meagher: Given a patient with idiopathic
or asymptomatic optic atrophy, should this be investi-
gated in any way?
Dr. Hunt: Our policy has been that any pro-
gressive, unexplained — and take careful note of
both those words — any progressive, unexplained
blindness calls for surgical exploration of the optic
chiasm regardless of negative radiographic informa-
tion. An article has been written surveying a number
of patients that have been managed with this polity
and about 50 per cent of that series did have surgical
disease of the optic chiasm. Within the past twro
years we have applied this to two patients and found
in an elderly woman a craniopharyngioma, in a 40-
year-old man a cystic tumor of the stalk of the pitui-
tary. Both of these were benign lesions amenable
to complete cure. So it’s a sound polity’ and I
think it’s worth emphasizing.
Dr. von Haam: You never discussed the pos-
sibility of metastatic disease and its importance for
for September, 1966
919
clinical diagnosis. Are there any arguments pro and
con ?
Dr. Hunt: Actually metastatic neoplasm has a
tendency to act like a malignant glioma in that it
progresses rapidly and is intracerebral, but it often
has the relatively slow circulation of the meningioma.
So perhaps it would not be a bad idea to point out
that a metastatic tumor is as valid a diagnosis as
primary tumor, even though we have not found the
primary. I think one of the things that I have left
out is the possibility of a tuberculous granuloma,
which would give us this picture.
CLINICAL DIAGNOSIS
Malignant glioma
PATHOLOGIC DIAGNOSIS
Neuroblastoma
DISCUSSION OF PATHOLOGY
Dr. Liss: At the time of autopsy there was found
bilateral hemorrhagic bronchopneumonia. The main
pathological findings were limited to the brain. On
the base of the brain there were many cauliflower-
like protrusions from the left frontal lobe. In the
middle fossa there was a thickening of the left optic
nerve and chiasm. On sagittal section a large neo-
plasm, fairly well circumscribed, has pushed the
chiasm forward. There is also evidence of congestion
and hemorrhagic infarct in the midbrain area, which
is secondary to the increased intracranial pressure and
the shift. The neoplastic mass was involving the
hypothalamus, the posterior portion of the left frontal
lobe, the optic chiasm, and the left optic nerve. The
extension into the left frontal area looks well circum-
scribed. If you have a tumor originating from the
chiasm, the optic nerve, or hypothalamus, it will not
infiltrate but will invade brain from the base, and
what you see is invagination of brain tissue caused by
the pressure of the tumor from below. So we can
get this appearance of separation between brain tissue
and the tumor, which gives grossly the appearance
of a metastatic lesion.
The histologic sections show the pleomorphism of
this tumor. There are large giant cells, small round
cells, and intermediate forms. The large cells form
clusters which are well circumscribed and surrounded
by vessels and perivascular connective tissue. In
silver impregnation, the characteristics of the tumor
cells are easily recognizable. The neurons and oli-
godendroglial elements can be demonstrated. There
are distinct satellite fibers from the oligodendroglial
cells and astrocytes. Some of the large neoplastic
cells have distinct satellite formation of oligoden-
droglia. Of course, oligondendroglia always will ar-
range around neurons no matter whether this is a
normal or a neoplastic neuron. This should be con-
sidered as an indicator that we are dealing with a
tumor of ganglionic origin, not of glial origin. The
oligodendroglia will never surround the large cells in
glioblastoma in this fashion.
The neoplastic cells have many processes as in
gangliocytoma of the sympathetic system. The least
differentiated types are the large cells with few
processes. The large number of processes through-
out this tumor is derived both from the neoplastic
cells and from the glial elements. The poorly dif-
ferentiated neuroblastic elements form characteristic
islands. The optic nerve is markedly enlarged. The
central area of the optic nerve is unchanged except
for some increase in glial population which should be
regarded as reactive. Only few nerve fibers are
surviving; they are thickened and form bulbs and
skeins. These signs of destruction explain the inter-
ruption of function by pressure. The meninges of
the optic nerve are infiltrated by tumor cells.
In conclusion, we are dealing here with a malig-
nant neoplasm which should be designated as gangli-
oblastoma, and because of its neuronal characteristic
I would assume that this neoplasm arose in the hy-
pothalamus. In the hypothalamus, areas of hetero-
topia frequently occur, and there is a possibility that
a displaced island of not maturing neurons, located
paraventricularly, can be a potential tumor.
General Discussion
Dr. Meagher: When I explored this patient,
there was a dense inflammatory reaction of the optic
nerve and the basal portion of the frontal lobe was
densely adherent and literally sharp dissection was
necessary to dissect the arachnoid covering of the
frontal gyri from the optic nerve. We felt that this
man had neoplasm which we didn’t find and we
knew he would come back. It was a highly malig-
nant tumor and it was not compatible with a life
span of more than four to six months.
Question : Retrospectively, would you have done
a biopsy of the optic nerve? Was this part with the
tumor in it available for biopsy at surgery?
Dr. Meagher: We biopsied brain and found no
contiguous neoplastic elements in the frontal gyri.
We felt that if this were reactive fibrosis or gliosis
secondary to an adjacent tumor, we should have had
it in our frontal lobe biopsies, and we were left with
what we thought at surgery was a granulomatous mass
etiology unknown, possibly inflammatory. We had
nothing to gain by biopsying the optic nerve and
we maybe had a slim chance of losing something.
Retrospectively, it would have been nice to biopsy
the optic nerve, but I doubt if we would have found
much in the nerve at that time.
Dr. von Haam: If you had stuck a needle
into the thalamic area, would definite injury result?
Dr. Meagher: We don’t like to put needles up
into this area, either from laterally or below. I
think we could have biopsied a piece of the tumor,
but again, we were trying to hook up the optic nerve
920
The Ohio State Medical Journal
and the adjacent frontal lobe. We saw a suprasellar
mass, which was our diagnosis at the time of surgery.
Question: Dr. Liss, was the immediate cause of
death central nervous system involvement or was it
something else?
Dr. Liss: Bronchopneumonia was found also
at the autopsy, but it was a contributing cause only.
The cerebral neoplasm with resulting edema and
shift was the cause of death.
Question: Would syphilis with a gumma for-
mation ever give a picture like this?
Dr. Meagher: I think it can give a parenchymal
inflammatory response but it wouldn’t give a mass
in the hypothalamus and progressive loss of vegeta-
tive function with focal neurologic deficit. I have
not seen these gummas — these were long before
my days. Can you recall any of these?
Dr. von Haam: To me, there is no difference
between gumma and tumor. They act alike.
Dr. Meagher: You saw them quite frequently?
Would they invade the hypothalamus? Would you
ever see gummas originating in the hypothalamus?
Dr. von Haam: In the hypothalamus they form
round, circumscribed lesions.
Dr. Hunt: I have seen one in that short two-
year period before syphilis was stamped out. They
certainly do deceive you. They look like gliomas
when they are in the brain. They also can produce
a syphilitic periostitis with hyperostosis and look like
a meningioma.
Dr. Liss: One case in our series is a 55-year-old
woman who had a gumma of the medulla, which,
although rare, does occur sporadically.
Dr. Hunt: I would like to point out here that
we knew roughly where something was going wrong
and at what rate. This is the order in which you
must approach the problem, and I think this problem
was approached and handled as well as it could be
handled.
Cornpicker’s Pupil
A Clinical Note Regarding Mydriasis from Jimson Weed Dust (Stramonium)
James A. Goldey, M. D., Dover A. Dick, M. D., and William L. Porter, M. D.*
IN THE FALL of 1965 we had occasion to see a
young man who presented with the single physi-
cal finding of a widely dilated left pupil. He was
referred to a neurosurgeon who performed an exten-
sive neurologic evaluation. However, no explanation
was found. After four days the pupil was entirely
normal.
Approximately two weeks later the same patient
returned with both pupils dilated. . At that time he
made the observation that on both occasions he had
been picking corn with a mechanical corn picker and
had got dust in his eyes. Upon further questioning
we learned that his cornfield contained considerable
amounts of jimson weed (Stramonium). With no
treatment his mydriasis completely subsided in several
days.
In the next two weeks we had occasion to see two
other farmers, each presenting with mydriasis as his
only physical finding. Each had been picking corn.
Upon further questioning jimson weed was deter-
mined to be present in their cornfields.
Ccrnpicking requires that the operator on occasion
climb under the machine on his back to remove ob-
structions. Each patient admitted to having perspira-
tion running into his eyes frequently during the day’s
work. Stramonium leaf contains more than adequate
amounts of atropine-like alkaloids to account for the
mydriasis.
To the best of our knowledge, "cornpicker’s pupil’’
has not been previously reported. In publicizing our
recent experience with this phenomenon we hope
that other farmers demonstrating this finding may be
spared needless expensive and painful neurologic
studies.
*Drs. Goldey, Dick, and Porter, are in general practice, Oxford,
Ohio.
Editor’s Note: Consult index for editorial comment on this interesting subject.
for September, 1966
921
Proceedings of The Council . . .
Report of Matters Considered and Actions Taken
At the Meeting Held in Columbus, July 23 and 24
A REGULAR MEETING of The Council of the
Ohio State Medical Association was held
- July 23 and 24, 1966, at Stouffer’s University
Inn, Columbus. All members of The Council were
present except Dr. George Newton Spears, Ironton,
Councilor of the Ninth District. Others attending
the meeting were: Dr. Charles L. Eludson, Cleveland,
President of the AMA; Dr. John H. Budd, Cleve-
land, chairman, Ohio delegation to the American
Medical Association; Mr. Wayne Stichter, Toledo,
OSMA legal counsel; Dr. William T. Washam, Co-
lumbus, executive secretary, Ohio State Medical
Board; Mr. Denver L. White, director, Mr. Robert
B. Canary, assistant director, and Mr. John Main,
chief of administrative services, Ohio Department
of Public Welfare; Mr. James Imboden, Columbus,
American Political Action Committee; Mr. Charles
H. Coghlan, executive vice-president, Ohio Medical
Indemnity, Inc.; Messrs. Page, Edgar, Gillen, Traph-
agan, Campbell and Moore, members of the OSMA
staff.
Introductions by the President
Dr. Meredith introduced Dr. Charles L. Hudson,
Cleveland, President of the American Medical Asso-
ciation, and Mr. Jerry J. Campbell, Columbus, who
joined the OSMA staff July 18, 1966.
Minutes Approved
Minutes of meetings of The Council held April
23-24 and May 27, 1966 were approved by official
action.
Membership Statistics
The following membership statistics were an-
nounced by Mr. Page: OSMA membership as of
July 22, 1966, 9,901, compared to a total member-
ship of 9,830 on July 22, 1965, and 10,042 on De-
cember 31, 1965. He reported that of 9,901 mem-
bers, 8,875 were affiliated with the AMA.
The Ohio State Medical Board
Dr. William T. Washam, Columbus, executive
secretary of the Ohio State Medical Board, was intro-
duced. Dr. Washam addressed The Council and dis-
cussed certain desirable changes in the Ohio Medical
Practice Act. Dr. Washam emphasized the fact that
the Act is a good one and basically sound. The new
secretary expressed a desire for cooperation between
his office and that of the Ohio State Medical Asso-
ciation.
A letter from the Academy of Medicine of Cin-
cinnati with regard to enforcement problems was re-
ferred to the Ohio State Medical Board.
Department of Welfare Advisory Committee
Dr. Light reported on meetings of the Ohio De-
partment of Welfare Advisory Committee.
Report on June AMA Meeting
Dr. Budd, chairman of the Ohio delegation to the
American Medical Association, reported to Council
on the 1966 annual meeting of the American Medical
Association. He advised The Council concerning the
922
The Ohio State Medical Journal
disposition of the following resolutions which origi-
nated from Ohio:
AMA Resolution No. 56 (OSMA House of Dele-
gates Resolution No. 21 from Stark County), provid-
ing that all patients eligible for military dependents,
medical care be afforded the same option of reim-
bursement provided for patients eligible for benefits
under Public Law 89-97, was amended to add a pro-
vision for usual and customary fee and was adopted.
AMA Resolution No. 57 (OSMA Resolution No.
36 from Huron County), with regard to protection
of the American Public against contaminated articles,
was adopted.
AMA Resolution No. 58 (OSMA House of Dele-
gates Resolution No. 23 from Summit County), on
the subject of endorsement of the "open staff” for
hospitals, was not adopted, but the AMA House re-
affirmed four previous principles established by that
body covering the subject of "open staff.”
AMA Resolution No. 59 (OSMA Resolution No.
45 from Cuyahoga County), with regard to sub-
scribers to Part B of Medicare being entitled to treat-
ment as private patients, was adopted as introduced.
AMA Resolution No. 99 (OSMA Resolution No.
46 from the Second Councilor District) was regard-
ing Civil rights pledges and agreements. The AMA
adopted a substitute resolution asking the AMA to
assist the state societies by working at the national
level to eliminate the requirements for such agree-
ments and pledges.
AMA Resolutions No. 73 and No. 105 on Medi-
care Regulation No. 5. A substitute resolution drafted
and submitted by the Ohio delegation, covering a
statement opposing sections of Medicare Regulation
No. 5, was adopted by the AMA House of Delegates.
AMA Resolution No. 1 was introduced as di-
rected by the OSMA Council. It specified that in the
case of resolutions referred to AMA Councils and
Committees, representatives of the states where the
resolutions originated be asked to attend hearings
thereon. The resolution was made permissive and
adopted.
AMA Resolution No. 2, calling for quarterly ses-
sions of the AMA House of Delegates and intro-
duced as directed by the OSMA Council, was referred
to the Board of Trustees.
AMA Resolution No. 3, on osteopathic intern-
ships and residencies in AMA approved programs,
introduced as directed by the OSMA Council, was
referred to the Board of Trustees.
Other Resolutions
Others of interest were AMA Resolutions No. 8
and No. 42 on usual and customary fee and AMA
Resolution No. 53, a policy statement on government
medical programs almost identical to the statement
drafted by the OSMA Council on March 20, 1966
and contained in OSMA Medicare Newsletter No. 3.
All were adopted on the floor of the House in lieu
of a substitute statement recommended by the AMA
Reference Committee "A” on Insurance and Medical
Service. The motion to adopt the original resolutions
was made by Dr. Budd, representing the Ohio dele-
gation.
AMA Resolution No. 104, introduced by the
Oregon delegation, was adopted. This resolution
would make it unethical for a physician to replace a
physician who had been displaced from a hospital
staff because of his insistence on following the pro-
cedure of direct billing.
"Usual and Customary” Definition
Report H of the Council on Medical Service, which
would have changed the definition of usual and cus-
tomary fees for professional services, was referred
back to the Council on Medical Sendee for further
study, with a request to report to the House at the
1966 clinical convention. It was reported that the
Ohio State Medical Association is requesting the
privilege of appearing before the Council on Medical
Service, since attempts are under way to interpose
the "prevailing fee” concept into the definition.
American Medical Association dues were raised
from $45 to $70 a year starting January 1, 1967.
Dr. Charles L. Hudson, Cleveland, was installed
as President of the AMA.
Dr. Budd, chairman of the Ohio delegation, com-
plimented the Ohio State Medical Association on its
series of Medicare newsletters which have received
acclaim throughout the country.
Director of Public Welfare and Staff
The Honorable Denver L. White, director of the
Ohio Department of Public Welfare, then addressed
The Council. Mr. White was accompanied by Mr.
Robert Canary, assistant director and Mr. John
Main, chief of administrative services. Mr. White
expressed appreciation for the cooperation of the
Ohio State Medical Association. He then reviewed
the history of the public assistance program in Ohio
and related the changes brought about by House Bill
37 6 in the 1965 Ohio General Assembly. Such bill
placed aid for dependent children, aid for the blind,
aid for the disabled, and aid for the aged under
county administration supervised by the State Depart-
ment of Public Welfare. He indicated that this will
result in a single program approach and a more uni-
form one.
Following this, considerable time was devoted to
a discussion of Title XIX. Subsequently, The Council
adopted the following statement and asked that it be
published in the OSMAgram for the information of
the membership:
for September, 1966
923
Text of Council Statement
The Council of the OSMA commends the Ohio
Department of Public Welfare for its expressed
interest in developing a usual, customary, and reas-
onable fee program as a basis for reimbursement of
physicians for professional medical sendees pro-
vided welfare patients.
The usual, customary, and reasonable fee concept
is in keeping with the policies of this Association
as established by its House of Delegates and The
Council.
For definitive purposes, usual, customary, and
reasonable fee is defined as follows:
Usual — The "usual” fee is that fee usually
charged for a specific service provided by an indi-
vidual physician for his patient.
Customary — A fee is "customary” when it
properly reflects the extent and nature of the serv-
ices provided the patient.
Reasonable — A fee is "reasonable” when it
meets the "usual and customary” criteria or, in the
opinion of a duly constituted medical society re-
view committee, is justified under what is con-
sidered a complexity of treatment which merits
special consideration.
This Association assures the Ohio Department
of Public Welfare that the usual review mecha-
nisms for such programs will be readily available
to the department.
In recognition of the fact that development of
this program must be based on adequate fiscal re-
sources being available for the department, The
Council of the OSMA will, for the time being, co-
operate with the department in a project whereby,
pending development of fiscal and actuarial exper-
ience, each physician will bill his usual, customary,
and reasonable fee and the department would re-
imburse the physician such a percentage of his
usual, customary, and reasonable fee as is practica-
ble under the fiscal circumstances now existing.
It would be understood that the percentage reim-
bursement would represent the maximum amount
available under these circumstances.
It would be agreed that this program would be
followed until sufficient funds to provide full pay-
ment of the usual, customary, and reasonable fee
are appropriated by the 107th Ohio General As-
sembly. It would be further understood that this
Association would support heartily before the Gen-
eral Assembly the appropriation of such funds as
may be required for an adequate and equitable
program.
This Association would endeavor to inform its
membership of the need for cooperation during
this temporary situation. The Welfare Department
also must endeavor to instruct welfare workers,
the people of Ohio, and the members of the Gen-
eral Assembly as to the gross inequities of the pro-
gram which have existed for 20 years.
This Association would point out that these wel-
fare medical care programs were established by
acts of the Ohio General Assembly and the United
States Congress, and that the responsibility for
adequate funding of such programs rests with the
General Assembly and the Congress.
1966 Annual Meeting
Mr. Traphagan reported on the 1966 Annual
Meeting in Cleveland. It was announced that the
scientific programs were unusually well attended.
1967 Annual Meeting
Mr. Traphagan discussed plans for the 1967 An-
nual Meeting. In that connection The Council di-
rected that all scientific programs be under the control
of the Committee on Scientific Work and that the
committee suggest the type and content of general
session programs presented by other organizations.
Referral of Resolutions
The Council then took up resolutions adopted by
the 1966 OSMA House of Delegates:
Amended Resolution No. 15, Hospital Admission
— With regard to the interpretation of Amended
Resolution No. 15, The Council concurred with op-
position to additional forms for the certification of
the necessity for the admission of Medicare patients
to the hospital. The Council did suggest, however,
that some statement of the necessity for admission is
presently required by law and that any method used
must originate with knowledge and approval of the
medical staff.
(All that the Social Security Administration re-
quires, according to information received at the
OSMA Headquarters, is an entry on the progress
notes of the physician, accompanied by his signature.)
Substitute Resolution No. 16, Reimbursement for
Services of Hospital-Based Physicians — The OSMA
staff was instructed to follow up on the resolution by
petitioning the Director of Insurance to require re-
moval from all prepaid hospital insurance plans pro-
visions for benefits covering physicians’ sendees.
Amended Resolution No. 24, Standardized
Claims Form — A suggested standardized claims form
developed to comply with the resolution was pre-
sented by the OSMA staff. In addition, forms used by
Ohio Medical Indemnity, Inc., Medical Mutual of
Cleveland and the Summit County Medical Society
were discussed. The form recommended by the
Health Insurance Council and approved by the Coun-
cil on Medical Service of the American Medical As-
sociation was reviewed. All were submitted to the
OSMA Insurance Committee with a request that a
924
The Ohio State Medical Journal
single form be developed and submitted to The
Council in September.
Resolution No. 30, Licensing Foreign Graduates
— This resolution was referred to the Judicial and
Professional Relations Committee.
Amended Resolution No. 32, Voluntary Health
Insurance — This resolution, calling for the contin-
uance of voluntary health insurance for persons 65
and older, was referred to the Insurance Committee
of the Ohio State Medical Association.
Amended Resolution No. 37, Health Insurance
for Migrant Workers — This resolution was referred
to the Insurance Committee of the Ohio State Medi-
cal Association.
Editorially Changed Resolution No. 39 — To
Upgrade the Education of the Hearing Handicapped
— This resolution was referred to the Committee on
Public Relations and Economics.
Substitute Resolution No. 29, Training More
General Practitioners - — This resolution was referred
to the Committee on Education.
Amended Resolution No. 42, Defining "receipted
bill” for Participants of Part B of Medicare — This
resolution was discussed by The Council. The Council
was advised of the passage of Resolution No. 22 at
the AMA 1966 Annual Meeting in Chicago, which
established AMA policy that the words "receipted
bill” be changed in the law to "physician’s bill.” The
Council voted to support and encourage action of the
American Medical Association to obtain passage of
this legislation.
Amended Resolution No. 17, Physicians, Ethics
and the Corporate Practice of Medicine — This reso-
lution was referred to the Judicial and Professional
Relations Committee for implementation and the
Executive Secretary was instructed to notify all county
medical societies of its adoption by the OSMA House.
Reports of Councilors
The Councilors reported on activities in their re-
spective districts.
Cleveland Academy of Medicine Amendments
The Council voted to approve amendments to the
constitution and bylaws of the Academy of Medicine
of Cleveland, subject to a minor clarification.
Jefferson County Amendments
The Council advised the Jefferson County Medical
Society to clarify its proposed amendments by amend-
ing the bylaws section on the classification of mem-
bers in order to include a classification of "retired
membership.”
Lawrence County' Amendments
Proposed amendments to separate the office of
Secretary-Treasurer to Secretary and Treasurer were
submitted by the Lawrence County' Medical Society'.
The Council expressed the opinion that these
amendments were not properly drafted and author-
ized Mr. Stichter to prepare suggested amendments to
carry out the purposes expressed by the society.
Lorain County Amendments
The proposed amendments to the constitution and
bylaws of the Lorain County Medical Society' were
then considered. The Council requested the Executive
Secretary to obtain clarification of proposed amend-
ments to Section 1, Chapter 5, asking that it be speci-
fied by whom the dues of active members or associate
members shall be "determined.” It was also suggested
that the percentage of dues for nonresident members
be based on the "active” membership dues rather
than on "regular” dues since there is no membership
category specified as "regular.”
Committee Reports
Athletic Injuries — The minutes of a meeting of
the Joint Advisory Committee on Athletic Injuries
held April 27, 1966 w'ere approved. Mr. Gillen re-
ported that the Advisory Committee had postponed
the Postgraduate Institute on Athletic Injuries until
1967 and that the Joint Committee on Athletic In-
juries would cosponsor with the Ohio State Univer-
sity Physical Education Department and Ohio High
School Athletic Association a workshop for high
school student trainers this year.
Rural Health — The Council approved the min-
utes of a meeting of the Subcommittee on Rural
Health Scholarships held July 13, 1966, at which
time Messrs. Harold L. Mast, Smithville, and Lawson
C. Smart, Boardman, were selected as winners of the
annual $2,000 OSMA scholarships.
Hospital Relations — On the recommendation of
the Committee on Hospital Relations, The Council
approved the cosponsorship of a one-day meeting on
area-wide planning of health facilities with the Ohio
Hospital Association and the Ohio Association ' of
Osteopathic Physicians and Surgeons. The tentative
date for this meeting is Sunday, January 15, 1967.
Emergency Nursing Procedures - — - A letter from
the Ohio State Nurses Association, asking modifica-
tion of the Ohio State Medical Association statement
relating to emergency nursing procedures, was dis-
cussed by The Council. By official action, The Coun-
cil expressed the opinion that it sees no reason to
change the original Ohio State Medical Association
statement.
Environmental and Public Health — The min-
utes of the first meeting of the new Committee on
Environmental and Public Health held July 20
were presented by Mr. Gillen. The minutes were
approved as presented.
Cancer — Mr. Traphagan presented the minutes
of a meeting of the Ohio Cancer Coordinating Com-
for September, 1966
92 5
new
^£>°
X\^
\*
a new formulation
that relieves pain
in tension headache
and neuralgia
Dialog is a combination of 15 mg allobarbital and
300 mg acetaminophen. Allobarbital, a proven bar-
biturate, provides desirable sedation in patients
experiencing pain and discomfort. Acetaminophen
is a nonsalicylate analgesic-antipyretic, well tolerated
and useful in a wide range of mildly painful and
febrile conditions.
Dialog is well tolerated, even by those sensitive to
aspirin. It is nonirritating to the gastrointestinal tract
and has no adverse effects on the kidneys.
• Raises the pain threshold
• Suppresses the pain-producing mechanism
2/3453MK— 2 • Reduces emotional tension
Many overweight patients
can benefit from the appetite
control provided by the sustained
anorexigenic-tranquilizing
action of BAMADEX SEQUELS:
anorexigenic action of
amphetamine; tranquilizing
action of meprobamate;
prolonged action through
sustained release of
active ingredients.
Bamadex Sequels®
DEXTRO-AMPHETAMINE SULFATE (15 mg.) SUSTAINED RELEASE CAPSULES
WITH MEPROBAMATE (300 mg.)
to help establish
a new dietary pattern
Contraindications.- Dextro-amphetamine sulfate: in
hyperexcitability and in agitated prepsychotic
states. Previous allergic or idiosyncratic reactions
to meprobamate.
Precautions: Use with caution in patients hypersensi-
tive to sympathomimetic compounds, who have
coronary or cardiovascular disease, or are severely
hypertensive.
Dextro-amphetamine sulfate: Excessive use by un-
stable individuals may result in psychological
dependence.
Meprobamate: Careful supervision of dose and
amounts prescribed is advised, especially for pa-
tients with known propensity for taking excessive
quantities of drugs. Excessive and prolonged use in
susceptible persons, e.g. alcoholics, former addicts,
and other severe psychoneurotics, has been re-
ported to result in dependence on the drug. Where
excessive dosage has continued for weeks or months,
reduce dosage gradually. Sudden withdrawal may
precipitate recurrence of preexisting symptoms such
as anxiety, anorexia, or insomnia; or withdrawal re-
actions such as vomiting, ataxia, tremors, muscle
twitching and, rarely, epileptiform seizures. Should
meprobamate cause drowsiness or visual distur-
bances, reduce dosage and avoid operation of
motor vehicles, machinery or other activity requir-
ing alertness. Effects of excessive alcohol consump-
tion may be increased by meprobamate. Appropri-
ate caution is recommended with patients prone to
excessive drinking. In patients prone to both petit
and grand mal epilepsy meprobamate may precipi-
tate grand mal attacks. Prescribe cautiously and in
small quantities to patients with suicidal tendencies.
Side Effects: Overstimulation of the central nervous
system, jitteriness and insomnia or drowsiness.
Dextro-amphetamine sulfate: Insomnia, excitability,
and increased motor activity are common and ordi-
narily mild side effects. Confusion, anxiety, aggres-
siveness, increased libido, and hallucinations have
also been observed, especially in mentally ill pa-
tients. Rebound fatigue and depression may follow
central stimulation. Other effects may include dry
mouth, anorexia, nausea, vomiting, diarrhea, and
increased cardiovascular reactivity.
Meprobamate: Drowsiness may occur and can be
associated with ataxia; the symptom can usually be
controlled by decreasing the dose, or by concomi-
tant administration of central stimulants. Allergic or
idiosyncratic reactions: maculopapular rash, acute
nonthrombocytopenic purpura with pefechiae, ecchy-
moses, peripheral edema and fever, transient leu-
kopenia. A case of fatal bullous dermatitis, following
administration of meprobamate and prednisolone,
has been reported. Hypersensitivity has produced
fever, fainting spells, angioneurotic edema, bron-
chial spasms, hypotensive crises (1 fatal case),
anuria, stomatitis, proctitis (1 case), anaphylaxis,
agranulocytosis and thrombocytopenic purpura, and
a fatal instance of aplastic anemia, but only when
other drugs known to elicit these conditions were
given concomitantly. Fast EEG activity, usually after
excessive dosage. Impairment of visual accommo-
dation. Massive overdosage may produce drowsi-
ness lethargy, stupor, ataxia, coma, shock, vaso-
motor and respiratory collapse.
LEDERLE LABORATORIES
A Division of American Cyanamid Company,
Pearl River, New York
695-6
for September, 1966
mittee, Inc., held June 9, 1966 and they were ap-
proved as presented.
Mental Health — Minutes of a meeting of the
Committee on Mental Health, held June 12, 1966,
were presented by Mr. Traphagan.
The report carried with it the approval of the
publication of a "Pocket Manual for Hospitalization
of the- Mentally 111 in Ohio.” The manual on hos-
pitalization of the mentally ill, with appropriate edi-
torial amendments, will be mailed to all members of
the Ohio State Medical Association and subsequently
will become a part of the OSMA new member packet.
In addition, The Council approved the committee’s
work on the implementation of OSMA House of
Delegates resolutions calling for the initiation of leg-
islation to create a separate Department of Mental
Health and Retardation in Ohio; establishing a posi-
tion of Director of Mental Health who, if possible,
would be a doctor of medicine; and establishing a
Board of Mental Health to be appointed by the Gov-
ernor, such legislation to be submitted by the com-
mittee to The Council for review prior to further
implementation.
The mental health report contained plans for a
steering committee for the purpose of bringing infor-
mation to "primary care” physicians with regard to
useful psychiatry. The idea of the steering committee
was approved with the provision that the Ohio State
Medical Association would pay the expenses of
OSMA representatives only.
There was no action on the sponsorship of legisla-
tion to permit the State of Ohio to pay the cost of
care of patients who have been declared mentally ill
but for whom there is no room in the state hospital
system. The cost involved would be for hospitaliza-
tion in private psychiatric facilities. The Council ac-
cepted the idea in principle but took no action on the
suggestion that legislation be prepared by the OSMA
on this matter.
The Council discussed the proposal for a subcom-
mittee of the Committee on Mental Health to study
the problem and formulate a statement with regard
to the misuse of LSD, marijuana and other conscious-
ness expansion drugs and approved the study with
a suggestion that other drugs be added to the study.
The Council then approved the report as a whole,
as amended, and commended the committee for the
development of the manual.
Eye Care — The minutes of a meeting of the
Committee on Eye Care held July 17 were approved
as presented by Mr. Page.
The approval of the report carried with it approval
of proposed revisions by the Ohio Department of
Education in Program Standards for Special Educa-
tion Units for Visually Handicapped Children, pro-
viding the four amendments developed by the Com-
mittee on Eye Care are included in the final draft
of the revisions.
Fall District Conferences
Mr. Page discussed plans for the Fall District Con-
ferences and pre-election activities. The Councilors
were asked to encourage county legislative chairmen
to complete the interviews of candidates in connec-
tion with these conferences.
Ohio Medical Indemnity, Inc.
The report of the Ohio Medical Indemnity Liaison
Committee, presented in writing by the chairman, Dr.
Robert E. Tschantz, was accepted for information by
The Council with the deletion of Item 7 of the re-
port. The text of the report follows:
1. OMI is in sound financial condition.
2. Only five cases have been referred to media-
tion committee on comprehensive policy compared
to problem presented by Workmen’s Compensation.
3. Blue Shield has been forced by some large
employers to write special contracts around Medi-
care.
4. OMI has offered Blue Cross Plans an interim
Blanket Policy to pay that portion of Blue Cross
contract that pays hospital-based specialists. To
date, no Blue Cross Plan has accepted this offer. In
connection with this, OMI has met with state rep-
resentatives of radiologists, pathologists, and cardi-
ologists. Physicians representing these hospital-
based physicians have indicated a desire to separate
their bills — except the cardiologists.
5. The matter of billing procedures brought up
by anesthesiologists has been answered as follows:
"The request by OSMA Council had been re-
viewed by the Executive Committee of OMI and
a memorandum had been prepared on this ques-
tion which pointed out the administrative prob-
lems involved in the direct processing of OMI
of claims filed for the services of anesthesiolo-
gists. This memorandum was dated March 15,
1966, and was reviewed by The Council of the
OSMA at their meeting of April 23-24, 1966,
and The Council of the OSMA asked "that offi-
cials of the Ohio Medical Indemnity, Inc. confer
with responsible members of the Ohio Society
of Anesthesiology, with the expressed hope that
the principle of individual and direct billing may
be extended to Blue Shield claims involving the
services of anesthesiologists.
"After considerable discussion it was agreed
that it would not be appropriate at this time to
change the OMI claim forms used throughout
the State of Ohio, but it was agreed that the
OMI claim form would be changed for claims
filed in the Toledo area on an experimental
basis so that the administrative staff would have
932
The Ohio State Medical Journal
an opportunity to record the success or difficul-
ties involved in a segment of the State, in the
change of the traditional method of filing OMI
claims for the sendees of anesthesiologists.”
6. OMI has notified Blue Cross that it no longer
will subsidize Blue Cross Medicare advertising.
Mr. Coghlan reported on progress in the develop-
ment of coverage providing benefits to patients of
medical specialists who are hospital-based. He an-
nounced that Blue Cross Associations have refused
to transfer premiums covering medical sendees. As of
this date, the Superintendent of Insurance has not
permitted Ohio Medical Indemnity to cover Blue
Cross subscribers in Ohio by issuing a blanket policy".
Mr. Coghlan announced that Ohio Medical In-
demnity will offer and promote "riders” to Blue
Shield contracts covering the sendees of hospital-
based specialists.
The Council discussed the efforts of the radiologists
in Ohio to bill for their own services, noting that
the Ohio State Medical Association and the American
Medical Association have both declared the billing
for the professional sendees of a physician by a hos-
pital is unethical and that such action by a hospital
is the unlawful practice of medicine.
The Council instructed the OSMA staff to work
through Dr. Paul A. Jones, Zanesville and Dr. M. M.
Thompson, Toledo, in a survey of radiologists in
the state to determine progress on the separation of
contracts with hospitals involving medical care of
patients and a change over to direct billing by the
physician for sendees to his patients.
The general counsel of the Ohio State Medical
Association was authorized to attend a meeting of
the radiologists in Columbus on Thursday, July 28,
1966.
Problems arising from the policy of "coordination
of benefits” recently adopted by various Blue Cross
Plans in Ohio were brought to the attention of The
Council through communications from several mem-
bers. The Council instructed the Executive Secretary
to assemble data on the subject of "coordination of
benefits” and to refer the matter to the Insurance
Committee for study.
Appalachia Program
Dr. Beardsley reported on developments in the Ap-
palachia program. He submitted to Council for its
information a letter from Dr. Robert R. Huntley,
executive codirector, Health Advisory Committee,
The Appalachian Regional Commission, Washing-
ton, D. C., accompanied by a letter to the West Vir-
ginia State Medical Society, which revealed certain
amendments to the criteria of the program.
The Council asked that physicians be made aware
of the implications of the program, - that they be
alert to developments in their own communities, and
that they provide information to The Council of the
Association with regard to these developments. It
was suggested that county medical societies advise
local health departments to consult with the societies
in advance in developing a program.
AMA Report by Dr. Hudson
Dr. Hudson reported to The Council with regard
to the American Medical Association discussions with
the Federal government and problems now facing
medicine concerning Medicare regulations. Discus-
sing the document "Application of Criteria for Deter-
mination of Reasonable Charges,” Dr. Hudson stated
that the AMA has strongly recommended that the
statement not be issued, or if one is believed neces-
sary that the present one be completely rewritten.
With regard to a document entitled "Conditions
for Coverage of Sendees of Independent Labora-
tories,” Proposed Regulations — Subpart M, Part 405
(Regulations 5), Dr. Hudson pointed out that the
regulations in this document should not apply to
physicians’ offices. He stated that the American
Medical Association has pointed out to Commissioner
Robert M. Ball of the Social Security Administration
that it is clear that the law refers only to a lay lab-
oratory that is independent from a physician’s office.
A physician-operated laboratory is a physician’s of-
fice, therefore should not be subject to the supervi-
sion or control by the Federal government. Such
proposed regulations would establish a precedent for
Federal regulation of medical practice and services
that is not supported by law and which is not in the
public interest, the American Medical Association has
pointed out.
Air Pollution
A document concerning what a county medical so-
ciety can do about air pollution, submitted by Dr.
Tschantz who attended the AMA Conference on Air
Pollution Medical Research in Los Angeles, March
2-4, 1966, was referred to the Committee on Environ-
mental and Public Health.
Ohio Federation of Licensed Practical Nurses
The appointment of Dr. Henry A. Crawford,
Cleveland, to the Advisory Committee of the Ohio
Federation of Licensed Practical Nurses was approved
by The Council.
Ohio State Nurses Association
The Council acknowledged receipt of a letter from
the Ohio State Nurses Association regarding a com-
bined meeting of the committees on legislation of the
OSMA and OSNA. The Executive Secretary was in-
structed to acknowledge the communication and ex-
plain to the OSNA that special items of legislation
are considered by The Council and by the special
committees of the OSMA engaged in the areas of
specific legislation under consideration and therefore
the meeting of the legislative committees would not
for September, 1966
933
be practicable. The Council requested that any pro-
posed legislation be submitted in writing for study
by the proper committee or The Council.
Compulsory Autopsies
A communication asking for legislation to make
autopsies mandatory on patients dead on arrival in
hospital emergency rooms was discussed. The Coun-
cil expressed the opinion that these autopsies are a
problem of the coroner and received this communica-
tion for information.
AMA Rehabilitation Conference
Dr. Henry A. Crawford, Cleveland, was appointed
to represent the Ohio State Medical Association at
the AMA Conference on Rehabilitation in Chicago,
September 8-9, 1966.
Closed Chest Cardiopulmonary Resuscitation
A letter from the Ohio State Heart Association re-
garding closed chest cardiopulmonary resuscitation in-
struction for physicians was referred to the Commit-
tee on Education for implementation.
Ohio Hospitalization Benefits Committee
Dr. Crawford reported on meetings of the Ohio
Hospitalization Benefits Committee. It was announced
that Dr. Crawford has been appointed chairman of
a subcommittee of that organization to study the
problem of the removal of medical benefits from
Blue Cross contracts.
Health Planning Project
The Council authorized the appointment of Mr.
Gillen to the Advisory Committee to the Ohio De-
partment of Health Centralized Health Planning In-
formation Project.
Vocational Rehabilitation
A letter from Dr. O. L. Coddington, State Medi-
cal Administrative Consultant, Bureau of Vocational
Rehabilitation, Ohio State Board of Education, and
a fee schedule of the Bureau of Vocational Rehabil-
itation were received for information.
Symposium on Immunization
The Council authorized the President to appoint
a representative of the Ohio State Medical Association
to attend the Symposium on Immunization, October
17, 1966, in Atlanta, Georgia, such symposium being
conducted by the AMA Council on Environmental
and Public Health and cosponsored by the Communi-
cable Disease Center, Public Health Service, U. S.
Department of Health, Education, and Welfare.
Student AMA Advisor Appointed
The Council approved the appointment of Dr.
Richard L. Fulton, Columbus, as advisor to the Stu-
dent American Medical Association Chapter at the
Ohio State University College of Medicine.
Ad Hoc Committee Appointed
A letter from Dr. Sol Maggied, Madison County,
regarding the heavy burdens connected with the presi-
dency of the Ohio State Medical Association, was
discussed by The Council. The Council acknowledged
Dr. Maggied’s letter with thanks and authorized
the appointment of an ad hoc committee to study
the matter.
Cleveland Travel Committee
The Council received a request from the Travel
Committee of the Cleveland Academy of Medicine,
asking the OSMA to provide addressograph service
in connection with promotion of tours sponsored by
the committee and offering to reimburse the Associa-
tion for this service. Permission was not granted by
The Council for use of the equipment for this pur-
pose because of standing policies. The Executive
Secretary was asked to refer the Academy to the AMA
Department of Circulation and Records.
ODH Laboratory Advisory Committee
In response to a request from the Ohio Director of
Health, asking for suggestions for three appointments
to the Ohio Department of Health Laboratory Com-
mittee, The Council authorized the submission of
the names of the following physicians from which
list the new appointees may be selected: Dr. Horace
B. Davidson, Columbus; Dr. Gerald A. Wyker,
Fredericktown; Dr. Charles Jean Cooley, Oberlin;
Dr. Bernard Leslie Huffman, Jr., Toledo; Dr. John
R. McKay, Warren; Dr. Robert P. Stafford, Dayton;
Dr. Richard Gene Weber, Marion; and Dr. Ernest
D. Davis, Hamilton.
Articles in NEW YORKER Magazine
The Council discussed a series of articles recently
published by the magazine New Yorker on the medi-
cal profession. The staff was instructed to submit a
letter to that magazine, pointing out, for the record,
errors in the material.
Crippled Children’s Program
A communication from Dr. H. William Porter-
field, Columbus, with regard to problems in the Ohio
Crippled Children’s program, was discussed by The
Council. By official action, the matter was referred
to the Committee on Government Medical Care Pro-
grams for study.
Summit County Matter
A communication from the Summit County Medi-
cal Society, dealing with problems between the so-
ciety and the Joint Commission on Accreditation
of Hospitals, was received by The Council. The
discussion centered on the right and responsibility
of the medical society to determine the basic profes-
sional, ethical and moral qualifications of a person
proposing to practice medicine in a community. The
Council expressed the opinion that this is a matter
934
The Ohio State Medical Journal
for proper inquiry by county and state societies. The
Executive Secretary was instructed to interview the ap-
propriate departments of the American Medical As-
sociation on the matter and to refer the entire situa-
tion to the Judicial and Professional Relations Com-
mittee for study.
Committee to Study Councilor Districts
The Council authorized the appointment by the
President of the following committee to study the
composition of the OSMA Councilor Districts: Dr.
Robert C. Beardsley, Zanesville, Chairman; Dr. Rich-
ard L. Fulton, Columbus; Dr. Paul N. Ivins, Hamil-
ton; Dr. P. John Robechek, Cleveland.
Federal Legislation
The Council received for information a report on
several pieces of Federal legislation. Mr. Edgar
reported that S. 3008, Health Planning Grants, to
provide $10 million for fiscal 1967, had been recom-
mended for passage by the Senate Labor and Public
Welfare Committee, with $1 million to be made im-
mediately available for community mental retardation
center services, including staffing.
He also reported that the issue on legislation reg-
ulating transportation and treatment of research dogs
was confused because of so many bills dealing with
this subject, and that a Senate-House conference
committee was attempting to resolve the issue; that
Senator Hart (D-Mich.) had announced plans to
resume hearings on his bill (S. 2568) to ban physi-
cians from profiting on drugs and eyeglasses or any
other appliances they prescribe; that Senator Long
(D-La.) had introduced a bill (S. 3614) to require
generic prescribing for medicare patients and all
other public assistance patients.
It was announced that the next meeting of The
Council will be held on September 9, 10, 11, 1966,
in Columbus.
There being no further business, The Council
adjourned.
Attest: Hart F. Page
Executive Secretary
Dr. J. Martin Byers, Greenfield, former comman-
der of the 112th Medical Battalion, 37th Infantry
Division of the Ohio National Guard, was awarded
a Certificate of Achievement at Camp Grayling,
Michigan, where the division was in summer train-
ing. Dr. Byers retired from active military duty
June 1, 1965, with the rank of colonel.
Officers of the Western Reserve University Alumni
Association for this year are the following Cleveland
area physicians: Dr. Joseph C. Avellone, president;
Dr. Eduard Eichner, first vice-president; Dr. Edwin P.
Kennedy, second vice-president; and Dr. Hermann
Menges, Jr., secretary-treasurer.
AM A 20th Clinical Convention
To Be Held in Las Vegas
A scientific program especially designed for the
physician in practice is scheduled for the 20th Clini-
cial Convention of the American Medical Association.
The four-day meeting in Las Vegas, November 27-
30 will include scientific sessions on 18 major topics,
three postgraduate courses, breakfast roundtable con-
ferences, closed-circuit television and medical motion
picture programs, and a variety of scientific exhibits.
Of special interest are the postgraduate courses,
which have been expanded to three topics: Obstetrics
and gynecology, fluid and electrolyte balance, and
cardiovascular disease. Each course will consist of
three half-day sessions, each of which will feature
several outstanding teachers. There will be a $10
registration fee for each course.
Lively discussion should be a feature of four
Breakfast Roundtable Conferences. The topics: "An
Agonizing Reappraisal of Cancer Chemotherapy,”
"The Problem and Potential of LSD,” "The Man-
agement of Metabolic Bone Disease,” and "Indica-
tion for Cardioversion.”
An outstanding program of closed-circuit color tele-
vision and more than 25 medical motion pictures will
be presented.
Topics at the scientific sessions include: Scientil-
lation scanning, radiation and cancer, clinical pul-
monary physiology, gastroenterology, futuristic diag-
nostic and therapeutic tools, neck pain, antibiotics,
urology, aerospace medicine, unconsciousness, der-
matology, juvenile diabetes, endocrine and metabolic
diseases, pediatrics, surgery, hematology, psychiatry,
and otolaryngology.
Scientific and industrial exhibits and all scientific
meetings will be in the newly expanded Las Vegas
Convention Center.
The AMA House of Delegates will meet in the
Dunes Hotel and Caesar’s Palace.
The Eighth National Conference on the Medical
Aspects of Sports will be held in conjunction with
the Clinical Convention. A day-long program of
discussion of problems faced by team physicians at
all levels of athletic competition will be discussed.
The meeting will be Sunday, November 27, at
Caesar’s Place.
Dr. Mark T. Hoekenga, Cincinnati, was featured
in a special article in the AMA News of August 15,
as the author of "A Physician’s Vietnam Diary.”
the diary formed the body of the article.
for September, 1966
935
AM A Takes Firm Stand at Convention:
Ohioans Play Leading Roles
A RECOMMENDATION that physicians "vol-
untarily and under ordinary circumstances"
adopt the practice of billing their Medicare
patients directly was adopted by the AMA House of
Delegates at the 115th Annual Convention in
Chicago.
The House recommendation is based on a report
submitted to it by the Board of Trustees and reso-
lutions from three state delegations.
This action was the keynote in the AMA House
of Delegates’ determination to uphold the doctor’s
integrity and to preserve the physician-patient rela-
tionship in the face of governmental encroachment
on medicine.
Ohioans played leading roles in all phases of the
AMA Convention.
• Ohio’s Dr. Charles L. Hudson, of Cleveland,
Excerpts from the diary formed the body of the article,
points in his inaugural address on pages 939-940.)
• Ohio’s Mrs. Karl F. Ritter, of Lima, was named
President-Elect of the Woman’s Auxiliary to the
AMA. (Refer to story in August issue, page 830.)
• Ohio’s delegation introduced nine resolutions in
the House of Delegates, several of which developed
in the Ohio House of Delegates, and most of which
were acted upon favorably, or referred for further
study.
• Many hundreds of Ohio doctors were among
the 12,445 physicians who attended the Convention.
Added to this number were members of their fami-
lies, guests, etc., bringing the total to 35,506.
Leading Roles in House
Members of Ohio’s delegation took leading roles
in deliberations of the AMA House of Delegates and
had a part in the strong position taken by the AMA
in regard to direct billing and other principles set
forth in the adopted statement entitled "Physician’s
Role in Medicare.” (See text of this statement on
pages 940-941.)
One Ohio resolution entitled "Subscribers to Part
B of Medicare Are Entitled to Treatment as Private
Patients" was adopted in toto and became a part of
AMA policy. This resolution came out of the OSMA
House of Delegates at the last Annual Meeting. (Re-
fer to July issue of The Journal, page 706.)
A resolution drafted by Ohio delegates as a sub-
stitute resolution, regretted that publication of Medi-
care Regulations #5 was delayed until June 28, three
days before the effective date of Medicare, and said
that these regulations do not conform to the intent
of Congress as expressed in Section 1801 of the
Medicare law. It then declared:
"Resolved, That the House of Delegates instruct the
Board of Trustees and the Executive Vice-President
to request from the Social Security Administration
an extension of date of final adoption of the pro-
posed regulations of not less than 90 days, in order
that the American Medical Association and other
interested medical organizations be allowed reason-
able time to study, and to submit, to the Social Se-
curity Administration data, views or arguments and
pertinent constructive comments and suggestions.
"Resolved, That to preserve the professional inde-
pendence of medical practice that the Board of Trus-
tees and officers of the AMA be instructed to imme-
diately inform the membership that Medicare Reg.
#5 will not apply to physicians (whether hospital-
based or not) who
"1. have no financial relationship with a hospital
covering medical services to patients
"2. do not accept assignments but bill directly
and be it further,
"Resolved, That The AMA News and other appro-
priate media be used to advise all physicians who are
developing contractual relationships with hospitals
for professional service that they should delay the
finalization of any agreement pending further analysis
of the implementing regulations.”
Oath of Compliance
Ohio’s long fight against the arbitrary demand on
the part of some welfare agencies for an oath of
compliance under the Civil Rights Act of 1964 was
taken up by the AMA.
It was pointed out that the Civil Rights Act of
1964 does not require an oath of nondiscrimination.
It was further pointed out that such a demand for
an oath of compliance was unacceptable to physicians
who have traditionally treated patients regardless of
race, color, creed, or national origin.
The original resolution introduced by the Ohio
delegation came out of the OSMA House of Dele-
gates. The AMA substitute resolution reads as follows:
"That the Board of Trustees and the officers of the
AMA take whatever steps are necessary on the na-
tional level to assist the state associations in securing
the adoption by state agencies of procedures under
936
The Ohio State Medical Journal
the Civil Rights Act of 1964 which do not require
a participating physician to sign any statement or
agreement of compliance as a prerequisite to being
paid for his professional sendees under a federally
assisted program.”
Ohio Delegation Commended
The AMA House of Delegates commended the
Ohio delegation for its continued efforts to further
the principles of freedom of choice of physicians
and free competition among physicians. In rejecting
an Ohio resolution that originated in the OSMA
House of Delegates on "open staff” hospitals, the
House of Delegates reaffirmed a statement adopted
in December, 1959 as follows:
"The American Medical Association firmly believes
freedom of choice of physician and free competition
among physicians should be preserved and cherished
as fundamental principles which have, in large part,
been responsible for the high standard of medical
care in the United States and the leadership of Amer-
ican medicine throughout the entire world.”
Additional Meetings Proposed
A resolution presented by the Ohio delegation
would reouire the AMA House of Delegates to meet
four times a year in Chicago for the transaction of
business. These meetings would be in addition to the
present Annual and Clinical meetings. The AMA
House of Delegates adopted the recommendation of
the reference committee that the resolution be re-
ferred to the Board of Trustees with the request that
this problem be studied and a report be presented
to the 1966 Clinical Session to be held in Las Vegas.
Military Dependents’ Care
Another OSMA House of Delegates’ resolution en-
titled "Direct Reimbursement Under Military De-
pendents Medical Care Act” urged "that all necessary’
action be taken in order to provide that patients eli-
gible for benefits under Public Law 569 be afforded
the same option of reimbursement as is provided for
patients eligible for benefits under Public Law 89-97,
Part B.”
The AMA House of Delegates adopted the reso-
lution with an additional resolve that fees provided
under the Military Dependents Medical Care pro-
gram be the physicians’ "usual and customary charges.”
To Study Osteopathic Question
The AMA House of Delegates referred to the
Board of Trustees "because of the complex nature
of these matters” an Ohio resolution in regard to
osteopathic physicians. The resolve portion of the
Ohio resolution read as follows:
"That the House of Delegates of the AMA instruct
the Council on Medical Education to develop a
method whereby qualifications of osteopathic physi-
cians who are willing to subscribe to the Principles
of Medical Ethics of the AMA and who express the
wish to join a component county7 medical society
may be evaluated in order to determine eligibility for
intern and residency training in AMA approved hos-
pital programs, without jeopardizing the hospital’s
accreditation status.”
Hearings Before Board
An Ohio resolution urged the establishment of a
policy of the AMA to the effect that when resolu-
tions are referred to the Beard of Trustees, Commit-
tees or Councils, that "an invitation be extended to
representatives of the introducing delegation to par-
ticipate in hearings and discussions of such reso-
lutions.”
The AMA House of Delegates adopted a recom-
mendation of the reference committee making the
policy permissive instead of mandatory7 by stating
that "an invitation may be extended. . .”
Contaminated Articles
With slight amendment, the AMA House of Dele-
gates adopted an Ohio resolution in regard to con-
taminated articles imported from other countries. The
resolve part of the resolution as adopted reads as
follows :
"That the appropriate committee of the AMA be
instructed to continue to work with the proper pub-
lic health authorities to insure that the health of the
American public is protected from such dangers.”
This resolution originated in the OSMA House of
Delegates.
The Ohio Delegation
Because the number of AMA members in this state
went over the 9,000 mark last year, Ohio for the
first time had ten delegates in the AMA House of
Delegates.
All of Ohio’s delegates were present. They are:
Dr. George W. Petznick, Cleveland; Dr. Carl A.
Lincke, Carrollton; Dr. Theodore L. Light, Dayton;
Dr. Edmond K. Yantes, Wilmington; Dr. John H.
Budd, Cleveland; Dr. Richard L. Meiling, Columbus;
Dr. Frederick P. Osgood, Toledo; Dr. Charles A.
Sebastian, Cincinnati; Dr. Edwin H. Artman, Chil-
licothe; and Dr. Robert E. Tschantz, Canton.
Also present were the following Ohio alternate
delegates: Dr. H. T. Pease, Wadsworth; Dr. Robert
S. Martin, Zanesville; Dr. Kenneth D. Arn, Dayton;
Dr. Harry7 K. Hines, Cincinnati; Dr. P. John Robe-
chek, Cleveland; Dr. Frank F. A. Rawling, Toledo;
Dr. Robert N. Smith, Toledo; Dr. Philip B. Hardy-
mon, Columbus; and Dr. Henry A. Crawford, Cleve-
land.
Ohioans on Committees
Also in the House of Delegates were Dr. Walter
J. Zeiter, Cleveland, delegate from the Section on
Physical Medicine, and Dr. Donald Glover, also of
for September, 1966
937
Cleveland, alternate delegate from the Section on
General Surgery.
Three Ohoians served on Reference Committees of
rhe House of Delegates.
Dr. Lincke was on the Committee on Public Health
and Occupational Health.
Dr. Light was on the Committee on Rules and
Order of Business.
Dr. Sebastian was chairman of the Tellers Com-
mittee.
Dr. Petznick was named to the Judicial Council
of the AMA to succeed the late Dr. James H. Berge,
of Seattle, Wash.
Present as interested observers in the AMA House
of Delegates were the following OSMA officers: Dr.
Lawrence C. Meredith, President; Dr. Robert E.
Howard, President-Elect, and Dr. Henry A. Craw-
ford, Immediate Past President.
Accompanying the Ohio delegation to Chicago
were Hart F. Page, OSMA Executive Secretary;
Charles W. Edgar, Director of Public Relations; Her-
bert Gillen, and Michael Traphagan, of the OSMA
executive staff.
Circumventing Separate Billing
The House of Delegates declared it unethical for
a physician "to displace a hospital-based physician
who is attempting to practice separate billing when
said displacement is primarily designed to circumvent
separate billing.”
The House adopted a resolution, introduced by
the Oregon delegation, which cited the Principles
of Medical Ethics that a physician shall not dispose
of his sendees to a third party or "lay” organization.
The reference committee which considered the
resolution had recommended to the House that it be
IMPLEMENTATION DELAYED
The AMA Board of Trustees last month
announced that it was delaying implementa-
tion of this resolution following an inquiry
from and discussion with the Department of
Justice. The Board said it would report on
the matter to the House of Delegates at the
1966 Clinical Convention in Las Vegas.
referred to the Board of Tmstees because of apparent
unsolved legal issues involved in such a resolution.
The House voted to adopt the resolution, however.
The resolution stated that "A great number of
hospital-based physicians throughout the nation have
declared their intention to bill separately for their
professional sendees in keeping with this principle.”
The principle of separate billing by "hospital-
based” physicians has been endorsed by the AMA,
the American College of Radiology, the American
College of Pathologists and others, the resolution
noted.
Multiple Coverage Insurance
The House of Delegates approved a report of the
Council on Medical Service in regard to Multiple
Coverage in Voluntary Health Insurance.
It was pointed out in the report that the problem
of over-insurance arises when the person insured
under two or more contracts becomes entitled to re-
imbursement which exceeds the expenses against
which the individual has insured himself, often re-
sulting in a profit.
The following statement of policy in regard to
group policies adopted by the House is entitled
"Coordination of Benefits in Health Insurance Con-
tracts”:
"Over-insurance can arise when an individual is
insured under two or more policies of health insur-
ance. When the reimbursement from this multiple
coverage exceeds the expenses against which the indi-
vidual has insured himself, a profit may result. Over-
insurance thus encourages wasteful use of the public’s
health care dollar.
"A solution to this problem can be accomplished
by the use of contract language and the application
of coordination of benefits provisions which operate
to enable persons covered under two or more group
programs to be fully reimbursed for their expenses
of insured services without receiving more in total
benefits than the amount of such expenses.
"Therefore, the American Medical Association en-
courages the health insurance companies and pre-
payment plans to adopt policy provisions and mech-
anisms based upon the preceding principles which
would control the adverse effects of over-insurance.”
AMA Dues Increase
By a vote of 168 to 46, the House approved an
increase in AMA annual dues from $45 to $70, effec-
tive January 1, 1967, thus confirming a Board of
Trustees recommendation which was given initial
approval at the 1965 Clinical Convention.
The House, in approving the dues increase, ac-
cepted a reference committee statement which said:
"It is quite apparent that the programs necessary
to serve the needs of the members of the Association
cannot be conducted effectively without adequate
financing and it is equally apparent that such ade-
quate financing is impossible without the dues in-
crease requested by the Board of Trustees. Your
Reference Committee reaffirms its confidence in the
judgment of the Board of Tmstees which has in the
past and must in the future exercise the most careful
and prudent stewardship over the assets of the Asso-
ciation. The Board of Trustees is the Committee
elected by the House of Delegates to investigate and
control the finances of the Association. The appoint-
ment of any other committee to perform this func-
tion would be most inappropriate.”
938
The Ohio State Medical Journal
In Inaugural Address,
Against Expansion
Dr. Hudson Warns
of Federal Role
OHIO’S DR. CHARLES L. HUDSON, of
Cleveland, was inaugurated as 121st President
of the American Medical Association at gala
ceremonies during the AMA Annual Convention in
Chicago. He was named President-Elect at last year’s
Convention in New York City after serving on the
Board of Trustees.
After Dr. Hudson received the gavel from 1965-
1966 President James Z. Appel, of Pennsylvania, and
presented his inaugural address, he and Mrs. Hudson
were guest of honor at a reception cosponsored by the
AMA and the Ohio State Medical Association.
In his inaugural address before the House of Dele-
gates, Dr. Hudson told the House, "I am not an
apologist for medicare, nor for the first steps we take
in it. I am, however, trying to make a realistic assess-
ment of what I think is important, relatively, and
what is not. For, if we exhaust our energies in the
wrong defense, our cause may well be lost.”
He noted that physicians in private practice appar-
ently will be working by the side of government phy-
sicians "under many circumstances in which we still
have a choice . . . unless we are alert, and take a
positive attitude about our responsibilities and choices
of action, we might one day be astonished to find
that instead of working side by side with these peo-
ple, we are working at their direction, following
plans which they alone drew.”
He urged that physicians maintain communications
with government, to understand its problems as well
as to expect it to understand theirs, and concluded:
"We have been handed a challenge that is unlike
any we have faced before. We must be tireless in our
efforts to meet it, and meet it well, for the ultimate
benefit of our profession and — more important —
for the ultimate benefit of the patients we serve with
our judgment, our skills and our very lives.”
Advice to M. D.’s
Dr. Hudson said he proposes physicians use the
tools provided and developed by their backgrounds
and educations "to make the most, for our patients
and our colleagues, of this new program . . . and
to prevent extension of it, without demonstrated
need, toward a national health service.”
Dr. Hudson said several worries deter many phy-
sicians from supporting medicare, such as restriction
of freedom of professional judgment, imposition of
new clerical tasks, and the implication and assertion
that the government must intervene to assure ade-
quate medical care.
"However, these factors to my mind are not the
real threats of the Social Security Amendments,” he
said. "Rather, it is the possibility, through reduction
of the age limit under Title 18 and elevation of the
eligibility income level under Title 19, of expansion
• ’Ql
■ #
Charles L. Hudson, M. D.
to a national health service, covering everyone and
financed from the federal treasury exclusively.”
Federal Paternalism
Dr. Hudson said that would be the "epitome of
a widely supported philosophy that I abhor,” in
which the federal government is assigned responsi-
bility for the solution of all problems.
Dr. Hudson offered these proposals "to counteract
what offends our beliefs and aspirations”:
• Demonstrate the competency7 of the private field
of medicine to perform necessary technical, profes-
sional and administrative sendees by (A) showing
how physicians evaluate the quality of care provided
by the profession; (B) reappraising medical man-
power and facilities in relationship to sendee de-
mands; (C) evaluating the kinds and numbers of
services we should have in order to provide "the
for September, 1966
939
comprehensiveness of health care that is now being
sought.”
• Do everything possible to arrest the trend
toward dependency on government, particularly
■where medicine is concerned, and in all other fields
wherever possible.
• Encourage the government to confine its activi-
ties — in the organization of health services for those
who are not its wards or dependents — to the overall
stimulation and support of private enterprise.
• Continue to offer to the government the knowl-
edge and the competency of the health profession in
consultation and in cooperation, but with the health
profession and the insurance and prepayment plans,
acting as strong, independent agencies, not as exten-
sions of the government.
On the last point, Dr. Hudson said it was the
intention of the founding fathers of the nation that
there be interaction between the government and
governed.
Physicians Role in Medicare
The American Medical Association House of Delegates,
at the Annual Convention in Chicago, adopted the following
report, "Recommendations on the Physician’s Role in Medi-
care,’’ which was prepared by the AMA Council on Medical
Service.
Billing Procedures
The Council points out that the physician is legally
entitled to set his own valuation upon his services,
to bill his patient for services directly, and to
conduct himself in this respect essentially as though
the medicare program did not exist. The Council
is persuaded that this approach will be the least
productive of misunderstandings with patients, the
least demanding on the time of the physician and
his office assistants, and the least disturbing to nor-
mal physician-patient relationships. If the direct
billing approach is used, the physician will not be
involved in the multitude of complexities involved
in "assignments” — all of which may be properly
identified as matters of concern between the bene-
ficiary and the program carriers and fiscal interme-
diaries. Specifically, by using direct billing the doctor
will not need to concern himself with:
a. The eligibility status of the patient and extent
of coverage;
b. A distinction between "covered” and "excluded”
services;
c. The status of the Part "B” deductible;
d. The application of the $20 outpatient diagnos-
tic service; deductible (Part "A”) as a credit toward
the $50 Part "B” deductible;
e. The application of the "three month carry over”
provisions from a previous calendar year to the Part
"B” deductible;
f. The 20 per cent coinsurance provisions with the
inevitable need for double-billing when assignments
are accepted;
g. The technical problem of calculating the 20
per cent coinsurance factor prior to notification of
the fee determined by the carrier as "reasonable”;
h. The relation of what the physician feels his
service is worth as opposed to what the carrier defines
as a "reasonable” charge;
i. The presence or absense of supplementary or
complementary coverage;
j. Limitations of payment for outpatient services
for psychiatric conditions; and
k. The use of prescribed forms.
l. Direct billing does not require the listing of a
diagnosis on the receipted bill.
It is to be noted that the patient will be depend-
ent upon the cooperation of the physician to obtain
his reimbursement from the medicare program, since
he will need to submit a receipted bill which properly
identifies the beneficiary, the physician, the date of
service, the nature of the service given, the place of
service (home, office, hospital, etc.) and the charge
made.
The Council suggests that the physician bear in
mind these requirements in adapting his personal
billheads to this use in case he prefers not to use the
"Request for Payment” form which is to be provided
for this purpose.
The over-all conclusion of the Council on Medical
Service is that under ordinary circumstances direct
billing of patients will prove superior to the accept-
ance of assignments.
Utilization Review Committee Requirements
Physicians will need to decide whether or not they
are willing to serve as members of a committee which
is required to pass judgment on the medical need for
continuing in-hospital service of extended stay cases.
Although many physicians may have reluctance to so
serve, it should be noted that such review is a legal
requirement if any institution is to qualify as a pro-
vider of service. If the mandated review is not carried
out by an in-hospital staff committee it will neces-
sarily be provided by an extramural committee which
may well involve physician employees of a state
agency or a carrier. The clear choice facing the hos-
940
The Ohio State Medical Journal
pital is that of doing its own reviews or having its
hospital records reviewed by outsiders.
The Council on Medical Service points out that
utilization study, unrelated to extended-stay review,
is important to foster as an educational hospital staff
project and as a valuable mechanism for quality con-
trol. It urges hospital staffs not to let this activity
suffer because of entanglement with extended-stay
review. For this reason the Council recommends that
a hospital staff should consider compliance with the
requirements of the regulations in formulating an ac-
ceptable utilization review plan. In the event that
difficulties develop, it is recommended that these be
carefully documented. Utilization study should be
kept scrupulously distinct from extended case review,
and, if necessary, due notification should be given
the administration of the hospital that some extra-
mural mechanism for extended-stay case review will
be required if this staff function cannot conscien-
tiously be continued. The documentation of the diffi-
culties in extended-stay case review should be fully
provided to the local county medical society for trans-
mission to the state society and the American Medical
Association.
Impact on Medical Education
The Council on Medical Service recommends to the
House of Delegates that careful attention be paid to
the impact of PL 89-97 and PL 89-238 in postgrad-
uate medical education programs.
Collection of Data on Program Operation
The Council on Medical Service stresses the need
for reporting by individual physicians and by hos-
pital staff organizations problems arising in respect
to the medicare program. This should encompass any
factors which complicate the provision of medical
care or cause a deterioration in the quality of the
care provided. Such reporting should be specific and
should document any allegations which may be made.
These reports should be submitted to the appropriate
county medical societies for transmission to the state
medical societies and the American Medical Associa-
tion.
Advisory Committee
It is further recommended that the present Ad-
visory Committee of the Board of Tmstees be con-
tinued for the purpose of maintaining liaison with
the Secretary of Health, Education, and Welfare,
with appropriate officials in the Administration, and
with congressional leaders. It is to be hoped that
through these channels it may be possible to promote
desirable regulatory changes, or to initiate necessary
measures for amendment or repeal of undesirable
portions of the Law.
New Member Joins the Staff at
OSMA Headquarters Office
A new member has joined the Executive Staff of
the Ohio State Medical Association with the appoint-
ment of Jerry J. Campbell to the position of Admin-
istrative Assistant. The appointment was announced
by Dr. Lawrence C. Meredith, OSMA President,
after conferences between Campbell, the Executive
Staff, and the Association’s officers.
Mr. Campbell is a graduate of Ohio State Uni-
versity, where he majored in economics and sociology
and in I960 received a B. S.
degree in Agriculture. He
received an honorable dis-
charge from the Navy, then
went into the insurance busi-
ness in Columbus, where he
gained six years of experi-
ence in that field.
Diversified extracurricular
activities at high school in
Pewaukee, Wisconsin, in-
cluded football, baseball, the
band, the science club of
which he was president, and
the camera club of which he was treasurer.
In college, his campus interests also turned to
group activities. In the dormitory, he was proctor
and group leader, and served a term on the dormi-
tory senate. He was pledged to Alpha Gamma Rho
and served as pledge trainer and secretary. During
his senior year, he was recording secretary of Ohio
Staters, Inc., a community service organization.
Campbell was employed at the Columbus head-
quarters of the Nationwide Mutual Insurance Com-
pany from I960 until his recent appointment with
the OSMA staff. Positions there included those as
life and health policy issue supervisor, coding and
policy issue supervisor, Ohio 65 claims supervisor,
and health policyholders service manager.
Associated occupational activities at Nationwide in-
cluded a term as vice-chairman of the safety commit-
tee, and a tour as coordinator of the credit union and
the Red Cross blood lending program.
He completed several basic courses in life and
health insurance sponsored by the Life Office Man-
agement Association and Health Insurance Associa-
tion of America. He belonged to Toastmasters In-
ternational, and served as master at arms and admin-
istrative vice-president of the local group.
As Administrative Assistant in the OSMA head-
quarters office, Campbell will serve as secretary to
several of the Association’s Committees, do liaison
work, arrange meetings authorized by OSMA officers,
participate in the Association’s legislative activities,
and perform other duties as they arise.
Jerry Campbell and his wife Roberta are the par-
ents of two daughters, ages 3 years and 1 year.
Jerry J. Campbell
for September, 1966
941
Outstanding Scientific Exhibits
At the OSMA Annual Meeting
OUTSTANDING FEATURE at the 1966 OSMA Annual Meeting in Cleveland, May 24-28,
was the Scientific and Health Education Exhibit. In keeping with a policy recommended
by the Committee on Scientific Work and approved by The Council, awards were authorized
for certain exhibits designated as outstanding by the judging committee. This year seven exhibits
were selected to receive the special honors which included mounted and engraved plaques, certifi-
cates and monetary awards. The committee designated three exhibits in the field of teaching, and
three in the field of original investigation to receive respectively the gold, silver and bronze awards,
and named a seventh exhibit to receive a special award. Following are brief descriptions of two
of these award-winning exhibits.
Exhibit on Breast Cancer Wins
Silver Award in Teaching
Silver Award winner in the field of teaching at
the 1966 OSMA Annual Meeting was an exhibit
entitled "Simplified Treatment of Breast Cancer,’’
sponsored by Dr. George Crile, Jr., and Dr. C. B.
Esselstyn, of the Cleveland Clinic Foundation.
The exhibit was designed to show that in clinical
Stage I of breast cancer, when there is no palpable
involvement of the axiliary nodes, simple mastec-
tomy without prophylactic irradiation therapy gives
better results from the standpoint of survival up to
eight years than did conventional radical mastectomy
with or without irradiation. The rationale behind
this simplification of treatment lies in the immunolo-
gic importance of regional lymph nodes in the re-
sistance of the host to its cancer.
In mice, as Mitchison has shown, immunologic
resistance to an homologous cancer lies largely in
the regional nodes. In the clinic’s laboratory, investi-
gators have been able to decrease resistance of mice
to cancer by removing regional nodes, and have
been able to increase the incidence of metastasis by
any operation that removed regional nodes that drain
a cancer. This applies only in the early stage of the
cancer. Once the cancer is advanced, immunologic
resistance, if any, has spread throughout the body.
The work portrayed in the exhibit was reported in
Surgery, Gynecology and Obstetrics, May, 1965, Vol.
120, pp. 975-982, under the title "Rationale of Sim-
ple Mastectomy Without Radiation for Clinical Stage
I Cancer of the Breast.’’
Exhibit on Urinary Diversion
Awarded in Research Field
In the field of original investigation, the Silver
Award was presented to Dr. Arthur A. Roth, of
Cleveland, for his exhibit entitled, "Transabdominal
Transperitoneal Bilateral Omentoureterostomy.”
This exhibit depicted a new method of urinary
diversion which makes it unnecessary to use the bowel
as a urinary conduit. In the left panel, the exhibit
presented the history and methods of urinary di-
version. The center panel showed diagrams of the
technique of omentoureterostomy, early and late
kodachrome enlargements of the stomata, and in-
travenous pyelograms of the postoperative results.
The right panel delineated what the sponsor feels
are the advantages of this procedure over the use of
bowel conduits.
Dr. Roth described the procedure as follows:
Omentoureterostomy is essentially a method of
making a sleeve out of the omentum to protect and
vascularize the terminal ureter in its egress through
the abdominal wall. In all but one of a series of
eight cases, the umbilicus and fascia were excised
and the omentum split so that it could be wrapped
around each ureter. Before the omentum and the
ureter are brought out, interrupted catgut sutures
are placed in the peritoneum and muscle layers for
later suture to the omentum. The omentum is then
brought out and split in order to make the sleeve.
The ureters are sutured to the omentum with in-
terrupted 000 and 0000 chromic catgut through the
serosa of the ureter. The omentum is sutured to
itself with 00 catgut to make the sleeve. Silk sutures,
942
The Ohio State Medical Journal
Silver Award Winning Exhibits
This is the Silver Award winning exhibit in the field of teaching entitled " Simplified Treatment of Breast Cancer,” as it
was shown at the 1966 OSMA Annual Meeting in Cleveland. The awarded plaque is shown on the extreme left. (See
facing page for additional information.)
Dr. Arthur A. Roth, right, is holding the plaque presented for the Silver award winning exhibit in the field of original
investigation. The presentation, entitled ''Transabdominal Transperitoneal Bilateral Omentoureterostomy,” was shown
at the 1966 OSMA Annual Meeting. (See facing page for explanation.)
for September, 1966
943
again interrupted, anchor the omental sleeve to the
skin. The omentum is sutured around both ureters
below the peritoneum as well. The ureters are fish-
mouthed and sutured to the omentum. The collecting
bag is placed over the stomas in the operating room
without intubation of the ureters.
When cystectomy is performed on men, the pros-
tate and seminal vesicles are included, a panhysterec-
tomy is done on women. A long transverse incision
from the anterior superior spine of the ilium to the
opposite anterior superior spine is used. The rectus
sheath and aponeurosis are cut in the line of the
incision. The procedure is done under spinal anes-
thesia. A Cherny procedure is done when relaxation
is incomplete.
This method has been used in eight patients —
the oldest being 2 6 months postoperative. Six pa-
tients had carcinoma of the urinary bladder and in
four of these, total cystectomies were done. Two
patients, on whom cystectomy was not done, died
following palliative procedures. One died from pul-
monary emboli in the third week. Both of the
patients had widespread metastases and the procedure
followed because of excessive hematuria; no other
procedures were planned.
One patient died of a stroke and cardiac failure
three months after operation, and another from renal
cortical abscesses after six months. In the latter
patient, no hydronephrosis or ureteral obstruction
was observed postmortem. Operation was performed
on one patient who had a severely obstructed left
ureter (with no renal function on that side due to
tumor and radiation fibrosis) from carcinoma of the
cervix with the rectum involved by fibrotic process.
One patient (at the time of presentation only 12
weeks postoperative) had a primary carcinoma of the
right seminal vesicle with no renal function on the
right side as a result of bladder and ureteral involve-
ment.
Postoperatively all patients were given the usual
intravenous fluids and a Levin tube for three days.
All received chloramphenicol, initially intravenously
and later orally. One patient in whom pyelonephritis
developed on the right side in the sixth postopera-
tive month, responded well to chloramphenicol. The
ureters remained patent in all cases and no small
bowel obstruction has yet occurred.
Opportunities for physicians to receive residency
training in Public Health Service hospitals are de-
scribed in an illustrated booklet, entitled "Residencies
for Physicians, Public Health Service Bureau of
Medical Services,” PHS Publication No. 1408. Single
copies may be obtained free of charge from the Public
Health Service, Department of Health, Education,
and Welfare, Washington, D. C. 20201.
Blue Shield Plan Membership,
Benefits Continue Climb
Memberships and benefits of the 84 Blue Shield
Plans in the United States, Puerto Rico, and Canada
continued to climb during the first three months of
1966, the National Association of Blue Shield Plans
announced.
Membership increased 543,170 during the first
three months of 1966 to a record 58,453,324, up
over 2 million from a year ago.
Benefits paid out amounted to $363,866,053, an
increase of almost $29 million over last year’s first
quarter.
In the first quarter of 1966, 92.8 per cent of pre-
mium income was returned to subscribers in benefits,
up 0.8 per cent over the first quarter of 1965.
Included in the total enrollment figure is the mem-
bership of Medical Indemnity of America, Inc., a
stock company wholly owned by the National Associa-
tion of Blue Shield Plans.
During the first three months of 1966, membership
gains were reported by 60 Plans, 22 had losses, and
two remained the same. Gains totaled 651,113
while losses amounted to 107,943.
The 0.9 per cent enrollment increase in the first
three months brought Blue Shield coverage in the
United States to 27.6 per cent of the population.
Blue Shield now covers 26.7 per cent of the
Canadian population and 4.3 per cent of the popular
tion of Puerto Rico.
Ohioan Will Receive National Award
At Occupational Health Meeting
An Ohioan will be honored with a Presidential
citation at the American Medical Association Con-
gress on Occupational Health meeting in Portland,
Oregon, on September 29.
Dr. Herman J. Bearzy, director of the Department
of Physical Medicine and Rehabilitation, Miami Val-
ley Hospital, Dayton, has been selected to receive
the 1965 Physician’s Award of the President’s Com-
mittee on Employment of the Handicapped. The
award will be presented at the Oregon meeting.
The President’s Award is an illuminated scroll with
an appropriate inscription over the signature of the
President of the United States.
Nominations are now open for the naming of a
physician who has made an outstanding contribution
to the welfare and employment of the handicapped
workers as recipient of the 1966 Award. Nomina-
tions must be in the hands of the President’s Com-
mittee by December 31, 1966.
What is believed to be one of the largest groups
of LSD - related adverse reactions to date was studied
by investigators at the University of California, with
70 persons treated. Report of the study was pub-
lished in the August 8 issue of The Journal of the
American Medical Association.
944
The Ohio State Medical Journal
SEND FOR SAMPLES
Prednisolone Tablets 5 mg* U*S*P*
(West-ward)
West-ward makes the very best Prednisolone Tablet. Well compressed, breaks with a
sharp snap yet disintegrates in less than 1 minute (20 seconds average) into fine
particles with sufficient delay to prevent tasting. Here indeed is a fine product.
Here is what this means:
A — fast distintegration means more rapid absorption
B — fine particles mean more complete absorption
C — result, optimum physiological availability1’2’3
SPECIFY “PREDNISOLONE TAB. 5 mg. (West-ward)”
so that your patient receives the very best
at much lower costs
Doctor, do prove the superiority of the West-ward product yourself. Return coupon
below and upon receipt of test sample do this simple test: (It will take you just a
few seconds). Drop one tablet in a glass containing about 20 ml. warm water and
stir gently. See how tablet disintegrates in much less than 1 minute.
West-ward, Inc., 745 Eagle Ave., N. Y. 10456
I am interested in testing your Prednisolone tablet for fast disintegration.
Kindly ship the following at no cost or obligation:
Prednisolone Tablets 5 mg. U. S. P.
Licensed under Patent 3,134,718
vial of 12 (professional sample)
Ship To: M. D.
Zip Code
References :
1Morrison, A. B., and Campbell, J.
A., Journal of Pharmaceutical Sci-
ences, 54, 1 (1965)
2Campagna, F. A., Cureton, G.,
Mirigian, R. A., and Nelson, E.,
ibid., 52, 605 (1963)
3Levy, G., and Hayes, B. A., New
England Journal of Medicine, 262,
1053 (1960)
for September, 1966
945
Here Are Chairmen and Secretaries
Of OSMA Specialty Sections
Following are names and addresses of chairmen
and secretaries of the Ohio State Medical Association
Specialty Sections, with some program chairmen. Most
of these sections met during the OSMA Annual
Meeting in Cleveland and elected or re-elected of-
ficers. Specialty Sections aid the Committee on Sci-
entific Work to plan programs for the Annual
Meeting. These names and addresses are given for
the benefit of persons who may wish to correspond
with Section officers in regard to program matters.
Section on Anesthesiology — Chairman, Edward
Hartenian, M. D., 1236 East Rookwood Dr., Cincin-
nati 45208; Secretary, David M. Katchka, M. D.,
3939 Monroe Street, Toledo 43606.
Section on Ear, Nose and Throat — Chairman,
Stephen P. Hogg, M. D., 250 Wm. Howard Taft
Rd., Cincinnati 45219, (also president, Ohio ENT
Society); Secretary, Richard L. Ruggles, M. D., 10515
Carnegie Ave., Cleveland 44106, (also secretary,
Ohio ENT Society).
Section on General Practice of Medicine —
Chairman, William M. Wilson, M. D., 3316 Maize
Road, Columbus 43224; Secretary, Glenn W. Pfister,
Jr., M. D., 8040 Reading Road, Cincinnati 45237.
Section on Hospital Directors of Medical Educa-
tion — Chairman, Warren G. Harding, 2nd, M. D.,
Grant Hospital, 309 East State St., Columbus 43215;
Secretary, Lee Sataline, M. D., Toledo Hospital,
North Cove Boulevard, Toledo 43606; Program
Chairman, Robert V. Bachman, M. D., 14600 De-
troit Road, Cleveland 44107.
Section on Internal Medicine — Chairman, Ray
A. Van Ommen, M. D., 2020 East 93rd Street, Cleve-
land 4410 6; Secretary, William A. Millhon, M. D.,
3545 Olentangy River Rd., Columbus 43214.
Section on Neurological Surgery — Chairman,
Julius Wolkin, M. D., 10900 Carnegie Ave., Cleve-
land 44106, (also president, Ohio Neurosurgical So-
ciety); Secretary, John N. Meagher, M. D., 1275
Olentangy River Rd., Columbus 43214, (also secre-
tary, Ohio Neurosurgical Society).
Section on Obstetrics and Gynecology — Chair-
man, Sidney Kay, M. D., 2825 Burnet Avenue, Cin-
cinnati 45219; Secretary, Keith DeVoe, Jr., M. D.,
3545 Olentangy River Road, Columbus 43214.
Section on Occupational Medicine — Chairman,
Harold Imbus, M. D., 1128 Richland Terrace, Marion
43305; Secretary, Sidney I. Lerner, M. D., Kettering
Laboratory, Cincinnati College of Medicine, Eden
Avenue, Cincinnati 45219.
Section on Ophthalmology — Chairman, Russell
J. Nicholl, M. D., 10515 Carnegie Avenue, Cleve-
land 44106; Secretary, William E. Sovick, M. D., 207
Mahoning Bank Bldg., Youngstown 44503.
(Section Officers — Continued)
Section on Pathology — Chairman, James B. Mc-
Millan, M. D., 1425 West Fairview Ave., Dayton
45406, (also president, Ohio Society of Pathologists);
Secretary, L. J. McCormack, M. D., 2020 East 93rd
Street, Cleveland 44106, (also secretary, Ohio Society
of Pathologists).
Section on Pediatrics — Chairman, Henry F. Saun-
ders, M. D., 2002 Warrensville Center Road, Cleve-
land 44121; Secretary, Malcolm L. Robbins, M. D.,
4373 East Livingston Avenue, Columbus 43227.
Section on Physical Medicine and Rehabilitation
— Chairman, Marvin H. Spiegel, M. D., Dodd Hall,
472 West 8th Avenue, Columbus 43210; Secretary,
John L. Melvin, M. D., Dodd Hall, 472 West 8th
Avenue, Columbus 43210, (also secretary, Ohio So-
ciety of PMR).
Section on Plastic Surgery — Chairman, Clifford
L. Kiehn, M. D., 10605 Chester Avenue, Cleveland
44106; Secretary, H. William Porterfield, M. D.,
1100 Morse Road, Columbus 43224; Program Chair-
man, Robin Anderson, M. D., 2020 East 93rd St.,
Cleveland 44106.
Section on Psychiatry and Neurology — Chair-
man, John A. Whieldon, M. D., 196 East State Street,
Columbus 43215, (also president, Ohio Psychiatric
Association) ; Secretary, Philip C. Rond, Jr., M. D.,
130 South Davis Avenue, Columbus 43222, (also
secretary, Ohio Psychiatric Association); Program
Chairman, James R. Hodge, M. D., 1540 West Market
Street, Akron 44313.
Section on Radiology — Chairman, Sidney W.
Nelson, M. D., University Hospital, 410 West 10th
Ave., Columbus 43210; Secretary, Paul A. Jones,
M. D., 838 Market Street, Zanesville 43701.
Here Is Roster of Officers of
Ohio Specialty Societies
Ohio Specialty Societies in many instances cooper-
ated in sponsoring programs in connection with the
Ohio State Medical Association Annual Meeting,
many of them combining their programs with those
of the OSMA Specialty Sections. Some organizations
hold meetings at other times of the year. Follow-
ing are names and addresses of officers of Specialty
Societies announced to The Journal before this issue
went to press.
Ohio Chapter, American College of Chest Physi-
cians — President, Neil C. Andrews, M. D., 466
West Tenth Ave., Columbus 43210; Secretary-Treas-
urer, John H. Kennedy, M. D., Cleveland Metropoli-
tan General Hospital, 3395 Scranton Road, Cleve-
land 44109.
Ohio Ear, Nose and Throat Society — President,
Stephen H. Hogg, M. D., 250 William Howard Taft
( Continued on Next Page)
9 46
The Ohio State Medical Journal
(Specialty Society Officers — Contd.)
Rd., Cincinnati 45219, (also chairman of Section on
Ear, Nose and Throat); Secretary, R. L. Ruggles,
M. D., 10515 Carnegie Avenue, Cleveland 44106,
(also secretary of Section on Ear, Nose and Throat).
Ohio Society of Anesthesiologists — President,
William Hamelberg, M. D., Department of Anes-
thesiology, Ohio State University Hospital, 410 West
Tenth Avenue, Columbus 43210; Secretary-Treasurer,
Steven Kovacs, M. D., 17811 Lake Road, Lakewood
44107.
Ohio Society of Internal Medicine — President,
Leonard P. Caceamo, M. D., 2111 Belmont Avenue,
Youngstown 44505; Secretary-Treasurer, Edward O.
Hahn, M. D., Westgate Medical Arts Center, Fair-
view Park, Cleveland 44126.
Ohio Neurosurgical Society — President, Julius
Wolkin, M. D., 10900 Carnegie Avenue, Cleveland
44106, (also chairman of Section on Neurological
Surgery); Secretary, John N. Meagher, M. D., 1275
Olentangy River Road, Columbus 43212, (also secre-
tary of Section on Neurological Surgery).
Ohio Ophthalmological Society — President,
Robert Willard, M. D., 3626 Monroe Street, Toledo
43606; Secretary-Treasurer, Robert H. Magnuson,
M. D., 150 East Broad Street, Columbus 43215.
Ohio Society of Pathologists — President, James
B. McMillan, M. D., 1425 West Fairview Ave., Day-
ton 45406, (also chairman of Section on Pathology);
Secretary, L. J. McCormack, M. D., 2020 East 93rd
Street, Cleveland 44106, (also secretary of Section
on Pathology).
Ohio Chapter, American Academy of Pediatrics
— President, Thomas E. Shaffer, M. D., 561 South
17th Street, Columbus 43205; Secretary-Treasurer,
Lawrence C. Thompson, M. D., 120 Sturges Avenue,
Mansfield 44903.
Ohio Society of Physical Medicine and Rehabil-
itation — President, Robert J. Gosling, M. D., 3939
Monroe Street, Toledo 43606; Secretary, John L.
Melvin, M. D., 472 West 8th Ave., Dodd Hall,
Columbus 43210, (also secretary of Section on Physi-
cal Medicine and Rehabilitation).
Ohio Psychiatric Association — President, John
A. Whieldon, M. D., 196 East State Street, Columbus
43215, (also chairman of Section on Psychiatry and
Neurology); Secretary, Philip C. Rond, Jr., M. D.,
130 South Davis Avenue, Columbus 43222, (also
secretary of Section on Psychiatry and Neurology) ;
Program Chairman, James R. Hodge, M. D., 1540
West Market Street, Akron 44313; Executive Secre-
tary, Mr. Gene P. King, 88 East Broad Street, Co-
lumbus 43215.
Ohio State Radiological Society — President, M.
M. Thompson, M. D., 1544 South Byrne Road,
Toledo 43614; Secretary, Mortimer Lubert, M. D.,
Mt. Sinai Hospital, 1800 East 185th Street, Cleveland
44106.
Ohio Committee on Trauma, American College
of Surgeons — Chairman, Wesley Furste, M. D.,
3545 Olentangy River Road, Columbus 43214.
National Congress on Quackery
Is Scheduled in Chicago
The Third National Congress on Medical Quackery
will be held October 7-8 in Chicago at the Pick-
Congress Hotel.
The Congress will be sponsored by the American
Medical Association and the National Health Coun-
cil.
The Congress will bring together again major
American groups concerned with efforts to safeguard
the public against useless cures, mechanical gadgets,
food fads and other quack devices and worthless
treatment. The First National Congress on Medical
Quackery was held in 1961 and the Second Congress
was held in 1963.
Accredited by The Joint Commission on Accreditation of Hospitals.
WINDSOR HOSPITAL
A NONPROFIT CORPORATION
— ESTABLISHED 1 8 9 8 —
Chagrin Falls, Ohio 44022
247-5300 (Area Code 216)
A hospital for the treatment
of Psychiatric Disorders
Booklet available on request.
JOHN H. NICHOLS, NL D., Medical Director G. PAULINE WELLS, R. N., Admin. Director HERBERT A. SIHLER, Jr., Pres.
MEMBER: American Hospital Association — National Association of Private Psychiatric Hospitals — Ohio Hospital Association
for September, 1966
947
Are You Registered to Vote? . . .
September 28 Is Registration Deadline for Persons Who Must
Qualify Themselves to Vote in November 8 General Election
^TOVEMBER 8 is General Election Day, but for
citizens who must register before they can
^ ^ vote, September 28 is an equally important
date. September 28 is the final day to register. A
citizen who is in doubt as to his registration status
should inquire of his County Board of Elections.
Here are some facts to remember and dates to
note in regard to the election as outlined by the of-
fice of the Secretary of State.
Each person voting in Ohio on November 8, 1966,
will receive at least three ballots:
1. Office Type Ballot;
2. Non-Partisan Ballot;
3. Questions and Issues Ballot.
The following state, district, and county offices will
appear on the Office Type Ballot: Governor, lieuten-
ant governor, attorney general, auditor of state, secre-
tary of state, treasurer of state, representatives to
congress, state senators, state representatives, one
county commissioner, and county auditor.
The Non-Partisan Ballot will contain the candidates
for: two judges of the Supreme Court of Ohio, many
common pleas and probate judges, judge of the Court
of Appeals in some counties.
The Questions and Issues Ballot will contain any
bond issues, tax levies, and miscellaneous questions
and issues submitted in your political subdivision.
Important Dates
September 9 — Boards of Elections begin mailing
Absent Voter Ballots to members of the armed serv-
ices from whom applications have been received.
Also first day for Boards of Elections to receive ap-
plications for Absent Voter Ballots by civilians out-
side the United States, and to begin mailing Absent
Voter Ballots to civilians outside the United States.
September 28 — Last day to register.
October 9 — First day for Boards of Elections to
receive applications for disabled and civilian absent
voter ballots for persons located within the United
States.
Also first day of period during which votes may
be cast at Boards of Elections by voters who expect
to be absent from their counties and precincts on
Election Day.
November 3 — Last day (ending at 4 p. m.) for
voting at Boards of Elections by voters who will be
absent from their counties and precincts on Election
Day.
November 4 — By 12:00 noon of this date civilian
absent, sick or disabled voter ballots must be deli-
vered to clerks of Boards of Elections.
November 5 — By 12:00 noon of this date appli-
cations for Armed Sendee Absent Voter Ballots must
be received by clerks of Boards of Elections.
November 8 — General Election Day. Polls open
at 6:30 a. m. (EST) and close at 6:30 p. m. (EST).
Qualifications for Voting
You are qualified to vote if:
• You are a citizen of the U. S.
• You are at least 21 years of age or will be
on the day of the next General Election (November
8, 1966).
• You have, at the time of the election, been a
resident of: the state for one year; the county for 40
days; the voting precinct for 40 days.
[If you have moved from one county to another
county within Ohio, or from one precint to another
in the same county within 40 days before the elec-
tion, you may vote in the precinct from which you
moved.]
• You are registered. (This requirement applies
only to persons who reside in registration territory.)
You must be registered to vote if:
You reside in registration territory. (Any city
having a population of 16,000 or over, or any area
which has adopted registration. Contact your County
Board of Elections to determine your registration
status.)
Registration in Ohio is permanent, and need not
be renewed unless:
• You have not voted at least once in the past two
calendar years.
• You moved since you registered.
• You have changed your name. (A woman
must re-register if she has married since she registered.
If married after September 28, she may vote on
November 8, but not thereafter, under her former
name. )
Additional information is available from County
Boards of Elections as to the following:
• Voting for members of the Armed Forces and
their spouses;
• Registration for members of the Armed Forces
and their spouses returning home;
• Absent Voting; and
• Voting and registration for disabled voters.
948
The Ohio State Medical Journal
In contact dermatitis
Synalar
(fluocinolone acetonide)
stabilizes cell and capillary walls
protects against the chemical impact of cytotoxins
interrupts the chain reaction of destructive
changes at the cellular level
permits inactivation, absorption and transportation
of toxins away from the injured area by natural
processes... edema is absorbed and cells return
to normal size, shape, and activity
In inflammatory dermatoses choose a steroid syn-
thesized specifically for topical use. Synalar (fluocin-
olone acetonide) provides therapeutic results often
comparable to those of systemic and intralesional
corticosteroids with fewer hazards.1 "3
when complicated by infection
lieo - sy iialar9
(fluocinolone acetonide-neomycin sulfate cream)
For initiation of therapy: Cream 0.025%, 5 and 15 Gm.
tubes, 425 Gm. jars; for emollient effect: Ointment
0.025%, 15 Gm. tubes; for maintenance therapy: Cream
0.01%, 15 Gm. tubes, 45 Gm. tubes, 120 Gm. jars; for
intertriginous or hairy sites: Solution 0.01%, 20 cc. and
60 cc. plastic squeeze bottles; for infected inflammatory
dermatoses: Neo-Synalar® Cream (0.025% fluocinolone
acetonide, neomycin sulfate, equivalent to 0.35% neo-
mycin base), 5 and 15 Gm. tubes.
Contraindications: Tuberculous, fungal, and most viral
lesions of the skin, (including herpes simplex, vaccinia,
and varicella). Not for ophthalmic use. Contraindicated
in individuals with a history of hypersensitivity to any of
its components. Precautions: Synalar preparations are
virtually nonsensitizing and nonirritating. However, the
solution may produce burning or stinging when applied
to denuded or fissured areas. In some patients with dry
lesions, the solution may increase dryness, scaling or
itching. The neomycin in Neo-Synalar Cream rarely
produces allergic reactions. Prolonged use of any anti-
biotic may result in overgrowth of nonsusceptible orga-
nisms; if this occurs, appropriate therapy should be
instituted. Where severe local infection or systemic
infection exists, the use of systemic antibiotics should
be considered, based on susceptibility testing. While
topical steroids have not been reported to have an
adverse effect on pregnancy, the safety of their use on
pregnant females has not absolutely been established.
Therefore, they should not be used extensively on preg-
nant patients, in large amounts, or for prolonged periods
of time. Side Effects: Side effects are not ordinarily
encountered with topically applied corticosteroids. As
with all drugs, however, a few patients may react un-
favorably to Synalar under certain conditions.
References : 1. Kanee, B. : Canad Med Ass J 88:999 (May 18) 1963. 2. Scholtz,
J. R.: Calf Med 95:224 (Oct.) 1961. 3. Jansen. G- T., Dillaha, C. J., and
Honeycutt, W. M.: Arch Derm 92:283 (Sept.) 1965.
fluocinolone acetonide — an original steroid from
SYNTEXEE3
LABORATORIES INC., PALO ALTO, CALIF.
» i " Jr, 'Tt*
Ohio Voices Objections to HEW. . .
President of OSMA Forwards Statement to Washington
Outlining Fallacies and Discrepancies in Regulations
IN EFFORTS TO OBTAIN CHANGES in objec-
tionable regulations established by the U. S. De-
partment of Health, Education, and Welfare
regarding - Medicare, welfare programs under Title
XIX of the Medicare Law, and the Civil Rights Act,
the Ohio State Medical Association submitted to the
House Committee on Ways and Means a prepared
statement pointing out the fallacies and discrepancies
in these regulations.
The text of the statement follows:
August 15, 1966
The Hon. Wilbur D. Mills, Chairman
Committee on Ways and Means
U. S. House of Representatives
Washington, D. C. 10025
Dear Chairman Mills:
It is our understanding that you currently are
conducting hearings into the matter of Title XIX,
Public Law 89-97. Therefore, we respectfully sub-
mit for your information and consideration certain
adverse conditions resulting from the implementation
of Title XIX in Ohio.
It is our conviction that the Department of Health,
Education, and Welfare has, by restrictive, arbitrary
and capricious regulation, created a situation that is
contrary to the intent of the Committee on Ways
and Means and the intent of Congress; namely, that
the administration of P. L. 89-97 shall be conducted
without interference in the patient-physician relation-
ship and in the spirit of Sections 1801, 1802, and
1803.
Situation Described
Please permit me to describe this situation, point
by point:
1. The Ohio Department of Public Welfare has
made available to Aid for the Aged recipients an
additional $3 cash a month for these individuals to
use to "buy in’’ under Part B of the Social Security
program. Approximately 90 per cent of these reci-
pients have done so.
2. Under regulations which the Ohio Department
informs us have been promulgated by HEW, the
only methods by which these AFA recipients can
obtain Part B payment on their behalf is (A) that
the doctor accept assignment or (B) that the recipi-
ent pay the physician out of his monthly subsistence
allowance and send a receipted bill to the Part B
carrier.
3. The Ohio Department has adopted a policy
stating that it will pay the $50 deductible but will
not pay the 20 per cent deductible.
4. This Association has suggested that the physi-
cian bill the patient and the patient forward the bill
to the Ohio Department of Public Welfare. The
Department then would pay the bill and send a copy
of the payment voucher (in effect, a receipted bill)
to the Part B carrier, which would reimburse the
department 80 per cent of the charges.
5. The Part B carrier in Ohio has expressed a
willingness to follow this recommended procedure,
but the Ohio Department of Public Welfare informs
us that HEW, by regulation, will not permit the
Department to do so. It states that HEW regula-
tions give it no choice in the matter.
This situation violates Section 1801 by establishing
regulatory control over the method of "* * * com-
pensation of any * * * person providing health
services.”
Section 1812 (a) states that an individual, under
the program, is entitled to have payment made on his
behalf. It does not state that payment cannot be
made to a person responsible for the medical needs
of the patient, whether that person is a guardian or
a state agency.
Regulations Conflict
On the other hand, HEW has issued regulations
that make it impossible for a State to meet the pur-
pose of Title XIX, Section 1901, which is to enable
each State to furnish medical assistance for the aged,
among others.
The physician is forced to (1) accept assignment,
regardless of his personal preference, or (2) require
the AFA patient to reimburse him from his limited
monthly cash subsistence in order to obtain a re-
ceipted bill, or (3) simply throw up his hands in
disgust and abandon his efforts to cooperate in this
program.
The physicians of Ohio are sincerely striving to co-
operate in this program, but they cannot do so when
they are forced to sacrifice their personal beliefs and
their professional freedom.
The autocratic, dictatorial attitude of HEW is an
insult to the intent of Congress. It has been, and
952
The Ohio State Medical Journal
you’ve ever had to hunt for
your ECG cables, straps, electrodes
. . . pull out the wall plug
and reverse it... struggle with
paper that wouldn’t thread
... or needed a faster chart
speed or different sensitivity...
should have a 500 Viso
to save you time.
Ail electrodes, straps,
Redux Creme and cables
store conveniently inside
500 Viso.
Reverse power line polar-
ity on 500 by pushbutton.
Reload Permapaper chart
rolls with no threading, in
seconds (one roll makes
25 12-lead tests).
All 500 Viso’s have 25 and
50 mm/sec. chart speeds
. . . Vi, 1 or 2X sensitivity
settings for optimum trace
amplitude.
HEWLETT
PACKARD jh^ SANBORN
DIVISION
Measuring for Medicine and the Life Sciences
Cleveland Sanborn Division, 2067 East 102nd Street, (216) 721-5708
Cleveland, Ohio 44106
Columbus Sanborn Division, 1620 West First Avenue, Grandview Heights, (614) 488-5988
Columbus, Ohio 43212
CincInnati Sanborn Division, 4110 North Avenue, Silverton, (513) 891-7396
Cincinnati, Ohio 45236
for September, 1966
953
continues to be, equally insulting to the medical
profession.
For example, HEW has ordered that physicians, to
be reimbursed for their professional services provided
Title XIX patients, must sign an oath that they have
abided and will continue to abide by the Civil Rights
Act. FIEW has coldly ignored our protests of this
directive and has refused to recognize our Principles
of Medical Ethics, particularly that section which
states: "Physicians should observe ALL LAWS, up-
hold the dignity and honor of the profession and ac-
cept its self-imposed disciplines.”
"Second-Class Citizens”
HEW has, in effect, said, "You doctors are second-
class citizens. Therefore, you will have to sign a
statement that you are law-abiding.”
This ridiculous imposition has forced a consider-
able number of physicians to discontinue treatment
of Title XIX patients because they refuse to be
relegated to second-class citizenship.
Now we are confronted with the second situation,
being these arbitrary and totally unnecessary admin-
istrative regulations HEW has promulgated under
Titles XVIII and XIX, P. L. 89-97, regulations which
force physicians to abandon their personal beliefs or
else refuse to participate under conditions not au-
thorized and not intended by Congress.
Still another negative development under Title
XIX is Ohio’s discontinuance of participating in the
Mills Section of the Kerr-Mills Act, once it adopted
a Title XIX program. It is our position that such
participation is important because it provides financial
assistance for the medically indigent in order that he
not become totally indigent.
It is our sincere hope that the Committee on Ways
and Means will see fit to instruct the Department of
Health, Education, and Welfare (1) to withdraw
these contradictory and unlawful regulations in order
to permit the various State Welfare Departments to
meet their responsibilities and obligations in a clear
and direct manner.
HEW should be concerned with creating an atmos-
phere that would provide optimum communication
and trust on the part of all persons and parties in-
volved in carrying out the purposes of P. L. 89-97.
Finally, and I hope that I will not be considered
presumptuous, I sincerely recommend that the Com-
mittee on Ways and Means constitute itself as a
"watchdog committee” to supervise closely the future
Medicare regulations and operations of the Depart-
ment of Health, Education, and Welfare in order that
the administration of P. L. 89-97 be carried out within
the intent and the spirit of Congress.
Respectfully,
(Signed) L. C. Meredith, M. D.
President
Ohio State Medical Association
USE ‘POLYSPORINL.
POLYMYXIN B-BACITRACIN
OINTMENT
for topical antibiotic therapy with minimum
risk of sensitization
Caution: As with other antibiotic products, prolonged use may
result in overgrowth of nonsusceptible organisms, including
fungi. Appropriate measures should be taken if this occurs.
Supplied in V2 oz. and 1 oz. tubes.
Complete literature available on request from Professional
Services Dept. PML.
BURROUGHS WELLCOME & CO. (U.S.A.) INC.
Tuckahoe, N.Y.
954
The Ohio State Medical Journal
Disaster Institute Program . . .
Planning for Management of Mass Medical Emergencies
To Be Theme at Columbus Meeting, Sunday, October 30
A Diaster Institute Program is scheduled in Co-
lumbus on Sunday, October 30, for all per-
sons interested in the specific theme "Plan-
ning for the Management of Mass Medical Emer-
gencies.’’ Sponsoring organizations are the Ohio
State Medical Association, the Ohio Hospital Asso-
ciation, Ohio Department of Health, the Ohio Osteo-
pathic Association of Physicians and Surgeons, the
American Red Cross, and the Ohio Civil Defense
Service.
Place is the Neil House, downtown Columbus
hotel, with registration opening at 8:00 A. M. and
the first program feature at 9:30. Adjournment time
is 4:00 p. m. The program has been announced as
follows:
Morning Session
Registration
Greetings
William Slabodnick, President, Ohio Hospital As-
sociation, Administrator, Fisher-Titus Memorial
Hospital, Norwalk
Introduction and Setting the Theme
Roger Marquand, Chairman, Ohio Hospital Asso-
ciation Disaster Preparedness Planning Commit-
tee, Administrator, Polyclinic Hospital, Cleveland
"My Organization’s Role in Disaster Management"
Medicine
Lawrence C. Meredith, M. D., President, Ohio
State Medical Association, Elyria
Civil Defense
Dr. Alfred E. Diamond, Ohio Civil Defense,
Columbus
Hospitals
James O. Helland, Administrator, Defiance Hos-
pital, Defiance
Red Cross
Alfred L. Baron, Executive Director, Franklin
County Chapter of Red Cross
Ohio Department of Health
Albert E. Dyckes, Chief, Division of Adminis-
tration
Ohio Department of Public Welfare
Robert B. Canary, Assistant Director, Ohio De-
partment of Public Welfare
"What Are the Problems?”
Keynoter
Roger Marquand will be noting that speakers
to follow will be talking on disasters which
could occur in Ohio (i. e. Tornado or plant
explosion) .
Jackson, Mississippi Tornado
C. E. Wallace, M. D., Chairman, Disaster Plan-
ning Committee, Central Medical Society, Jack-
son, Mississippi
Mr. Richard H. Malone, Administrator, Id'nds
General Hospital, Jackson, Mississippi
Morning Break
DuPont Explosion, Louisville, Kentucky
William Rumage, M. D., Member, Committee
on Disaster Medical Care, American Medical
Association, Chicago
"Here’s How Your Problems Can Be Solved”
Communications
Lt. William H. Hildebrand, Asst. Director of
Civil Defense, Alameda, California
Transportation
Franklin V. Wade, M. D., F. A. C. S., Chief,
Section for the Surgery7 of Trauma, Hurley
Hospital; Chairman, Committee on Trauma,
American College of Surgeons, Flint, Michi-
gan
Medical Authority
Francis C. Jackson, M. D., F. A. C. S., Chief
Surgeon, Veterans Administration Hospital,
Pittsburgh, Pennsylvania; Chairman, Commit-
tee on Disaster Medical Care, American Medi-
cal Association
Lunch and Exhibit Break
Four Workshops
(Faculty will rotate every half hour)
How One Committee Does it
Franklin County Disaster Program, Philip Tay-
lor, M. D., Group Leader
Ben Carlisle, Ohio Hospital Association
Communications
Lt. William H. Hildebrand, Group Leader
Max E. Knickerbocker, OH A
Medical Authority
Francis C. Jackson, M. D., Group Leader
W. Michael Traphagan, OSMA Staff
Transportation
Franklin V. Wade, M. D., Group Leader
Andreas Heuser, Red Cross Staff
For additional information and registration forms,
contact W. Michael Traphagan, Secretary, Committee
on Disaster Medical Care, Ohio State Medical Asso-
ciation, 17 South High Street, Suite 500, Columbus,
Ohio 43215.
for September , 1966
955
Ohio Academy of General Practice
Reports Election of Officers
Dr. Benjamin W. Gilliotte, Zanesville, was in-
stalled as president of the Ohio Academy of General
Practice at that organization’s Annual Scientific As-
sembly in Columbus, August 2-4. He succeeded Dr.
William P. Smith, Jr., of Columbus.
The statewide organization of general practitioners
held its Scientific Assembly and business meeting at
the Sheraton-Columbus Motor Hotel in downtown
Columbus. Governor James A. Rhodes paid special
honor to the organization’s meeting by declaring the
period Family Doctor Week in Ohio.
Other new officers installed at the meeting were
Drs. B. L. Huffman, Jr., Toledo, president-elect;
Charles H. Jobe, Cleveland, vice-president; George
Clouse, Columbus, treasurer; Fred V. Light, Cleve-
land, speaker of the House of Delegates; Dr. Sanford
Press, Steubenville, vice-speaker of House of Dele-
gates; Raymond M. Kahn, Dayton, A AGP Delegate;
and William P. Smith, Jr., Columbus, AAGP Alter-
nate.
Newly elected directors are Drs. William J. Lewis,
Dayton; L. W. Siberd, Toledo; Harry A. Killian,
Willoughby; H. Judson Reamy, Dover; Edward A.
Carlin, Newark; and Thomas M. Hughes, Columbus.
Fertility Control Film Available
For Medical Group Showing
"Fertility Control and the Physician” is the name
of a film in two parts available for showing to pro-
fessional groups. The film is designed for a broad
scientific audience, particularly students and graduates
in medicine and public health. Its purpose is to
stimulate discussion of the crucial role that the health
professions play in helping individual families and
nations cope with rapid global population growth.
The film is in two parts; Part I running 20 minutes
and Part II, 24 minutes.
The film may be ordered for showing from:
Planned Parenthood - World Population Film Li-
brary, 267 West 25th Street, New York, N. Y. 10001.
Drug Manufacturing Company Announces
New Product Identification Code
Eli Lilly and Company recently announced the
development of Identi-Code, trademark name for a
new system of drug identification. The code con-
sists of one letter and two numbers, the letter desig-
nating the product form and the numbers indicating
product name and formula.
The system was announced at the recent Annual
Convention of the American Medical Association in
Chicago, and by special mailing to physicians. Fur-
ther announcement has been made through the pages
of The Journal.
r.
in the treatment of
IMPOTENCE
Android
(thyroid-androgen)
TABLETS
>v
Effectiveness confirmed by another double blind study
ANDROID
GOOD TO EXCELLENT 75%
PLACEBO
20%
1 1
i n
percent ^ 0 10 20 30 40
SUMMARY
1. Forty cases reported.
2. Excellent to good results, 75% with Android, 20% with Placebo.
3. Cites synergism between androgen and thyroid.
4. No side effects in patients treated.
5. Alleviation of fatigue noted.
6. Case histories on 4 patients.
7. Although psychotherapy still needed, role of
chemotherapy cannot be disputed.
*“ Sexual impotence treatment with methyl testosterone - thyroid (ANDROID) a
double blind study” - Montesano, Evangelista: Clinical Medicine, April 1966.
60
70
80
90
100
CONTRAINDICATIONS - Methyl testosterone is
not to be used in malignancy of reproductive
organs in male, coronary heart disease, hyper-
thyroidism. Thyroid is not to be used in heart
disease, hypertension unless the metabolic
rate is low.
CAUTION: Federal law prohibits dispensing
without prescription.
REFER TO
PDR
ANDROID
Each yellow tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. 11/6 gr.) 10 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
ANDROID-HP
Each red tablet contains:
Methyl Testosterone
Thyroid Ext. (1/2 gr.)
Glutamic Acid
Thiamine HCL
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
. 5.0 mg.
. 30 mg.
50 mg.
10 mg.
ANDROID-XJ
Each orange tablet contains:
Methyl Testosterone 12.5 mg.
Thyroid Ext. (1 gr.) 64 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 or 2 tablets daily.
Available:
Bottles of 60, 500.
V
Write for literature and samples:
BRclUDfcTHF BROWN PHARMACEUTICAL CO. 2500 W. 6th St., Los Angeles, Calif. 90057
ANDROID-PLUS
Each white tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. (V4 gr.) 15 mg.
Thiamine HCL 25 mg.
Ascorbic Acid (Vit. 0 250 mg.
Glutamic Acid 100 mg.
Pyridoxine HCL 5 mg.
Niacinamide 75 mg.
Calcium Pantothenate 10 mg.
Vitamin B-12 2.5 meg.
Riboflavin 5 mg.
Dose: 1 tablet twice daily.
Available:
Bottles of 60, 500.
956
The Ohio State Medical Journal
An eminent role in
medical practice
• Clinicians throughout the world con-
sider meprobamate a therapeutic
standard in the management of anxi-
ety and tension.
• The high safety-efficacy ratio of
‘Miltown’ has been demonstrated by
more than a decade of clinical use.
Miltowir
(meprobamate)
i
Indications: Meprobamate is effective
in relief of anxiety and tension states.
Also as adjunctive therapy when anxi-
ety may be a causative or otherwise
disturbing factor. Although not a hyp-
notic, meprobamate fosters normal
sleep through both its anti-anxiety and
muscle-relaxant properties.
Contraindications: Previous allergic or
idiosyncratic reactions to meprobamate
or meprobamate-containing drugs.
Precautions: Careful supervision of
dose and amounts prescribed is advised.
Consider possibility of dependence,
particularly in patients with history of
drug or alcohol addiction; withdraw
gradually after use for weeks or months
at excessive dosage. Abrupt withdrawal
may precipitate recurrence of pre-exist-
ing symptoms, or withdrawal reactions
including, rarely, epileptiform seizures.
Should meprobamate cause drowsiness
or visual disturbances, the dose should
be reduced and operation of motor ve-
hicles or machinery or other activity re-
quiring alertness should be avoided if
these symptoms are present. Effects of
excessive alcohol may possibly be in-
creased by meprobamate. Grand mal
seizures may be precipitated in persons
suffering from both grand and petit
mal. Prescribe cautiously and in small
quantities to patients with suicidal tend-
encies.
Side effects: Drowsiness may occur
and, rarely, ataxia, usually controlled
by decreasing the dose. Allergic or idio-
syncratic reactions are rare, generally
developing after one to four doses.
Mild reactions are characterized by an
urticarial or erythematous, maculopap-
ular rash. Acute nonthrombocytopenic
purpura with peripheral edema and
fever, transient leukopenia, and a single
case of fatal bullous dermatitis after ad-
ministration of meprobamate and pred-
nisolone have been reported. More severe
and very rare cases of hypersensitivity
may produce fever, chills, fainting spells,
angioneurotic edema, bronchial spasms,
hypotensive crises (1 fatal case), anuria,
anaphylaxis, stomatitis and proctitis.
Treatment should be symptomatic in
such cases, and the drug should not be
reinstituted. Isolated cases of agran-
ulocytosis, thrombocytopenic purpura,
and a single fatal instance of aplastic
anemia have been reported, but only
when other drugs known to elicit these
conditions were given concomitantly.
Fast EEG activity has been reported,
usually after excessive meprobamate
dosage. Suicidal attempts may produce
lethargy, stupor, ataxia, coma, shock,
vasomotor and respiratory collapse.
Usual adult dosage: One or two 400
mg. tablets three times daily. Doses
above 2400 mg. daily are not recom-
mended.
Supplied: ‘Miltown’ (meprobamate) is
available in two strengths: 400 mg.
scored tablets and 200 mg. coated tab-
lets. ‘Meprotabs’ (meprobamate) is
available as 400 mg. white, coated, un-
marked tablets. Before prescribing, con-
sult package circular.
^ WALLACE LABORATORIES
\kfeCr anbury, N.J. cm-tsw
Sixth District Postgraduate Day
Scheduled in Akron, Oct. 19
The Sixth Councilor District Postgraduate Day
clinical sessions, comprised of nationally renowned
medical educators will be held at the Sheraton-May-
flower Hotel in Akron, on Wednesday, October 19-
Registration will be from 8:30 to 9:30 A.M.'on the
first floor of the hotel, and the remainder of the
program will be conducted completely on one floor.
Cost of registration will include luncheon and park-
ing facilities.
Advance registration is being arranged via a mail-
ing of programs and advance registration cards to
members of the Sixth Councilor District. The pro-
gram has been announced as follows:
9:40-10:30 a. m.
Inguinal Hernia, Dr. Chester B. McVay, clinical
professor of surgery, University of South Dakota —
Cincinnati Room;
Heart Failure, Dr. James V. Warren, professor
and chairman, Department of Medicine, Ohio State
University School of Medicine — Ballroom;
Pediatric Panel, Dr. Morris Green, associate pro-
fessor of pediatrics, Indiana University Medical Cen-
ter; Dr. Ernest K. Cotton, assistant professor of pedi-
atrics, University of Colorado Medical School; Dr.
Robert H. Parrott, director, Childrens Hospital,
Washington, D. C. and clinical professor of pedi-
atrics, George Washington University — Ohio Room;
10:40-11:30 a. m.
Amniocentesis for Prediction of Erythroblastosis
Fetalis, Dr. Richard W. Stander, associate professor,
Department of Obstetrics and Gynecology, Indiana
University Medical Center — Cincinnati Room;
Medical Surgical Panel, Dr. McVay; Dr. Edmund
B. Flink, professor of medicine and chairman of
Department of Medicine, West Virginia School of
Medicine; Dr. Roger B. Hickler, assistant professor
of medicine and director of Hypertension Laboratory,
Peter Bent Brigham Hospital; Dr. Lester Dragsted,
research professor of surgery, University of Florida;
Dr. James V. Warren, professor and chairman, De-
partment of Medicine, Ohio State School of Medi-
cine; Dr. Desiderius Emerick Szilagyi, head, Division
of General Surgery, Henry Ford Hospital — Ballroom.
Behavorial Problems of Childhood, Dr. Cotton
— Ohio Room.
11:40-12:30 p. m.
High Risk Obstetrics, Robert E. L. Nesbitt, Jr.,
professor and chairman, Department of Obstetrics
and Gynecology, College of Medicine, State Uni-
versity of New York, Upstate Medical Center — Cin-
cinnati Room;
Duodenal Ulcer, Dr. Dragsted — Ballroom;
(Sixth District — Contd.)
Respiratory Distress Syndrome in Newborn, Dr.
Cotton — Ohio Room.
12:40-2:00 P. m. — Luncheon - Ballroom
2 : 10-3:00 p. m.
Endometriosis, Dr. Carl T. Javert, professor, clin-
ical obstetrics and gynecology, Columbia University
— Cincinnati Room;
Diagnosis, Treatment and Prevention of Viral
Diseases, Dr. Parrott — Ballroom;
Renin and Aldosterone Relationships in Hyper-
tension, Dr. Hickler — Ohio Room.
3:10-4:00 P. M.
Abortion — Body Types — Emotional Factors —
Preventive Drugs — Long-Term Counseling, Dr.
Javert and Dr. Richard W. Stander — Cincinnati Room.
Vascular Surgery, Dr. Szilagyi — Ballroom;
Theoretical and Practical Considerations of
Magnesium Deficiency in Man, Dr. Flink — Ohio
Room.
National Rheumatism Program
Scheduled in Cincinnati
Preliminary announcement has been made of the
American Rheumatism Association’s 12th Interim
Session to be held in Cincinnati on December 2 and 3-
Meeting place is the Netherland-Hilton Hotel.
Deadline for abstracts of presentations offered for
this program is September 15. Abstracts should be
mailed to: Carl M. Pearson, M. D., University of
California Medical Center, Los Angeles, Calif., 90024.
Additional information may be obtained from Rob-
ert M. Lincoln, The Arthritis Foundation, Ohio Val-
ley Chapter, 2400 Reading Rd., Cincinnati, 45202.
Lectures on Human Reproduction
Are Scheduled in Cleveland
The Institute for the Study of Human Reproduc-
tion invites physicians to attend a non-tuition series
of courses scheduled in Cleveland under the title
"I. S. H. R. Reviews.” Programs are scheduled on
Wednesdays from 2 to 4 p. m. in the Conference
Room of Saint Ann Hospital, Cleveland.
The Institute, in association with The Saint Ann
Hospital, will present Lecture Series No. 5, en-
titled "New Horizons in Reproductive Physiology
and Pathology, November 7-9, in the Academy of
Medicine of Cleveland facilities, 10525 Carnegie
Avenue, from 5 to 8 p. m. on the three days.
Topics and speakers for the weekly series of pro-
grams in September are as follows:
September 7 — "The Cell as a Mirror of Dis-
ease,” James W. Reagan, M. D., professor of patho-
logy at Western Reserve University.
September 14 — "Prenatal Drug Effects on Off-
spring,” Joseph M. Ordy, Ph. D., instructor in sur-
( Continued on Next Page )
958
The Ohio State Medical Journal
(Human Reproduction — Contd.)
gery at Western Reserve and research associate at
the Cleveland Psychiatric Institute.
September 21 — "Illegitimacy: A Socio-Psychiatric
Problem,” L. Douglas Lenkoski, M. D., acting direc-
tor of the Department of Psychiatry at Western
Reserve.
September 28 — "LSD and History,” Albert Sat-
tin, M. D., Departments of Pharmacology and Psy-
chiatry, Western Reserve.
Watch for additional information on these pro-
grams in coming issues of The Journal. Details may
be obtained from Miss Barbara A. Kasprow, Regis-
trar, Institute for the Study of Human Reproduction,
Saint Ann Hospital, 2475 East Blvd., Cleveland
44120.
Physicians in State Mental Hygiene
Schedule Program October 14
The Association of Physicians of the Department
of Mental Hygiene and Correction of the State of
Ohio will meet on October 14 at the Columbus State
School, Columbus. Joining them will be the Associ-
ation of Directors of Out-Patient Clinics of the De-
partment.
Dr. Rudolph A. Buki, president, will present Dr.
Judith Rettig, superintendent of Columbus State
School, who will welcome the Associations. "The
Community Service Unit” will be the subject of the
paper of Dr. Abdon E. Villalba following which a
business meeting will be held prior to lunch.
Dr. Julius Nemeth, in the afternoon, will present
a paper, coauthored by Dr. M. Petrovich on "Four
Years of Clinical Experience with combined Chlor-
promazine and Trifluoperazine Treatment.”
Guest and principal speaker will be Dr. William
Grater, clinical assistant professor of allergy in the
Southwestern Medical School, Dallas, Texas, who
will address the session on "Common Sense in Drug
Allergy.”
American College of Physicians
Postgraduate Courses, 1966
The American College of Physicians has released
a list of postgraduate courses to be given in various
areas of the country. Details on these programs
may be obtained by writing to the college at 4200
Pine Street, Philadelphia, Pa. 19104. Following are
courses scheduled in the near future:
September 28 - October 1 — Advances in Cutaneous
Medicine for Internists, Rochester, Minn.
October 3-7 — The Care of the Critically 111
Medical Patient, Syracuse, N. Y.
November 7-11 — Endocrine and Metabolic Dis-
orders, Brooklyn, N. Y.
November 14-18 — Newer Aspects of Experi-
mental and Clinical Allergy, Boston, Mass.
November 28 - December 2 — Progress in Gastro-
enterology— 1966, Philadelphia, Pa.
December 5-9 — What the Internist Should Know
About Cancer, New York City.
December 14- 17 — Infectious Diseases, Pittsburgh,
Pennsylvania.
New Ways to Teach Nursing
Promoted by PHS Grant
TV programs, movies, self-teaching textbooks, and
other instruction aids will be produced by Western
Reserve University’s Frances Payne Bolton School of
Nursing in an experimental project to develop more
effective ways to teach the techniques of nursing.
The project, beginning in September and extending
over five years, has been made possible by a grant of
$266,032 from the United States Public Health
Service. USPHS funds for this purpose were pro-
vided by Congress in the Nurses Training Act of
1964, designed "to improve nursing.”
SUCCESSOR TO
NONE OF ITS DISADVANTAGES
insures full sedative action
• LESS TOXIC • NON-IRRITATING • STABLE
AVAILABLE THROUGH YOUR WHOLESALER
BLESSINGS, INC.
Cleveland 3t Ohio
References on request
Chloral — the “old reliable” — for more than 100 years
is dramatically improved in DriClor (5 grains chloral
hydrate with the amino acid glycene). DriClor is less
toxic . . . more stable . . . non-irritating to the stomach
. . . and more effective grain for grain.
The effective sedative, hypnotic and anti-convulsant
form of Chloral Hydrate.
Also Chlorasec for quick, even sleep. DriClor inner core
(equivalent to 3.75 Grs. of Chloral Hydrate). Seco-
barbital acid outer coat (.75 Grs.)
for September, 1966
961
Obituaries
Ad Astra
George Steele Bowers, Sr., M.D., Toledo; Medi-
cal College of Virginia, 1935; aged 56; died July 18;
member of the Ohio State Medical Association, the
American Medical Association, the American Thor-
acic Society; fellow of the American College of Chest
Physicians. A practicing physician in Toledo for 20
years, Dr. Bowers specialized in treating diseases of
the chest, and was a past president of the local
tuberculosis societies. From 1941 to 1946 he served
with the Army Medical Corps and attained the rank
of lieutenant colonel. Survivors include two daugh-
ters, two sons, his mother, three sisters, and two
brothers.
Henry Howard Bowman, M. D., Canton; Ohio
Medical University, Columbus, 1907; aged 84; died
July 12; member of the Ohio State Medical Associa-
tion and the American Medical Association; past presi-
dent of the Canton Academy of Medicine. A native
of Stark County, Dr. Bowman practiced for some 59
years in the Canton area. Among affiliations, he was
a member of the Presbyterian Church and of the
Masonic Lodge. Survivors include two daughters and
his son, Dr. Harold J. Bowman, also of Canton.
Joseph George Brady, M. D., Naples, Fla.; West-
ern Reserve University School of Medicine, 1919;
aged 72; died July 15 in a boating accident; mem-
ber of the Ohio State Medical Association and the
American Medical Association. A Cleveland phy-
sician for many years before his retirement in I960,
Dr. Brady was medical director of the American
Bureau of Analysis in downtown Cleveland, and
was physician also for a number of industrial firms.
Among survivors are his widow, three sons and
a sister.
Richard Edmund Burdsall, M. D., Seven Mile;
Medical College of Ohio, Cincinnati, 1901; aged 93;
died July 9; member of the Ohio State Medical Asso-
ciation and the American Medical Association. A
native of Southwestern Ohio, Dr. Burdsall devoted a
lifetime to practice in the Seven Mile and Collins-
ville area of Butler County. He was a member of the
Knights of Pythias and an elder in the Presbyterian
Church. Surviving are his widow, two daughters, a
son, and a half-brother.
Alto E. Feller, M. D., Charlottesville, Va.; State
University of Iowa College of Medicine, 1933; aged
56; died July 4; former member of the Ohio State
Medical Association. A former faculty member at
Western Reserve University School of Medicine
962
where he was assistant professor of preventive medi-
cine, Dr. Feller was more recently associate dean of
medicine at the University of Virginia.
Ernest Henry Ferrell, Jr., M. D., New Haven,
Conn.; Western Reserve University School of Medi-
cine, 1947; aged 42; died July 14. Dr. Ferrell left
Ohio shortly after finishing his medical schooling,
and had been practicing surgery in New Haven. He
leaves his widow, three sons, his father, and a brother.
Kenneth Russel Howard, M. D., Sylvania; Uni-
versity of Cincinnati College of Medicine, 1924;
aged 66; died July 14; member of the Ohio State
Medical Association, the American Medical Associa-
tion, Industrial Medical Association, and the Ameri-
can Society of Abdominal Surgeons. A lifelong resi-
dent of Lucas County, Dr. Howard was medical di-
rector of the Owens-Illinois Libbey Products Division
for 42 years. During World War II he served with
the Army Air Corps medical unit and attained the
rank of lieutenant colonel. His widow and a brother
survive.
Merritt Stanley Huber, M. D., Bettsville; Univer-
sity of Louisville School of Medicine, 1934; aged 62;
died July 22; member of the Ohio State Medical As-
sociation and the American Medical Association. Dr.
Huber practiced for two years at Pemberville, then
went to Bettsville where he completed 30 years of
practice. He served as a member of the Seneca County
Board of Health and for a number of years was
president of that group. During the war he was
county health commissioner, and for four terms was
on the local village council. A member of the Catho-
lic Church, he is survived by his widow and a son.
Paul Zedock King, M. D., Bedford; Rush Medical
College, 1936; aged 72; died July 24; member of the
Ohio State Medical Association and the American
Medical Association. A native of Chardon, Dr. King
practiced for some 30 years in the Greater Cleveland
area. During World War I he was a member of the
famous Lakeside Unit, the first American medical
group to serve in France. His widow and a brother
survive.
John Adam Knapp, M. D., London; University
of Wisconsin Medical School, 1933; aged 62; died
July 1; member of the Ohio State Medical Associa-
tion and the American Medical Association. A gen-
eral practitioner in the London area since 1934, Dr.
Knapp was a veteran of World War II. Among affili-
The Ohio State Medical Journal
ations, he was a member of the Catholic Church and
of the Knights of Columbus. His widow survives.
David Franklin Leach, M. D., Youngstown;
Western Reserve University School of Medicine,
1939; aged 52; died July 13; former member of the
Ohio State Medical Association and the American
Medical Association. A practicing physician for about
ten years in Youngstown, Dr. Leach formerly prac-
ticed in Bellaire and in Beaver, Pa. Among affilia-
tions, he was a member of the Christian Church. His
mother with whom he made his home survives.
Alfred Parsons Magness, M. D., Coshocton; Ohio
State University College of Medicine, 1916; aged 75;
died July 31 in a traffic accident; member of the
Ohio State Medical Association and the American
Medical Association. Dr. Magness was a physician of
long standing in the Coshocton area, having moved
there in 1922. Among professional activities he was
physician for the Pennsylvania Railroad in his area.
He was a member of the American Legion, having
served in the Navy during World War I. Other
affiliations include membership in the Presbyterian
Church and the Masonic Lodge. Mrs. Magness died
with her husband in the accident. Surviving are two
daughters and two sons, Dr. Alfred H. Magness, also
of Coshocton, and Dr. John L. Magness, Fargo, N. D.
Tilman H. McLaughlin, M. D., Illinois Medical
College, 1903; aged 90; died July 23. A practicing
physician in Toledo many years ago, Dr. McLaughlin
moved to California in 1921. Two daughters survive.
Paul David Meyer, M. D., Columbus; Ohio State
University College of Medicine, 1935; aged 57; died
July 15; member of the Ohio State Medical Associa-
tion, the American Medical Association, Radiologi-
cal Society of North America, and a Fellow of the
American College of Radiology; diplomate of the
American Board of Radiology. Dr. Meyer was head
of the X-ray Department at Grant Hospital and as-
sistant professor of radiology at Ohio State University
College of Medicine. He was past president of both
the Central Ohio and Ohio State Radiological Socie-
ties and was affiliated with numerous other profes-
sional organizations. He was a major in the Army
Medical Corps, was a member of the Jewish Center
board, former member of the United Jewish Fund,
a member of B’nai B’rith, and a past president of the
American Jewish Physicians Committee. Survivors
include his widow; two sons, Dr. Teale L. Meyer,
Cincinnati, and Dr. Bruce P. Meyer, Dallas, Texas;
also a brother, Dr. Jerome Meyer, of Dayton.
Edmund C. Mohr, M. D., Toledo; University of
Michigan Medical School, 1916; aged 74; died July
10; member of the Ohio State Medical Association,
the American Medical Association, Central Associa-
tion of Obstetricians and Gynecologists; fellow of the
American College of Obstetricians and Gynecologists,
Right there
where he’s needed
Improvement of mental alertness and aware-
ness in the management of the senility syndrome
requires a comforting environment, a stimulating
dietary regimen and concomitant drug therapy.
LEPTINOL® is a non-addictive stimulant which
is a useful adjunct in elevating the mood of the
elderly patient who displays apathy, mental con-
fusion or memory lapses.
LEPTINOL® is a combination of pentylenet-
etrazol, niacin, thiamin and ascorbic acid which
acts as a central nervous stimulant and which
exerts its primary effect on the mid-brain and the
medullary center. LEPTINOL® may be pre-
scribed for patients with mild hypertension or
other organic diseases.
Each LEPTINOL® bi-layer tablet contains: PENTYL-
ENETETRAZOL, 100 mg., NIACIN, 50 mg., THIAMINE
HYDROCHLORIDE, 1 mg., ASCORBIC ACID, 20 mg.
DOSE one or two tablets, 3 times daily.
Side Effects: overdosage may produce tremor, convulsions
or respiratory paralysis.
Caution should be taken when treating patients with a low
convulsive threshold. Patients should be warned not to exceed
recommended dose which offers maximum effectiveness.
Write for detailed literature and
starter LEPTINOL® doses.
THE VALE CHEMICAL COMPANY, INC.
Pharmaceuticals
Allentown, Pennsylvania
for September, 1966
963
and the American College of Surgeons; diplomate of
the American Board of Obstetrics and Gynecology.
Elmer Herman Nagel, M. D., Youngstown; Ohio
State University College of Medicine, 1916; aged 79;
died July 6; member of the Ohio State Medical Asso-
ciation and the American Medical Association; past
president of the Mahoning County Medical Society.
Only recently Dr. Nagel was honored for completing
50 years of devotion to the practice of medicine, with
virtually all of that time served in the Youngstown
area. For a period during World War I he served
with the Army Medical Corps. He was a member
of the Catholic Church, the American Legion, Maen-
nerchor, and the Elks Lodge. Survivors include his
widow, a son, a daughter, a brother and two sisters.
Josiah Merton Pumphrey, M. D., Mt. Vernon;
Jefferson Medical College of Philadelphia, 1904;
aged 87; died July 23; member of the Ohio State
Medical Association and the American Medical As-
sociation; past president of the Knox County Medical
Society. A native of Mt. Vernon, Dr. Pumphrey de-
voted most of his professional career to practice
in that area. He was a veteran of World War I
and formerly active in the Ohio National Guard.
He was a member of the American Legion, Cham-
ber of Commerce, Elks Lodge, the Christian Church,
and several Masonic bodies. Dr. Gordon H. Pum-
phrey, also of Mt. Vernon, is a son. Other sur-
vivors include a daughter and a sister.
Daniel S. Quickel, M. D., Anderson, Indiana;
Cincinnati College of Medicine and Surgery, 1894;
aged 98; died April 19. An alumnus of an Ohio
medical college, Dr. Quickel established his practice
early in the Anderson community, according to avail-
able records.
David John Roberts, M. D., Akron; Cornell Uni-
versity Medical College, 1933; aged 59; died May 27;
member of the Ohio State Medical Association, the
American Medical Association, American Academy
of General Practice, and American Society of Abdom-
inal Surgeons. A practitioner of many years standing
in Akron, Dr. Roberts was a veteran of World War
II, having served in the Air Force as a medical
officer. His widow and three children survive.
William Thomas Shriner, M. D., Cincinnati; Uni-
versity of Cincinnati College of Medicine, 1930; aged
60; died July 7; former member of the Ohio State
Medical Association. Dr. Shriner retired from prac-
tice some years ago for health reasons.
Ezra Israel Silver, M. D., Cleveland; Wayne State
University College of Medicine, 1934; aged 57; died
July 23; member of the Ohio State Medical Associa-
tion and the American Academy of General Practice.
A native of Cleveland, Dr. Silver practiced there for
32 years. He was a member of the Temple, a past
master in the Masonic Lodge, past president in B’nai
. . . introduce your patient to
(BENZTHIAZIDE)
AQUATAG (Benzthiazide) is a potent, orally
active, nonmercurial, diuretic agent. It is effective
orally in producing diuresis in edema states,
where it is therapeutically comparable to mercu-
rials given parenterally. AQUATAG (Benzthia-
zide) is mildly antihypertensive in its own right
and enhances the action of other antihyperten-
sive drugs when used in combination.
DIURETIC ACTION: Clinically, the oral administration of AQUATAG (benzthiazide) re-
sults in diuretic activity within two hours with maximal natriuretic, chloruretic, and diuretic
effects occurring during the fourth, fifth and sixth hours. Maintenance of response con-
tinues for approximately 12 to 18 hours. Acidosis is an unlikely complication since thera-
peutic doses of AQUATAG (benzthiazide) do not appreciably increase bicarbonate
excretion. Edematous patients receiving 50 mg. of AQUATAG (benzthiazide) daily for
five days developed a maximal increase in the rate of sodium excretion on the first day,
and maintained this high rate until depletion of excessive body stores of sodium.
In congestive heart-failure patients, AQUATAG (benzthiazide) produced the same
weight loss, during a 48-hour treatment period as did a maximally effective dose of
hydrochlorothiazide.
DOSAGE: Diuresis, initially 50 to 200 mg.; maintenance 25 to 150 mg., daily. Hyper-
tension 50 to 100 mg. initially, adjusted to 50 mg. t.i.d: or downward to minimal effective
dosage level.
WARNINGS: Use with caution in the presence of renal disease as azotemia may be
precipitated or increased. In patients with advanced hepatic disease, electrolyte imbal-
ance may result in hepatic coma. Dosage of coadministered antihypertensive agents
should be reduced by at least 50%. In cases of suspected electrolyte imbalance, serum
electrolyte determinations.should be performed and imbalance, if any, corrected. Stenosis
or ulcer of small intestine have been reported with coated potassium formulas, and
surgery has been required and deaths have occurred. Based on surveys of both United
States and foreign physicians, incidence of these lesions is low and a causal relationship
in man has not been definitely established. Until further experience has been obtained,
Ihe use of the drug in pregnant patients should be weighed against possible hazards
to the fetus.
CONTRAINDICATIONS: AQUATAG (benzthiazide) is contraindicated in progressive
renal disease or dysfunction including increasing oliguria and azotemia. Continued
administration of this drug is contraindicated in patients who show no response to its
diuretic or antihypertensive properties. Severe hepatic disease is a relative contra-
indication. (See "Warnings" above.)
PRECAUTIONS AND SIDE EFFECTS: Electrolyte imbalance with hypokalemia (digitalis
toxicity may be precipitated), hypochloremic alkalosis and hyponatremia may occur.
Patients with cirrhosis should be observed for impending hepatic coma and hypokalemia.
Other reactions may include blood dyscrasias. hyperuricemia and gout, nausea, jaundice,
anorexia, vomiting, diarrhea, dizziness, paresthesia, photosensitivity and headache
Hepatic fetor, tremor, confusion and drowsiness are
signs of impending pre coma and coma in patients
with cirrhosis. Insulin requirements may be altered
in diabetes. AQUATAG (benzthiazide) should be
used with caution post-operatively as hypokalemia
is not uncommon. Potassium supplementation may be
advisable pre- and post-operatively. There have been
occasional reports of thrombocytopenia, leukopenia,
agranulocytosis, aplastic anemia and precipitation of
acute pancreatitis or jaundice.
Before prescribing or administering, read the pack-
age insert or file card available on request.
S.J.TUTAG
Available as 25 or 50 mg. scored tablets.
Request clinical samples and literature on your
letterhead.
& COMPANY
Detroit. Michigan 48234
964
The Ohio State Medical Journal
B’rith; active in the Big Brothers organization and
the Odd Fellows lodge. During World War II he
served overseas in the Medical Corps as a lieutenant
colonel. Survivors include his widow, a daughter, a
son, two brothers and a sister.
Orlow Chapin Snyder, M. D., Polk; University of
Michigan Medical School, 1915; aged 76; died Feb-
ruary 16. A former resident of New York, Dr.
Snyder was living in retirement.
Benjamin William Spero, M. D., Cleveland;
Western Reserve University School of Medicine,
1911; aged 76; died July 12; former member of
the Ohio State Medical Association. Dr. Spero prac-
ticed for many years in Cleveland, specializing in
dermatology. He was a member of the Temple. Sur-
vivors include a son, two daughters, four sisters, and
a brother.
Frederick W. Trinkle, M. D., Cincinnati; Eclec-
tic Medical College, Cincinnati, 1917; aged 72; died
July 28; member of the Ohio State Medical Associa-
tion, the American Medical Association, and the
American Academy of General Practice. A resident
of the Clifton area, Dr. Trinkle practiced for approx-
imately a half century. Among affiliations, he was
active in a number of Masonic bodies. Survivors in-
clude a daughter, a brother, and two sisters.
Beulah Wells, M. D., Chautauqua, N. Y.; Johns
Hopkins University School of Medicine, 1922; aged
80; died July 7; member of the Ohio State Medical
Association, the American Medical Association, and
the American Academy of Pediatrics; diplomate of
the American Board of Pediatrics. A practitioner in
Cleveland for a number of years before her retire-
ment in 1958, Dr. Wells was former head of the
pediatrics department at Woman’s Hospital. A
brother survives.
John F. Zielinski, M. D., Lorain; Stritch School
of Medicine of Loyola University, 1932; aged 57;
died July 4; member of the Ohio State Medical Asso-
ciation and the American Medical Association. A resi-
dent of Lorain since 1940, Dr. Zielinski was medical
director of the Brush Beryllium Company in Cleve-
land. He was a member of the Catholic Church. Sur-
viving are his widow and three sons.
CORRECTION
In the obituary of Eugene R. Hammersley, M. D.,
of Tuscarawas, in last month’s issue, The Journal er-
roneously omitted the widow from the list of survi-
vors. The staff apologies for this omission and for
any embarrassment it may have caused relatives and
friends. Mrs. Hammersley who survives her husband
helped Dr. Hammersley in his practice for many years
by working in the office.
Activities of
County Societies . . .
COSHOCTON
Dr. Milton A. Boyd, who practiced internal medi-
cine in Coshocton since 1958, accepted a position at
St. Marys Hospital, Richmond, Va., effective July 1.
Dr. Jose Louis Becerra opened an office in War-
saw, in Coshocton County, August 1. He formerly
practiced in Middlefield. Dr. Becerra is a graduate
of the National Autonomous Medical School of the
University of Mexico, 1948. He interned at General
Hospital, Mexico City, and was licensed to practice
in Ohio, August, 1961.
CUYAHOGA
The annual golf tournament of the Academy of
Medicine of Cleveland was held at Shaker Heights
Country Club on July 18. About 120 golfers played
the course and enjoyed the club facilities. Results
were published in the August issue of The Bulletin.
MAHONING
The Mahoning County Medical Society is continu-
ing its weekly participation in "Diagnosis,” the radio
program broadcast over WFMJ at 8:05 p. m. each
Tuesday.
On broadcasts for July were the following topics
and speakers: Food Poisoning — Sidney Franklin,
M. D., J. R. Gillis, M. D., and George Canatsey,
Ph. D., Heat Exhaustion and Stroke — G. E. De-
Cicco, M. D., and John J. McDonough, M. D.; Hos-
pital Emergency Room — P. G. Giber, M. D., and
F. W. Morrison, M. D.
The Mahoning County Medical Society cooperated
with sponsors of the Red Cross First Aid Station at
the Canfield Fair in Mahoning County. At the early
September fair, persons manning the Red Cross First
Aid Station served in shifts during the five day affair.
Ohioans on Program of International
Medical History Congress
Two Ohio physicians were on the program for
the 20th International Congress on Medical History,
held in Berlin, August 22-27.
Dr. Bruno Gebhard, retired director of the Museum
of Health Education, Cleveland, was one of ten
delegates from the United States, and was listed on
the program as lecturing on the topic, "Alfred
Grotjahn’s Social Pathology and the Development
of Social Medicine.”
Dr. Harold Feil, Cleveland Heights, was listed
as lecturing on the "History of Poetry Concerning
the Foxglove.”
for September, 1966
965
Woman’s Auxiliary Highlights
By MRS. S. L. MELTZER, Publicity Committee
Chairman, 2442 Dorman Dr., Portsmouth 45662
T’S ALMOST HERE AGAIN — Fall Conference
time. This year the workshop scene is set for
October 11 and 12, in Columbus, at Stouffer’s
University Inn. It will have a bit of a New Look
and it is hoped that county auxiliaries will be well
represented — as they most certainly should be! Mrs.
Paul Sauvageot, state president-elect, has coined a
new Conference slogan: "At least four from every
auxiliary" ... It is wise to remember that Fall Con-
ference time is Practical Assistance time.
Four people in particular have worked long and
hard to set up this important meeting: Mrs. James
Wychgel, state president; Mrs. Sauvageot; Mrs. Ros-
coe J. Kennedy, Fall Conference chairman; and Mrs.
Joseph Kaplan, cochairman. Along with them on
the working staff are Mrs. James Gavin, Conference
treasurer; Mrs. Fred Kelly, assistant treasurer; every
state officer and board member; and helpers from
Columbiana, Franklin, Huron, and Medina counties.
Registration is the morning of Tuesday, October
11, between 9:00 and 11:30 A. M. The opening
luncheon at noon will be primarily to get acquainted
and to set the pattern for a smooth conference. Dis-
trict directors will be on hand at least 30 minutes
before the luncheon to see that people from the
various counties are introduced to each other. Three
sessions — those on International Health, Mental
Health, Credits and Awards — will run simulta-
neously, each leader presenting her material three
times. Persons attending will be divided into Groups
A, B and C, each of which will hear all three sub-
jects. The groups will not move — program leaders
will go from room to room. The word is that there
will be no long talks. Leaders will give enough
background to set the stage, but what is particularly
wanted is audience participation: the opportunity to
ask questions, get answers and — yes — even criticize!
An elective sesison that afternoon of October 11
should be one to which everyone will want to flock:
Parliamentary Procedures (under the leadership of
Mrs. Rudolf Cooks). I don’t know of anything that
is more difficult to master (or more frustrating at
times as well as bewildering) ! You may think you
know all there is to know about Parliamentary Pro-
cedures — but you’d better attend this session and
find out how much, amazingly, you DON’T know . . .
The dinner that night will run toward the general
New Look by not having a speaker. Instead there
will be a program of entertainment, followed by
the showing of films that local groups will find
especially adapted to their use. Also that night, the
Exhibits Section will be open where materials will
be available and further questions may be asked. The
exhibits will, of course, cover the various phases of
Auxiliary work and will be manned by the different
chairmen. Again quoting Ludel Sauvageot, "the ex-
hibits will tell a story.”
The morning of October 12 (9:00 a. m.) will
feature an hour-long "sample program” on Health
and Charm as presented by Summit County. There
will also be a question and answer period. At 10:15
A. M., Mrs. Harry L. Fry, legislative chairman, will
come up with a "sample” Political Action program
which should be a "must” for every auxiliary mem-
ber attending the Conference. It will effectively cue
you in on what you can do back home. The Septem-
ber Auxiliary News will contain detailed information
on the Conference. I’m only hitting the high spots.
One last word — to members-at-large: PLEASE
come. Your state officers want very much to greet
you, see you, know you, help you.
Around the State
These are delayed news items that had to make
way for the Convention story and the Pre-Election
Conference. And now — at long last:
In May, the Butler Auxiliary held its last meeting
of the auxiliary year with the president, Mrs. Richard
Mense, presiding. This is the 25th anniversary of
the Butler group, and the second president, Mrs.
C. F. Macready, was introduced to the members. Mrs.
Mense in reviewing the highlights of the year spoke
of the annual Health Careers Day with over 300
high school students participating, the Today’s Health
magazine that is sent to all schools as well as rest
homes in the area, the 21 barrels of medicine sent to
World Medical Relief, the awarding of the seventh
Health Careers scholarships to a high school senior.
These officers were elected and installed for 1966-67:
Mrs. Paul Woodward, Jr., president; Mrs. William
Crawford, vice-president; Mrs. Louis Skimming, re-
cording secretary; Mrs. Jerry Hammond, correspond-
ing secretary; Mrs. Marvin Max, treasurer; Mrs. Carl
Leyrer, director, and Mrs. Everett Jung, president-elect.
Columbiana members were invited to be guests
of the County Medical Society at a dinner held at
the Wick Hotel in Lisbon. Dr. and Mrs. C. W. De-
walt showed films of their 72 day trip through
Africa. The Columbiana group lent assistance to the
Camp Fire Girls of the area’s County School for Re-
tarded Children in their camping activities. A craft
day was scheduled and the children were instructed
in the making of clown puppet dolls. Mrs. J.
9 66
The Ohio State Medical Journal
Lauva and daughter Inez; Mrs. William Horger;
Mrs. H. F. Banfield and daughter Debbie; Mrs. R. J.
Bonistalli and daughter Margaret served on the
teaching staff. A party was also given on the closing
day. And these women in the Columbiana auxiliary7
certainly believe in an early start: Three "coffees”
were held for advanced showing of Christmas cards
sold on behalf of AMA-ERF (this happened in
June; an 8 per cent discount is given by the card
company). The "coffees” were held by Mrs. R. J.
Bonistalli in East Liverpool, Mrs. R. J. McConnor
in Salem and Mrs. W. A. Bacon in Lisbon.
Half-Page Spread
If any auxiliary wants a practical lesson in pub-
licity, I suggest contacting the Hamilton auxiliary!
This group certainly seems to have succeeded in con-
vincing the newspaper people in Cincinnati of the
importance of the work of doctors’ wives. On July
19, the Cincinnati Enquirer devoted a half-page
spread by the Women’s Club editor whose lead said
"summer doesn’t mean a recess of the volunteer work
of members of the Woman’s Auxiliary . . .” The
story was detailed and good, and there were three
excellent photographs to boot. This isn’t the first
time that there has been outstanding feature cover-
age in the local papers. It happens again and again !
Mrs. Ben I. Friedman is the new president. Mrs.
Joseph E. Ghory is president-elect; Mrs. Ralph H.
Miller, vice-president; Mrs. Robert E. Johnstone,
treasurer; Mrs. Emil I. Barrows and Mrs. Mitchell
Ede, secretaries. At the May meeting, members and
guests boarded the Jubilee for a boat ride and lunch-
eon. A program of folk music was presented by the
Medi-Chords, an instrumental combo of eight physi-
cians (how about that!) and by the Choral Group of
the auxiliary.
The Huron auxiliary recently completed a survey
of the health facilities in its county. The idea for
this survey was brought to the group’s attention by
the local Health Department with the backing of the
County Health Commissioners and was done under
the auspices of the Department of Rural Sociology
of Ohio State University. The survey included hos-
pitals and their facilities, nursing homes, professional
personnel, clinics and health services, voluntary agen-
cies in the health field, school health programs, pub-
lic health and welfare services and a breakdown of
the health insurance coverage.
Mrs. Robert Sylvester is the new president of the
Licking auxiliary. Serving with her are: Mrs. Charles
F. Sinsbaugh, president-elect; Mrs. James H. Johnson,
vice-president; Mrs. J. F. Barker, treasurer and Mrs.
John Hauser, secretary. The group’s late spring
meeting was a dinner at the Moundbuilders Country
Club, with Mrs. Lawrence Miller presiding. Three
recent recipients of the group’s nursing scholarships
were introduced: Marcia Smith, Benita Moore and
Mona Phillips.
Looking Back
A few months ago the Lucas County auxiliary7 trav-
eled back 25 years via the magic wands of Mrs. E.
Benjamin Gillette, Mrs. Gregor Sido and Mrs. Ward
Jenkins. To quote from one account: "These women
served as archeologists excavating interesting facts of
the past 25 years.” Also at this occasion called
"Something Special in Silver,” past presidents as
well as the three state presidents from Lucas County
were honored and new officers were installed. Mrs.
Richard L. Schafer is the 1966-67 president; Mrs.
Howard Smith, president-elect; Mrs. Ronald Wade
and Mrs. James Roberts were chairmen of the 25th
anniversary luncheon.
Also in May, prizes were awarded at the Bridge
Marathon finale. Winners were Mrs. Henry7 B run-
sting and Mrs. A. J. Kuehn. Runners-up were Mrs.
Paul Geiger and Mrs. John Brunner. The Lucas
County women hope to double participation in the
Bridge Marathon this auxiliary year when proceeds
will again go toward AMA-ERF and the Hospital
Ship Hope. And talking of elections — one of
Lucas County’s very own members — Jane Kuebbeler
— is running for Congress ! She is at present a city
councilwoman. (Remember what former Vice-
President Richard Nixon said about doctors’ wives
and politics?)
Protect Your Family — Now — With the OSMA-PLAN
of comprehensive group major medical insurance sponsored by the
Ohio State Medical Association for its members and their families
NEW —
Also available to Ohio Physicians:
up to $100,000
DISABILITY
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( All three at low group rates)
Call or write : DANIELS-HEAD & ASSOCIATES, INC.
Daniels- 1 lead Building, Portsmouth, Ohio 45662 lei. 353-3124
9*7
for September, 1966
New drugs take exams, too.
Today, virtually every medical school in the
United States cooperates with pharmaceutical
manufacturers in the clinical evaluation of new
and promising drugs. Just as you might find it
significantly more difficult to practice medicine
without the useful new compounds made avail-
able through original pharmaceutical research
in the past twenty years — prescription-drug
manufacturers would find it equally difficult to
obtain extensive, long-term, dependable evalu-
ations of new therapeutic agents without the
close cooperation of medical staffs and clinical
facilities of medical schools and teaching hos-
pitals. Such cooperation leads toward more
effective care of more patients— the common
goal of medical and pharmaceutical research —
toward reduction in the cost of disease, toward
increase in useful longevity.
This message-is brought to you as a courtesy of this publica-
tion on behalf of the producers of prescription drugs.
Pharmaceutical
Manufacturers Association
Pharmaceutical
Advertising Council
1155 Fifteenth St.. N. W., Washington, D.C. 20005
State Association Officers and Committeemen
Headquarters Office: 17 S. High St. — Suite 500, Columbus 43215. Telephone: (611+) 228-6971
OFFICERS and COUNCILORS
Lawrence C. Meredith, M. D., President
205 Elyria Block, Elyria 44035
Robert E. Howard, M. D., President-Elect
2500 Central Trust Tower, Cincinnati 45202
Paul N. Ivins, M. D., First District
306 High Street, Hamilton 45011
Theodore L. Light, M. D., Second District
2670 Salem, Avenue, Dayton 45406
Frederick T. Merchant, M. D., Third District
1051 Harding Memorial Parkway,
Marion 43305
Robert N. Smith, M. D., Fourth District
3939 Monroe Street, Toledo 43606
P. John Robechek, M. D., Fifth District
10525 Carnegie Avenue, Cleveland 44106
Henry A. Crawford, M. D., Past President
1058 Hanna Bldg., Cleveland 44115
Philip B. Hardymon, M. D., Treasurer
350 East Broad St., Columbus 43215
Edwin R. Westbrook, M. D., Sixth District
438 North Park Avenue, Warren 44481
Sanford Press, M. D., Seventh District
525 N. Fourth Street, Steubenville 43952
Robert C. Beardsley, M. D., Eighth District
2236 Maple Avenue, Zanesville 43705
George N. Spears, M. D., Ninth District
2213 South Ninth Street, Ironton 45638
Richard L. Fulton, M. D., Tenth District
1211 Dublin Road, Columbus 43212
William R. Schultz, M. D., Eleventh District
1749 Cleveland Road, Wooster 44691
THE EXECUTIVE STAFF
Hart F. Page, Executive Secretary
Herbert E. Gillen, Administrative Assistant
W. Michael Traphagan, Administrative Assistant
Charles W. Edgar, Director of Public Relations
and Assistant Executive Secretary
Jerry J. Campbell, Administrative Assistant
R. Gordon Moore, Executive Editor
THE EDITOR: Perry R. Ayres, M. D.
COMMITTEES
Committee on Education — Thomas E. Rardin, Columbus, Chair-
man (1971) ; Clyde W. Muter, Warren (1970) ; Thomas S.
Brownell, Akron (1969) ; John G. Sholl, Cleveland (1968) ;
Elmer R. Maurer, Cincinnati (1967).
Judicial and Professional Relations Committee — Frank F. A.
Rawling, Toledo, Chairman (1968) ; Henry A. Crawford, Cleve-
land (1971) ; Homer A. Anderson, Columbus (1970) ; Chester H.
Allen, Portsmouth (1969) ; David Fishman, Cleveland (1967).
Committee on Public Relations and Economics — Frederick P.
Osgood, Toledo, Chairman (1969) ; Horace B. Davidson, Colum-
bus (1971) ; Luther W. High, Millersburg (1970) ; John H.
Budd, Cleveland (1968) ; John J. Cranley, Jr., Cincinnati
(1967).
Committee on Scientific Work — Samuel Saslaw, Columbus,
Chairman (1968) ; Jerry Hammon, West Milton (1971) ; Robert
E. Zipf, Dayton (1971) ; Jack Schreiber, Canfield (1970) ;
Walter J. Zeiter, Cleveland (1970) ; John D. Battle, Jr., Cleve-
land (1969) ; Harold J. Schneider, Cincinnati (1969) ; Isador
Miller, Urbana (1968) ; William Hamelberg, Columbus (1967) ;
F. A. Simeone, Cleveland (1967).
Committee on AMA-ERF — Robert S. Martin, Zanesville,
Chairman.
Committee on Auditing and Appropriations — William R.
Schultz, Wooster, Chairman; Edwin R. Westbrook, Warren;
George Newton Spears, Ironton.
Committee on Cancer — Arthur G. James, Columbus, Chair-
man ; Thomas D. Allison, Lima ; Andrew M. Barone, Lima ;
William F. Boukalik, Cleveland; William J. Flynn, Youngs-
town ; Douglas P. Graf, Cincinnati ; Stanley O. Hoerr, Cleve-
land ; William A. Newton, Jr., Columbus ; W. D. Nusbaum,
Lancaster ; Arthur E. Rappoport, Youngstown ; Carl A. Wilz-
bach, Cincinnati.
Committee on Disaster Medical Care — Thomas D. Allison,
Lima, Chairman ; Thomas P. Bowlus, Toledo ; Nino M. Camardese,
Norwalk; Drew L. Davies, Columbus; John H. Davis, Cleveland;
Gregory G. Floridis, Dayton ; Robert D. Gillette, Huron ; Robert
S. Heidt, Cincinnati ; Robert E. Holmberg, Cleveland ; N. J. M.
Klotz, Wadsworth ; Thomas W. Morgan, Gallipolis ; Sterling
W. Obenour, Jr., Zanesville; Vol K. Philips, Columbus; Liaison
with the American Medical Association : Wendell A. Butcher,
Columbus.
Committee on Environmental Health — Rex H. Wilson, Akron,
Chairman ; William W. Davis, Columbus ; Larry L. Hipp, Gran-
ville; Robert C. Markey, Bowling Green; B. C. Myers, Lorain;
Tuathal P. O’Maille, Marietta ; Thomas N. Quilter, Marion ; I. C.
Riggin, Lorain; Robert E. Schulz, Wooster; Victor A. Simiele,
Lancaster; John P. Storaasli, Cleveland; Robert Vogel, Dayton;
Robert C. Waltz, Cleveland; Tennyson Williams, Delaware;
John L. Zimmerman, Fremont.
Committee on Eye Care — Arthur D. Collins, Cleveland, Chair-
man ; Martin J. Cook, Springfield ; Thomas L. Edwards, Lima ;
Robert H. Magnuson, Columbus ; Russell J. Nicholl, Cleveland ;
Claude S. Perry, Columbus ; Norman W. Pinschmidt, Gallipolis ;
Barnet R. Sakler, Cincinnati ; Robert L. Willard, Toledo.
Committee on Government Medical Care Programs — H. Wil-
liam Porterfield, Columbus, Chairman ; James O. Barr, Chagrin
Falls; Dwight L. Becker, Lima; Robert A. Borden, Fremont;
Edwin W. Burnes, Van Wert; Philip T. Doughten, New Phila-
delphia ; Robert B. Elliott, Ada ; George T. Harding, Sr.,
Worthington ; Roger E. Heering, Columbus ; M. Robert Huston,
Millersburg; Francis M. Lenhart, Defiance; Harold E. Mc-
Donald, Elyria ; Elliott W. Schilke, Springfield ; Bernard A.
Schwartz, Cincinnati ; Clarence V. Smith, Canton ; Joseph B.
Stocklen, Cleveland; Don P. Van Dyke, Kent; William M.
Wells, Newark.
Committee on Hospital Relations — Robert M. Craig, Dayton,
Chairman ; L. Fred Bissell, Aurora ; L. A. Black, Kenton ;
Wendell T. Bucher, Akron ; Oscar W. Clarke, Gallipolis ; Henry
A. Crawford, Cleveland; John V. Emery, Willard; Harvey C.
Gunderson, Toledo ; Henry L. Hartman, Toledo ; E. R. Haynes,
Zanesville ; Middleton H. Lambright, Cleveland ; Lloyd E. Lar-
rick, Cincinnati; James C. McLarnan, Mt. Vernon; Ben V.
Myers, Elyria ; E. W. Schilke, Springfield ; Robert A. Tennant,
Middletown ; V. William Wagner, Port Clinton ; William A.
White, Canton.
Committee on Insurance — David A. Chambers, Cleveland,
Chairman ; William F. Bradley, Columbus ; Walter A. Daniel,
Tiffin; Chester R. Jablonoski, Cleveland; William A. Knapp,
Zanesville; Marvin R. McClellan, Cincinnati: William Neal,
Archbold ; Oliver E. Todd, Toledo ; Robert E. Tschantz, Canton ;
Allan L. Wasserman, Dayton ; John W. Wherry, Elyria ; Wil-
liam A. White, Canton.
Committee on Laboratory Medicine — Horace B. Davidson,
Columbus, Chairman ; William H. Benham, Columbus ; John B.
Hazard, Cleveland ; Melvin Oosting, Dayton ; Arthur E. Rappo-
port, Youngstown ; William Sinclair, Cleveland ; Gilbert B.
Stansell, Toledo; Philip B. Wasserman, Cincinnati.
for September, 1966
969
State Association Officers and Committeemen (Continued)
Committee on Legislation — James T. Stephens, Oberlin, Chair-
man ; Chester H. Allen, Portsmouth ; Donald R. Brumley, Find-
lay ; Jonathan G. Busby, Columbus ; George D. J. Griffin, Cin-
cinnati ; Jack L. Kraker, Lancaster ; William J. Lewis, Dayton ;
Maurice F. Lieber, Canton ; James C. McLarnan, Mt. Vernon ;
Wesley J. Pignolet, Willoughby; Marvin J. Rassell, Hamilton;
Theodore E. Richards, Urbana ; Robert E. Rinderknecht, Dover ;
John H. Sanders, Cleveland; William W. Trostel, Piqua.
Committee on Maternal Health — Anthony Ruppersberg, Colum-
bus, Chairman ; Otis G. Austin, Medina ; Raymond E. Barker,
Columbus; William D. Beasley, Springfield; Keith R. Brande-
berry, Gallipolis ; Thomas E. Byrne, Mentor ; Mel A. Davis,
Columbus; Marion F. Detrick, Jr., Findlay; John P. Garvin,
Columbus ; Richard P. Glove, Cleveland ; Robert A. Heilman,
Columbus; John F. Hillabrand, Toledo; Robert E. Johnstone,
Cincinnati; Albert A. Kunnen, Dayton; James F. Morton,
Zanesville ; Ralph K. Ramsayer, Canton ; Robert E. Swank,
Chillicothe ; Densmore Thomas, Warren; Robert S. VanDervort,
Elyria.
Committee on Medicine and Religion — Charles A. Sebastian,
Cincinnati, Chairman ; John D. Albertson, Lima ; Eugene F.
Damstra, Dayton ; Francis M. Lenhart, Defiance ; Ralph W.
Lewis, Portsmouth ; George W. Petznick, Cleveland ; J. Kenneth
Potter, Cleveland; John R. Seesholtz, Canton; William B.
Smith, Zanesville; James T. Stephens, Oberlin; Donald J.
Vincent, Columbus ; Don G. Warren, West Lafayette.
Committee on Mental Health — Wendell A. Butcher, Columbus,
Chairman ; Homer A. Anderson, Columbus ; Robert D. Eppley,
Elyria; Max D. Graves, Springfield; Richard G. Griffin, Worth-
ington ; Warren G. Harding, Columbus ; Edward O. Harper,
Cleveland ; Henry L. Hartman, Toledo ; William H. Holloway,
Akron ; C. Eric Johnston, Columbus ; Robert E. Reiheld, Orr-
ville ; Philip C. Rond, Columbus ; W. Donald Ross, Cincinnati ;
Viola V. Startzman, Wooster ; Victor M. Victoroff, Cleveland.
Military Advisory Committee — Drew L. Davies, Columbus,
Chairman ; Ralph G. Carothers, Cincinnati ; Homer D. Cassel,
Dayton ; Henry A. Crawford, Cleveland ; Walter L. Cruise,
Zanesville ; Charles R. Keller, Mansfield ; Ralph W. Lewis,
Portsmouth ; Edward L. Montgomery, Circleville ; Frank T.
Moore, Akron ; Frederick P. Osgood, Toledo ; Earl Rosenblum,
Steubenville; Richard G. Weber, Marion.
Committee on Rural Health — Robert E. Reiheld, Orrville,
Chairman ; Chester J. Brian, Eaton ; Robert R. C. Buchan,
Troy ; J. Martin Byers, Greenfield ; Walter A. Campbell, Co-
shocton ; E. Joel Davis, East Canton ; Victor R. Frederick,
Urbana ; Benjamin W. Gilliotte, Zanesville ; Jerry L. Hammon,
West Milton; Jasper M. Hedges, Circleville; Luther W. High,
Millersburg ; E. D. Mattmiller, Athens; John R. Polsley, North
Lewisburg ; Leonard S. Pritchard, Columbiana ; Harold C.
Smith, Van Wert ; Kenneth W. Taylor, Pickerington.
OSMA Advisory Committee to the Ohio State Society of
Medical Assistants — Richard L. Fulton, Columbus, Chairman ;
George Newton Spears, Ironton.
Committee on School Health — Charles H. McMullen, Loudon-
ville, Chairman; Walter Felson, Greenfield; Howard H. Hop-
wood, Cleveland ; Dale A. Hudson, Piqua ; Howard J. Ickes,
Canton ; Charles L. Kagay, Dayton ; Thomas E. Wilson, Warren ;
Robert C. Markey, Bowling Green ; Robert J. Murphy, Colum-
bus ; Carey B. Paul, Jr., Columbus ; Carl L. Petersilge, Newark ;
William H. Rower, Ashland ; Thomas E. Shaffer, Columbus ;
Aubrey L. Sparks, Warren ; Homer B. Thomas, Gallipolis.
OSMA Members of the Joint Committee on School Bus Driver
Examinations — Carey B. Paul, Jr., Columbus ; Thomas N.
Quilter, Marion ; Drew L. Davies, Columbus.
OSMA Members of the Joint Advisory Committee on Athletic
Injuries — Walter A. Hoyt, Jr., Akron; John R. Jones, Toledo;
Don A. Kelly, Cleveland ; Sol Maggied, West Jefferson ; Marvin
R. McClellan, Cincinnati ; Robert P. McFarland, Oberlin ;
Charles H. McMullen, Loudonville ; Robert J. Murphy, Colum-
bus ; Carey B. Paul, Jr., Columbus ; Thomas E. Shaffer,
Columbus.
Committee on Workmen’s Compensation - — H. P. Worstell,
Columbus, Chairman ; A. L. Berndt, Portsmouth ; Thomas H.
Brown, Jr., Toledo ; Charles A. Browning, Jr., Bellefontaine ;
Oscar W. Clarke, Gallipolis ; Frederick A. Flory, Columbus ;
Lawrence T. Hadbavny, Cleveland ; Clyde O. Hurst, Ports-
mouth; Edmund F. Ley, Tiffin; Joseph Lindner, Sr., Cincinnati;
John D. Osmond, Jr., Cleveland; James G. Roberts, Akron;
George L. Sackett, Sr., Painesville ; William V. Trowbridge,
Cleveland; Rex H. Wilson, Akron; James N. Wychgel, Cleve-
land ; Joseph H. Shepard, Columbus ; Frederick A. Wolf,
Cincinnati.
Woman’s Auxiliary Advisory Committee — Robert C. Beard-
sley, Zanesville, Chairman ; Theodore L. Light, Dayton ; Fred-
erick T. Merchant, Marion.
Ohio Medical Indemnity Liaison Committee — Robert E.
Tschantz, Canton, Chairman ; Henry A. Crawford, Cleveland ;
Lawrence C. Meredith, Elyria ; Mr. Hart F. Page, Executive
Secretary, OSMA, Columbus.
DELEGATES AND ALTERNATES
Delegates and Alternates to the American Medical Association
— George W. Petznick, Cleveland ; H. T. Pease, Wadsworth, alter-
nate ; Carl A. Lincke, Carrollton ; Robert S. Martin, Zanesville,
alternate ; Theodore L. Light, Dayton ; Kenneth D. Arn, Dayton,
alternate; Edmond K. Yantes, Wilmington; Harry K. Hines,
Cincinnati, alternate; John H. Budd, Cleveland; P. John Robe-
chek, Cleveland, alternate ; Richard L. Meiling, Columbus ;
Frank F. A. Rawling, Toledo, alternate ; Frederick P. Osgood,
Toledo ; Robert N. Smith, Toledo, alternate ; Charles A. Sebas-
tian, Cincinnati ; J. Robert Hudson, Cincinnati, alternate ; Ed-
win H. Artman, Chillicothe; Philip B. Hardymon, Columbus,
alternate ; Robert E. Tschantz, Canton ; Henry A. Crawford,
Cleveland, alternate.
County Societies’ Officers and Meeting Dates
First District
Councilor: Paul N. Ivins, Hamilton 45011
306 High Street
ADAMS — Gary J. Greenlee, President, Manchester 45144 ; Stan-
ley H. Title, Secretary, Manchester 45144.
BROWN — Charles H. Maly, President, Sardinia 45171 ; Charles
W. Hannah, Secretary, Sardinia 45171. 1st Monday monthly.
BUTLER — Robert Johnson, President, 500 S. Breiel Boulevard,
Middletown 45042 ; Mr. Charles G. Greig, Executive Secretary,
110 North Third Street, Hamilton 45011. 4th Wednesday
monthly.
CLERMONT — Cecil F. Barber, President, State Route 133, Feli-
city 45120; Phillips F. Greene, Secretary, Route 1, Box 509,
New Richmond 45157. 3rd Wednesday monthly, except July
and August.
CLINTON — Richard R. Buchanan, President, 115 West Main,
Wilmington 45177 ; Mary Ranz Boyd, Secretary, Box 629,
Wilmington 45177. 4th Tuesday monthly.
HAMILTON — Robert M. Woolford, President, 320 Broadway,
Cincinnati 45202 ; Mr. Edward F. Willenborg, Executive
Secretary, 320 Broadway, Cincinnati 45202. Monthly meet-
ing dates, 1st Tuesday; Academy, 3rd Tuesday, except June,
July and August.
HIGHLAND — Thomas L. Jones, President, 528 South St., Green-
field 45123 ; Walter Felson, Secretary, 357 South St., Greenfield
45123. 3rd Tuesday bimonthly.
WARREN — O. Williard Hoffman. President, 20 East Fourth
Street, Franklin 45005; Ray E. Simendinger. Secretary. 901
North Broadway Street. Lebanon 45036. 2nd Tuesday monthly.
Second District
Councilor: Theodore L. Light, Dayton 45406
2670 Salem Ave.
CHAMPAIGN — Myron J. Towle, President. 848 Scioto Street,
Urbana 43078 ; Fred R. Denkewalter. Secretary. 848 Scioto
Street, Urbana 43078. 2nd Wednesday monthly.
CLARK — Henry M. Tardif, President, 2608 E. High Street,
Springfield 45505 ; Mrs. Marion L. WHooxonn. Executive
Secretary, 616 Building, Room 131, 616 N. Limestone St.,
Springfield 44503. 3rd Monday monthly, except June, July
and August.
DARKE — William A. Browne, President. 722 Sweitzer St..
Greenville 45331 ; Delbert D. Blickenstaff, Secretary, 552 S.
West St., Versailles 45380. 3rd Tuesday monthly.
GREENE — Clement G. Austria, President, 1142 North Monroe
Drive, Xenia 45385 ; Mrs. C. K. Elliott, Executive Secretary,
225 Pleasant Street, Xenia 45385. 2nd Thursday monthly
except July and August.
MIAMI — David Brown, President, 1060 North Market Street,
Troy 45373: Jack P. Steinhilber, Secretary, 145 Sunset Drive,
Piqua 45356. 1st Tuesday monthly.
MONTGOMERY — Charles E. O’Brien, President, 600 Fidelity
Building, Dayton 45402 ; Mr. Robert F. Freeman, Executive
Secretary, 280 Fidelity Medical Building, Dayton 45402. 1st
Friday monthly October through May — 1st Wednesday June.
PREBLE — John D. Darrow, President, 228 N. Barron St., Eaton
45320 ; Willard C. Clark. Jr., Secretary, 228 N. Barron, Eaton
45320. Irregular meetings.
SHELBY — George J. Schroer. President, 322 Second Ave., Sidney
45365 ; Alfonsas Kisielius. Secretary, Ohio Bldg., Sidney 45365.
970
The Ohio State Medical Jour:::
County Societies’ Officers and Meeting Dates (Continued)
Third District
Councilor: Frederick E. Merchant, Marion 43305
1051 Harding Memorial Pky.
ALLEN — Carl H. Zinsmeister, President, 729 W. Market Street,
Lima 45801 ; Thomas D. Allison, Secretary, 401 Metropolitan
Bank Building, Lima 45801. 3rd Tuesday monthly.
AUGLAIZE — Robert Sobocinski, President, 75 Blackhoof Street,
Wapakoneta 45895 ; J. F. Bowling, Secretary, 319 West Spring
Street, St. Marys 45885. 1st Thursday monthly except July.
CRAWFORD — Don E. Ingham, President, 201 N. Market Street,
Galion 44833 ; Johnson H. Chow, Secretary, 1040 Devonwood
Drive, Galion 44833. Called meetings.
HANCOCK — Raymond J. Tille, President, 801 S. Main St., Find-
lay 45840 ; Herbert L. Queen, Secretary, 828 Woodworth Dr.,
Findlay 45840.
HARDIN — William D. Dewar, President, 405 North Main Street,
Kenton 43326 : John J. Roget, Secretary, Belle Center 43310.
2nd Tuesday monthly.
LOGAN — Thomas Seitz, President, 223 E. Columbus Street,
Bellefontaine 43311 ; Glen Miller, Secretary, R. D. 2, West
Liberty 43357. 1st Friday monthly.
MARION — Ransome Williams, President, 1035 Harding Me-
morial Parkway, Marion 43302 ; Alice Fisher, Secretary, 1040
Delaware Avenue, Marion 43302. 1st Tuesday monthly.
MERCER — R. Duane Bradrick, President, Rockford 45882 ; R. L.
Dobbins, Secretary, 5402 State Route 29 East, Celina. 3rd
Thursday, monthly.
SENECA — Olgierd C. Garlo, President, 53 Clay Street, Tiffin
44883 ; Leonard M. Gaydos, Secretary, 233 South Monroe
Street, Tiffin 44883. 3rd Tuesday monthly.
VAN WERT — Norman L. Marxen, President, Medical Arts Bldg.,
Fox Road, Van Wert 45891; W. L. Her, Secretary, Medical
Arts Bldg., Fox Road, Van Wert 45891. 4th Friday monthly.
WYANDOT — Herschel A. Rhodes, President, 777 N. Sandusky
Ave., Upper Sandusky 43351 ; J. J. Browne, Secretary, 777 N.
Sandusky Ave., Upper Sandusky 43351. 2nd Tuesday monthly.
Fourth District
Councilor: Robert N. Smith, Toledo 43606
3939 Monroe St.
DEFIANCE — L. F. Berry, Jr., President, 1400 East Second
Street, Defiance 43512 ; W. S. Busteed, Secretary, Box 218,
Defiance 43512.
FULTON — B. H. Reed, Jr., President, Delta 43515 ; R. L. Davis,
Secretary, Wauseon 43567. 2nd Tuesday quarterly March,
June, September, December.
HENRY — J. J. Harrison, President, 113 East Clinton Street,
Napoleon 43545 ; Gamble S. Hall, Secretary, 834 Strong
Street, Napoleon 43545. 1st Tuesday monthly.
LUCAS — E. L. Doermann, President, 2001 Collingwood Blvd.,
Toledo 43620 : Mr. Robert W. Elwell, Executive Secretary, 3101
Collingwood Blvd., Toledo 43610. 3rd Tuesday monthly except
July and August.
OTTAWA — V. Wm. Wagner, President, 122 East Perry, Port
Clinton 43452 ; William Coon, Secretary, 120 East Perry, Port
Clinton 43462. 2nd Thursday monthly.
PAULDING — Roy R. Miller, President, 220 W. Perry, Paulding
45879 ; D. Paul Ward, Secretary, Box 416, Oakwood 45873.
Meetings called.
PUTNAM — Arthur P. Daniel, President, 144 N. Walnut, Ottawa
45875 ; Oliver N. Lugibihl, Secretary, Pandora 45877. 1st
Tuesday monthly.
SANDUSKY — J. L. Zimmerman, President, Memorial Hospital
of Sandusky County, Fremont 43420 ; Mrs. Patsy J. Askins.
Executive Secretary, Memorial Hospital of Sandusky County,
Fremont 43420. 3rd Wednesday monthly.
WILLIAMS — John E. Moats, President, Central Drive, Bryan
43506 ; Neil T. Levenson, Secretary, 907 Noble Drive, Bryan
43506. 2nd Tuesday monthly.
WOOD — Roger A. Peatee, President, 140 S. Prospect Street,
Bowling Green 43402 ; Douglas Hess, Secretary, 920 North
Main St., Bowling Green, Ohio 43402. 3rd Thursday monthly.
Fifth District
Councilor: P. John Robechek, Cleveland 44106
10525 Carnegie Ave.
ASHTABULA — J. R. Nolan, President, 2736 Lake Avenue, Ash-
tabula 44004 ; Richard Millberg, Secretary, 430 West 25th
Street, Ashtabula 44004. 2nd Tuesday monthly.
CUYAHOGA — David Fishman, President, Room 404, 10515 Car-
negie Avenue, Cleveland 44106 ; Mr. Robert A. Lang, Executive
Secretary, 10525 Carnegie Avenue, Cleveland 44106.
GEAUGA — Bruce F. Andreas, President, 400 Downing Drive.
Chardon 44024 ; Mrs. Martha Withrow, Executive Secretary,
P. O. Box 249, Chardon 44024. 2nd Friday monthly.
LAKE — Robert W. Colopy, President, 89 E. High Street, Paines-
ville 44077 ; Mrs. Owen A. McLaren, Executive Secretary,
7408 Cadle Avenue, Mentor 44060. 4th Wednesday evening
monthly, January, May, March, September and November
unless otherwise ordered by Council.
Sixth District
Councilor: Edwin R. Westbrook, Warren 44481
438 North Park Ave.
COLUMBIANA— Edith S. Gilmore, President, 432 W. 5th St.,
E. Liverpool 43920 ; Fraser Jackson, Secretary, 205 W. 6th
St. 3rd Tuesday monthly.
MAHONING — F. A. Resch, President, Doctors Park, Canfield
44406 ; Mr. Howard C. Rempes, Jr., Executive Secretary, 245
Bel-Park Building, 1005 Belmont Avenue, Youngstown 44504.
3rd Tuesday monthly except July and August.
PORTAGE — David Palmstrom, President, 124 North Prospect
Street, Ravenna 44266 ; William R. Brinker, Secretary, 141
East Main Street, Kent 44240. 3rd Tuesday monthly.
STARK — A. R. Furnas, Jr., President, 420 Lake Avenue, N. E.,
Massillon 44646 : Mr. John H. Austin, Executive Secretary,
405 4th Street, N. W., Canton 44702. 2nd Thursday monthly.
SUMMIT — James G. Roberts, President, 655 West Market Street,
Akron 44303 ; Mr. Sidney H. Mountcastle, Executive Secretary,
437 Second National Building, 159 South Main Street, Akron
44308. 1st Tuesday monthly.
TRUMBULL — John F. McGreevey, President, 297 Hawthorne
Lane N. E., Warren 44484 ; Mrs. Kay Ticknor, Executive
Secretary, 280 North Park Avenue, Warren 44481. 3rd
Wednesday monthly September through May.
Seventh District
Councilor: Sanford Press, Steubenville 43952
525 North Fourth Street
BELMONT — James Sutherland, President, 9 North 4th Street,
Martins Ferry 43935 ; Bertha M. Joseph, Secretary, 100 South
4th Street, Martins Ferry 43935. 3rd Thursday of February,
March, April, June, September, October, November and
December.
CARROLL — Glen C. Dowell, President, 207 West Main, Car-
rollton 44615 ; Thomas J. Atchison, Secretary, 292 East
Main, Carrollton 44615. 1st Thursday monthly.
COSHOCTON — Don Warren, President, 600 East Main Street,
West Lafayette 43845 ; Harold Lear, Secretary, 133 South
Fourth Street, Coshocton 43812. 2nd Tuesday monthly.
HARRISON — Charles D. Evans, President, 159 South Main
Street, Cadiz 43907 ; G. E. Vorhies, Secretary, Scio 43988,
Quarterly.
JEFFERSON — Jacob R. Cohen, President, 341 Market Street,
Steubenville 43952 ; Irving Dreyer, Secretary, Ohio Valley
Hospital, Steubenville 43952. 4th Tuesday monthly except
December, January, February.
MONROE — Byron Gillespie, Secretary, Woodsfield 43793.
TUSCARAWAS — Robert J. Kuba, President, 319 Grant St., Den-
nison 44621 ; Thomas E. Ogden, Secretary, 138 E. Main St.,
Gnadenhutten. 2nd Thursday monthly.
Eighth District
Councilor: Robert C. Beardsley, Zanesville 43705
2236 Maple Ave.
ATHENS — D. R. Johnson, President, 52 West Washington
Street, Nelsonville 45764 ; L. A. Hamilton, Secretary, 400 East
State Street, Athens 45701. 2nd Tuesday monthly except July
and August.
FAIRFIELD — George W. LeSar, President, 216 Harmon Avenue,
Lancaster 43130 ; Stephen R. Hodsden, Secretary, 1423 West
Market Street, Baltimore 43105. 2nd Tuesday monthly.
GUERNSEY — A. C. Smith, President, 1115 Clark Street, Cam-
bridge 43725 ; Dayle O. Snyder, Secretary, 840 Wheeling
Avenue, Cambridge 43725. 1st Tuesday monthly.
LICKING — Carl L. Petersilge, President, 104 Hudson Avenue,
Newark 43065 : Robert P. Raker, Secretary, 317 N. Granger
Street, Granville 43023. 4th Tuesday monthly.
MORGAN — A. H. Whitacre, President, Chesterhill 43728 ; Henry
Bachman, Secretary, Box 199, Malta 43758.
MUSKINGUM — Paul A. Jones, President, 838 Market Street,
Zanesville 43701 ; Myron Powelson, Secretary, 2825 Maple
Avenue, Zanesville 43705. 2nd Tuesday monthly.
NOBLE — Frederick M. Cox, President, Caldwell 43724 ; Edward
G. Ditch, Secretary, 415 Main Street, Caldwell 43724. 1st
Tuesday monthly.
PERRY — Charles B. McDougal, President, 319 High St., New
Lexington 43764; Michael P. Clouse, Secretary, West Main St.,
Somerset 43783.
WASHINGTON — Mary L. Whitacre, President, Rt. 6, Marietta
45750 ; G. E. Huston, Secretary, 328 Fourth St., Marietta
45750. 2nd Wednesday monthly.
for September, 1966
971
County Societies’ Officers and Meeting Dates (Continued)
Ninth District
Councilor: George N. Spears, Ironton 45638
2213 S. 9th St,
GALLIA — Quentin Korfhage, President, Gallipolis Clinic, Gal-
lipolis 45631 ; John Groth, Secretary, Holzer Clinic, Gallipolis
45631. Monthly meetings at called times.
HOCKING — Jan S. Matthews, President, 9 East Second Street,
Logan 43138 ; H. M. Boocks, Secretary, Route 3, Logan 43138.
2nd Tuesday monthly.
JACKSON — John M. Cook, President, Box 316, Oak Hill 45656 ;
Earl J. Levine, Secretary, 120 N. Ohio Ave., Wellston 45692.
LAWRENCE — Frank W. Crowe, President, 2110 South 9th
Street, Ironton 45638 ; George Newton Spears, Secretary, 2213
South Ninth Street, Ironton 45638. Quarterly at called times.
MEIGS — Charles J. Mullen, President, 210 *4 E. Main St., Pome-
roy 45769 ; Edmund Butrimas, Secretary, 204 E. Main St.,
Pomeroy 45769.
PIKE — Robert T. Leever, President, 100 East Third St., Waverly
45690 ; Albert M. Shrader, Secretary, East Water St., Waverly
45690. 1st Tuesday monthly.
SCIOTO — Chester H. Allen, President, 1405 Offnere Street,
Portsmouth 45662 ; Erich Spiro, Secretary, 1735 Waller Street,
Portsmouth 45662. 2nd Monday in February, April and Octo-
ber ; December meeting and summer meeting decided by the
Council and members notified one month in advance.
VINTON — Richard E. Bullock, President, 203 South Market St.,
McArthur 45651.
Tenth District
Councilor: Richard L. Fulton, Columbus 43212
1211 Dublin Rd.
DELAWARE — Don K. Michel, President, 98 W. William, Dela-
ware 43015 ; Tennyson Williams, Secretary, Box 265, Delaware
43015. 3rd Tuesday monthly.
FAYETTE — R. D. Woodmansee, President, 403 East Market
Street, Washington C. H. 43160; M. H. Roszmann, Secretary,
1005 East Temple Street, Washington C. H. 43160. 2nd
Friday monthly
FRANKLIN — Joseph A. Bonta, President, 3100 Olentangy River
Road, Columbus 43202; Mr. W. “Bill” Webb, Jr., Executive
Secretary, 17 South High St., Suite 528, Columbus 43215.
3rd Tuesday monthly.
KNOX — Richard L. Smythe, President, 812 Coshocton Road,
Mt. Vernon 43050 ; Robert E. Sooy, Secretary, Box 470, Mt.
Vernon 43050. 1st Wednesday evening monthly.
MADISON — Sol Maggied, President, 15 East Pearl Street, West
Jefferson 43162 ; Michael Meftah, Secretary, 11 East 2nd
Street, London 43140. 1st Wednesday monthly.
MORROW — Francis W. Kubb, President, 140 North Main. Mt.
Gilead 43338 ; William S. Deffinger, Secretary, Box 8, Marengo
43334. 1st Tuesday monthly.
PICKAWAY — V. D. Kerns, President, 143 E. Main Street,
Circleville 43113; Carlos Alvarez, Secretary, 147 Pinckney
Street, Circleville 43113. 1st Friday evening monthly, except
months of July and August.
ROSS — Joseph McKell, President, 174 W. Main Street, Chilli-
cothe 45601; Lowell O. Smith, Secretary, 217 Delano Avenue,
Chillicothe 45602. 1st Thursday evening monthly.
UNION — Malcolm Maclvor, President, 110 N. Court St., Marys-
ville 43040 ; May B. Zaugg, Secretary, 225 Stockdale Drive,
Marysville 43040. 1st Tuesday, February, April, October,
December.
Eleventh District
Councilor: William It. Schultz, Wooster 44ti!tl
1749 Cleveland Road
ASHLAND — Henry C. Chalfant, President. 309 Arthur Street,
Ashland 4 4805; H. W. Smith, Secretary, 4 14 Samaritan Ave-
nue, Ashland 44805. 1st Thursday monthly.
ERIE — Clinton F. Lavender, President, 1218 Cleveland Road,
Sandusky 44870 ; Mrs. David Wolfert, Executive Secretary,
1205 Tyler Street, Sandusky 44870.
HOLMES — Charles H. Hart, President, 109 South Clay Street,
Millersburg 44654 ; William A. Powell, Secretary, 8 West
Adams Street, Millersburg 44654. 3rd Thursday monthly.
HURON — W. R. Graham, President, 15 Main Street, Wakeman
44889 ; E. R. McLoney, Secretary, 257 Benedict Avenue, Nor-
walk 44857. 2nd Wednesday of February, April, June, Au-
gust, October, and December.
LORAIN — Joseph A. Cicerrella, President, 209 6th Street, Lorain
44052 ; Mrs. Gladys Davidson, Executive Secretary, 428 West
Avenue, Elyria 44035. 2nd Tuesday monthly except June,
July and August.
MEDINA — Myrl A. Nafziger, President, Albrecht Building,
Wadsworth 44281 ; Mr. A. Dana Whipple, Executive Secretary,
320 East Liberty Street, Medina, Ohio 44256. 3rd Thursday
monthly.
RICHLAND — C. J. Shamess, President, 74 Wood Street, Mans-
field 44903 ; Harold F. Mills, Secretary, 70 Madison Road,
Mansfield 44905. 3rd Thursday monthly except June, July and
August.
WAYNE — Howard MacMillan, President, 1740 Cleveland Road,
Wooster 44691 ; R. J. Watkins, Secretary, 1736 Beall Avenue,
Wooster 44691. 2nd Wednesday monthly, January, February,
April, September, November and December.
Grants Promote Research
Two new grants, totaling $50,737 have been re-
ceived by the Ohio State University College of Medi-
cine from the National Institutes of Health.
Dr. Francis E. Cuppage, Department of Pathology,
was awarded $15,992 to support his studies to deli-
neate the pathogenesis and pathophysiology of the
regenerative or reparative phase of acute renal tubular
injury.
Dr. Robert McCluer, Department of Psychiatry,
was granted $34,745 for investigation of the isolation
and characterization of the various functional and
molecular species of brain RNA.
Advance notice has been given of a National Con-
gress on Environmental Health Management to be
conducted by the American Medical Association in
New York City, April 24-26, 1967, at the Hotel
Americana. Additional information may be obtained
from James G. Telfer, M. D., director of the AMA
Department of Environmental Health.
Albany Medical College is sponsoring its eighth
Medical Seminar Cruise, January 6-23, 1967 — New
York to the Carribbean area and return. Persons
interested may write to the college at Albany, N. Y.
12208.
THE WOMAN’S AUXILIARY TO THE OHIO STATE MEDICAL ASSOCIATION
President : Mrs. James N. Wychgel
3320 Dorchester Rd., Cleveland 44120
Vice-Presidents: 1. Mrs. Malachi W. Sloan, II
415 Towerview Rd., Dayton 45429
2. Mrs. Carl F. Goll
1001 Granard Pkwy., Steubenville 43952
3. Mrs. Edward L. Doerman
3605 Laskey Rd., Toledo 43623
Past President and Nominating Chairman :
Mrs. Herbert F. Van Epps
425 E. 15th St., Dover 44622
President-Elect : Mrs. Paul Sauvageot
2443 Ridgewood Rd., Akron 44313
Recording Secretary : Mrs. James W. Loney
15450 Hemlock Point Rd., Chagrin Falls
Corresponding Secretary : Mrs. Vincent T. Kaval
19201 VanAken Blvd., Cleveland 44122
Treasurer : Mrs. Russell L. Wiessinger
2280 West Wayne St., Lima 45805
972
The Ohio State Medical Journal
JOURNAL ADVERTISERS
Advertisers in The Journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The Journal,
and help make it a quality publication. In return we
place their messages on the desks of Ohio’s physicians.
Please familiarize yourself with their services and pro-
ducts. and let them know that you see their advertising
in The Journal.
In This Issue:
Abbott Laboratories 891-892-893-894
Allergy Laboratories of Ohio, Inc
875
Ames Company, Inc
878
Appalachian Hall
895
Associated Credit Bureaus of Ohio
860
Blessings, Inc
961
The Brown Pharmaceutical Co
888. 956
Burroughs Wellcome & Co. (USA) Inc.
954
Ciba Pharmaceutical Company
. 926-927
Daniels-Head & Associates. Inc
967
Data Corporation
Dorsey Laboratories, a Division of the
Wander Company 861-862-863-864
Frigidaire Division. G. M. C
974
Geigy Pharmaceuticals. Division of
Geigv Chemical Corporation
889
Harding Hospital
865
Hewlett-Packard Company,
Sanborn Division
953
Hynson. Westcott & Dunning, Inc
833
Inland Steel Company
975
Lederle Laboratories, A Division of American
Cyanamid Company .... 859, 930-931,
949, 976
Lilly, Eli, and Company
896
The Medical Protective Company
890
Merck Sharp & Dohme, Division of
Merck & Co.. Inc
876-877
Neisler Laboratories. Inc., Subsidiary of
Union Carbide Corporation
868-869
North. The Emerson A.. Hospital. Inc. ..
867
Parke. Davis & Company Inside Front Coyer
Pharmaceutical Manufacturers
Association
872, 968
Philips Roxane Laboratories 884-885 974
Robins. A. H.. Company, Inc
959-960
Roche Laboratories, Division of
Hoffman-La Roche Inc Back Cover
Sanborn Division, Hewlett-Packard Company 953
Searle, G. D., & Company
928-929
Smith Kline & French Laboratories ..
879
Squibb. E. R.. & Sons
858, 871
Syntex Laboratories Inc 856-857
950-951
Turner & Shepard, Inc
Tutag. S. J., & Co
The Vale Chemical Company. Inc. ..
963
Wallace Laboratories
873, 957
Warren-Teed Pharmaceuticals Inc. .
886-887
The Wendt-Bristol Company
975
West-ward, Inc
Windsor Hospital
Winthrop Laboratories Inside Back Cover
Wyeth Laboratories
881-882
Table of Contents
(Continued From Page 85 5)
Page
860 Ohioans on Texas Gynecology Program
865 Americans Are Highly Mobile People
865 Cincinnati Physician Is Recipient of National
Pediatrics Award
870 Current Comments in the Field of the Drug
Manufacturers
870 Clevelander Heads Board of Regenrs of
American Chest Physicians
874 Related Factors in Increasing Motorscooter
Accidents
874 New Members of the Association
874 Ohio Physicians Help Establish Virus
Classification System
874 Veterans Administration Hospitals Providing
More Beds for Nursing Care
888 What To Write For
890 American College of Surgeons to Convene on
West Coast
890 Malignant Tumors in Trout Studied
890 Investigators Compile Collection of Papers on
Berylliosis
895 American College of Physicians Announces
Regional Programs
895 Establish Training Program for Obstetric
Anesthesiology
935 AMA Clinical Convention To Be Held in
Las Vegas
941 New Member Joins OSMA Headquarters Staff
944 Ohioan Will Receive National Award at
Occupational Health Meeting
946 Chairmen and Secretaries of OSMA Specialty
Sections
946 Officers of Ohio Specialty Societies
950 Ohio Academy of General Practice Reports
Election of Officers
955 Disaster Institute Program, Columbus,
October 30
958 Sixth District Postgraduate Day, Akron,
October 19
958 National Rheumatism Program, Cincinnati
958 Lectures on Human Reproduction, Cleveland
961 Physicians in State Mental Hygiene Schedule
Program
961 American College of Physicians Postgraduate
Courses
962 Obituaries
965 Activities of County Medical Societies
966 Woman’s Auxiliary Highlights
969 Roster of State Association Officers and
Committeemen
970 Roster of County Medical Society Officers and
Meeting Dates
972 State Officers of the Woman's Auxiliary
973 Index to The Journal’s Advertisers
974 Classified Advertisements (also on page 975)
for September, 1966
973
Classified Advertisements
Rates: 50 cents per line. Minimum charge of $1.00 for each insertion. Display classified, $1.00 per line.
(12 lines to the inch) Prices cover the cost of remailing answers. Forms close 15th of the month preced-
ing publication. To assure prompt delivery, when replying to an advertisement over a Journal box number,
address letters as follows:
Box (insert number), c/o The Ohio State Medical Journal,
17 South High Street, Suite 500, Columbus, Ohio 43215
Physicians seeking locations in Ohio are invited to contact
the Physicians’ Placement Service in the executive offices of
the Ohio State Medical Association, 17 South High Street,
Suite 500, Columbus, Ohio 43215. Through this medium
efforts are made to establish communications between physi-
cians seeking locations and communities where physicians are
needed, or other physicians who are in need of associates.
GENERAL PRACTITIONER. Available immediately position for
young G. P. in group practice. Group consists of two G. P.’s, an
Internist and an American Board Surgeon, in new medical building
with complete laboratory service and close to local hospital. Salary
first year leading to partnership, no investment. Rural community,
well located in northeast Ohio, excellent school system. Housing
available. Reply Box 422, Ohio State Medical Journal.
SPACE AVAILABLE — The Twinsburg Professional Center, on
State Route 14, across from the new TWINSBURG PLAZA shop-
ping center, in fast growing Twinsburg village. Air Conditioned,
ground floor space available, plenty of parking and good lighting.
Western Reserve design. This buifding is in a five mile radius of
Ford Motor Co., General Motors Corp., and Chrysler Corp., and is
surrounded by public and parochial schools, churches and approxi-
mately 5000 new homes. Eight interchanges in Twinsburg. A dire
need for physicians or surgeons in this area due to the expanding
population. Mr. Antonucci will make special arrangements for a
physician or a surgeon to help them get started and will also ar-
range housing facilities. A CHANCE OF A LIFETIME. For fur-
ther information call or write: Mr. Joseph Antonucci, 10570 Ravenna
Road, Twinsburg, Ohio. Twinsburg line 425-7141, Cleveland Line
421-7988. For particulars on business conditions contact Philip
Johnson, D. D. S., same address, Twinsburg line 425-2220.
ANESTHESIOLOGIST, 41, married, university trained, board
eligible wishes to relocate in Ohio. Box 473, c/o Ohio State Medical
Journal.
FOR RENT: Office suite. New Medical Bldg. Modern: on one
floor; parking space; air conditioned. Call 442-0106 (Cleveland).
EXCELLENT OPPORTUNITY for GENERAL PRACTITIONER,
INTERNIST and PEDIATRICIAN, with nine-man group now prac-
ticing in a rapidly growing suburban community, 18 miles east of
Cleveland. Available immediately or will wait for right man. Sal-
ary open, leading to partnership. Specialists board certified. Box
475, c/o Ohio State Medical Journal.
Anesthesiology — 2-year career residency now available; $10,000
yr. salary; Ann Arbor Veteran’s Administration Hospital. Integral
part of University of Michigan Anesthesiology Department. Write to
Dr. R. B. Sweet, Dept, of Anesthesiology, University Medical Center,
Ann Arbor, Michigan 48104.
COLLEGE HEALTH SERVICE PHYSICIAN, Kent, Ohio. Grow-
ing state university, 16,000 students. Full time position. Close to
Akron and Cleveland. Write: Director, Health Service, Kent State
University, Kent, Ohio 44240.
WANTED: A young General Practitioner or intern interested in
doing General Practice to join a group composed of two 35-45 year
old men and a senior partner who is practicing on a limited basis.
This group has an excellent new air-conditioned offire building.
Excellent hospital facilities and privileges in an all air-conditioned
500 bed hospital in this city of 400,000 people. This man must
be willing to work and make a few house calls. OB volume over
two hundred cases a year. All men doing usual procedures in inter-
nal medicine and pediatrics. Readily available medical-surgical
consultants. Excellent specialist — G. P. atmosphere. If interested
please call or write James M. Diethelm, M. D., 2304 Evergreen Rd.,
Toledo, Ohio, JE 6-0925.
WANTED: Board certified or Board eligible Internist to join
a four man medical group in Northeastern Ohio City, on the
shores of Lake Erie. Group consists of two General Practitioners
and two Board Certified Surgeons. Reply Box 483, c/o Ohio State
Medical Journal.
(More Ads on Facing Page)
STAFF PHYSICIAN
Full time industrial physician for Frigidaire Division
of General Motors Corporation, Dayton, Ohio. Medical
staff includes three full time physicians, fifteen nurses
and an industrial hygiene laboratory fully equipped
and staffed.
Duties will include pre-employment physical exami-
nations, treating illnesses and injuries and assisting
Medical Director in overseeing health of 16,000 em-
ploye.
Good starting salary, bonus plan and outstanding
employe benefits. Relocation expenses paid. Contact
J. L. Colglazier, M. D., Medical Director, Frigidaire Di-
vision, G. M. C., Dayton, Ohio 45401.
AN EQUAL OPPORTUNITY EMPLOYER
PHYSICIAN
(Zliaical
Tttaaitoi
Considering association with the phar-
maceutical industry? Physician we seek is
energetic with administrative and organiz-
ing skills. Duties will involve planning,
establishing and monitoring clinical stud-
ies; medical counseling, correspondence,
relations; sales training participation. Sal-
ary depends on qualifications and experi-
ence. Please send complete resume to:
Dr. William R. Ebert, Director of
Research & Development
PHILIPS ROXANE LABORATORIES
330 Oak Street
Columbus, Ohio 43216
An Equal Opportunity Employer
974
The Ohio State Medical Journal
^Jte
OHIO STATE MEDICAL
journal
OSMA OFFICERS jj
President HI
Lawrence C. Meredith, M. D. gj
205 Elyria Block, Elyria 44035 g
President-Elect HI
Robert E. Howard, M.D. g
2500 Central Trust Tower, g
Cincinnati 45202 ^
Past President =
Henry A. Crawford, M. D. g
1058 Hanna Bldg., Cleveland 44115 |§g
T rensurer =
Philip B. Haiidymon, M.D. g
350 E. Broad St., Columbus 43215
I: l)ITO RI AL STAFF §g
Editor g
Perry R. Ayres, M.D. |j
Managing Editor and g
Easiness Manager g
Hart F. Page S
Executive Editor and g
Executive Business Manager §§
R. Gordon Moore g
OSMA EXECUTIVE STAFF j§
Executive Secretary g
Hart F. Page {
Director of Public Relations and HI
Assistant Executive Secretary g
Charles W. Edgar g
Administrative Assistants g
W. Michael Traphagan g
Herbert E. Gillen g
Jerry J. Campbell g
Address All Correspondence: g
The Ohio State Medical Journal g
17 South High Street, Suite 500 =
Columbus, Ohio 43215 H
Published monthly under the direction of the
Council for and by members of The Ohio State
Medical Association, 17 South High Street, Suite |e|§
500, Columbus, Ohio 43215, a scientific society, i§|
nonprofit organization, with a definite member- =
ship for scientific and educational purposes.
Subscription, $6.00 per year to non-members;
single copy, 50 cents (outside Continental U.S., IJ
$7.50 and 75 cents). =e
Entered as second class matter July 5, 1905, at ^
the Postoffice at Columbus, Ohio, under the Act 1=
of Congress of March 3, 1879; Acceptance for
mailing at special rate of postage provided for in
Section 1103, Act of Oct. 3, 1917. Authority m§
July 10, 1918. Second-Class Postage Paid at H§
Columbus, Ohio. s||
The Journal does not assume responsibility for = ji
opinions expressed by the essayists. Advertisers
must conform to policies and regulations estab-
lished by The Council of the Ohio State Medical
Association. =
Table of Contents
Page Scientific Section
1023 The Many Faces of Depression. Ian Gregory, M. D.,
Columbus.
1028 Hemocholecyst. Report of a Case Associated with Anti-
coagulation Therapy. Jane Brawner, M. D., Hargo-
vind Trivedi, M. D., Cleveland, and Lee R. Sataline,
M. D., Toledo.
1031 Spontaneous Internal Biliary Fistulas. Report of 12
Cases with Discussion. Sharif Baig, M. D., Toledo.
1034 Anomaly of the Gallbladder. Case Report of an Unusual
Location. J. L. Bilton, M. D., and C. L. Huggins,
M. D., Cleveland.
1036 Hyperglobulinemic Purpura. Report of a Case and Re-
view of the Literature. C. Joseph Cross, M. D.,
W. A. Millhon, M. D., J. S. Millhon, M. D., and D.
E. Hoffman, M. D., Columbus.
1040 Adenoma of Brunner’s Glands. A Case Report. Noel
Purkin, M. D., Calgary, Alberta, Canada.
1043 A Clinicopathological Conference from The Ohio State
University Hospital, Columbus, Ohio.
1012 The Historian’s Notebook: Health Officers of Cincin-
nati, Ohio, and the Problems of Their Day — 1900
to I960. (Part IV.) Kenneth I. E. Macleod, M. D.,
Cincinnati.
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
News and Organization Section
1038 The Future of General Practice
Text of Lecture in Family Medicine
Presented at Ohio State University
1070 Outstanding Scientific Exhibits at the OSMA Annual
Meeting
( Continued on Page 1 096 )
STONEMAN PRESS, COLUMBUS, OHIO
[
PRINTED
IN US A-
I
C-14 AS MICROGRAMS NICOTINIC ACID PER LITER OF PLASMA
Sustained circulatory, respirator
and cerebral stimulation for th
i
500-
Fig. I. Average plasma levels of C-14 radioactivity following oral administration of C-14 nicotinic acid tablets. Key:™*iGroup
A, one sustained-release tablet containing 150 mg. C-14 nicotinic acid,- -—Group B, one nonsustained-release tablet
containing 50 mg. nicotinic acid, mmmmmmmm m Group C, one nonsustained-release tablet containing 50 mg. C-14 nicotinic acid
at 0, 4 and 8 hours.
Human volunteer subjects were administered Geroni-
azol TT tablets with the nicotinic acid component
made radioactive with C-14. Plasma and urine sam-
ples were analyzed. (See Figures I and II) The radio-
active tracer study substantiated the previous clinical
evidence that the release of nicotinic acid from the
Geroniazol TT tablet produced a gradual rise in
plasma levels to a plateau for a total of 12 hours and
more.
Such proven sustained activity makes the manage-
ment of geriatric patients much easier by minimizing
the possibility of neglected doses through absent-
mindedness or senile confusion. Therapy can be con
tinuous on a daily dose of only one Geroniazol TT tab
let every 12 hours.
The gradual release of nicotinic acid in Geroniazo
TT will provide the well-known peripheral vasodilata
tion needed in patients with deficient circulation ant
with a minimum amount (if any) of “flushing.” Also
cerebrovascular circulation is complemented by pen
tylenetetrazol, long-established as a cerebral and res
piratory stimulant.
Geroniazol TT improves the typical, unfortunate
signs of senile confusion. Patients become more alert
plus important supportive
benefits that help her through
those critical early months
of oral contraception
low incidence of side effects
Low incidence of BTB and spot-
ting, nausea and amenorrhea
tends to minimize side effect
problems and increases patient
cooperation.
no confusion about dosage
An unbreakable “confusionproof”
package makes it easy to adhere
to prescribed dosage schedule: in-
dividually sealed tablets numbered
from 1 through 20 plus monthly
calendar record enables patient
to double-check dosage intake by
day and corresponding tablet num-
Contraindications: Thrombophlebitis or pul-
monary embolism (current or past). Exist-
ing evidence does not support a causal
relationship between use of Norinyl and
development of thromboembolism. While
a study which was conducted does not
resolve definitively the possible etiologic
relationship between progestational agents
and intravascular clotting, it tends to con-
firm the findings of the Ad Hoc Advisory
Committee appointed by the Food and
Drug Administration to review this possi-
bility. Cardiac, renal or hepatic dysfunc-
tion. Carcinoma of the breast or genital
tract. Patients with a history of psychic
depression should be carefully studied and
the drug discontinued if depression recurs
to marked degree. Patients with a history
of cerebral vascular accident.
Warning: Discontinue medication pending
examination if there is sudden partial or
complete loss of vision, or if there is a
sudden onset of proptosis, diplopia or mi-
graine. If examination reveals papilledema
or retinal vascular lesions, medication
should be withdrawn.
Precautions: By May 1963, experience with
norethindrone 2 mg.— mestranol 0.1 mg.
had extended over 24 months. Through
miscalculation, omission or error in taking
the recommended dosage of Norinyl, preg-
nancy may result. If regular menses fail
to appear and treatment schedule has
not been adhered to, or if patient misses
two menstrual periods, possibility of preg-
nancy should be resolved before resuming
Norinyl. If pregnancy is established,
Norinyl should be discontinued during
period of gestation since virilization of the
female fetus has been reported with oral
use of progestational agents or estrogen.
When lactation is desired, withhold
Norinyl until nursing needs are established.
Existing uterine fibroids may increase in
size. In metabolic or endocrine disorders,
careful clinical preevaluation is indicated.
A few patients without evidence of hyper-
thyroidism had elevated serum protein-
bound iodine levels, which in the light of
present knowledge, does not necessarily
imply hyperthyroidism. Protein-bound
iodine increased following estrogen admin-
istration. Bromsulphalein retention has oc-
curred in up to 25% of patients without
evidence of hepatic dysfunction. Studies
from 24-hour urine collections have
shown an increase in aldosterone and 17-
ketosteroids and decrease in 17-hydroxy-
corticoid levels. Thus, Norinyl should be
discontinued prior to and during thyroid,
liver or adrenal function tests. Because
progestational agents may cause fluid re-
tention, conditions such as epilepsy,
migraine and asthma require careful obser-
vation. Thus far no deleterious effect on
pituitary, ovarian or adrenal function has
been noted; however, long-range possible
effect on these and other organs must
await more prolonged observation.
Norinyl should be used with caution in
patients with bone, renal or any disease in-
volving calcium or phosphorus metabolism.
Side Effects: Intermenstrual bleeding;
amenorrhea; symptoms resembling early
pregnancy, such as nausea, breast engorge-
ment or enlargement, chloasma and minor
degree of fluid retention (if these should
occur and patient has not strictly adhered
to medication plan, she should be tested
for pregnancy); weight gain; subjective
complaints such as headache, dizziness,
nervousness, irritability; in a few patients
libido was increased. In a total of 3,090
patients, 2.2% discontinued medication be-
cause of nausea.
NOTE: See sections on contraindications
and precautions for possible side effects
on other organ systems.
Dosage and Administration: One Norinyl
tablet orally for 20 days, commencing on
day 5 through and including day 24 of the
menstrual cycle. (Day 1 is the first day of
menstrual bleeding.)
Availability: Dispensers of 20 and 60 tab-
lets; bottles of 100.
References: 1. Council on Drugs. JAMA 187:664 (Feb.
29) 1964. 2. Brvans, F. E.: Canad Med Ass J 92:287
(Feb. 6) 1965. 3. Goldzieher, J. W.: Med Clin N Amer
48:529 (Mar.) 1964. 4. Cohen. M. R.: Paper presented
at Symposium on Low-Dosage Oral Contraception, Palo
Alto, Calif., July 15, 1965. Reported in Med Sci 16:26
(Nov.) 1965. 5. Hammond, D. O.: Ibid. 6. Rice-Wray, E.,
Goldzieher, J. W., and Aranda - Rosell, A.: Fertil Steril
14:402 (Jul.-Aug.) 1963. 7. Goldzieher, J. W., Moses,
L. E., and Ellis, L. T.: JAMA 180:359 (May 5) 1962.
8. Kempers, R. D.f GP 29:88 (Jan.) 1964. 9. Tyler, E. T.:
JAMA 187:562 (Feb. 22) 1964. 10. Rudel, H. W., Mar-
tinez-Manautou, J., and Maqueo-Topete, M.: Fertil Steril
16:158 (Mar.-Apr.) 1965. 11- Flowers, C. E., Jr.: N
Carolina Med J 25:139 (Apr.) 1964. 12. Goldzieher, J.
W.: Appl Ther 6:503 (June) 1964. 13. The Control of
Fertility. Report adopted by the Committee on Human
Reproduction of the American Medical Association. JAMA
194:462 (Oct. 25) 1965. 14. Flowers, C. E., Jr.: JAMA
188:1115 (June 29) 1964. 15. Merritt, R. I.: Appl Ther
6:427 (May) 1964. 16. Newland, D. 0.: Paper presented
at Symposium on Low-Dosage Oral Contraception, Palo
Alto, Calif., July 15, 1965. Reported in Med Sci 16:26
(Nov.) 1965.
norethindrone — an original steroid from
SYNTEXES
LABORATORIES INC. .PALO ALTO. CALIF.
Norinyl
(norethindrone 2 mg c mestranol 1 mg.)
for multiple contraceptive action
for October, 1966
983
AMA Issues Comprehensive Report on
Distribution of Physicians
"Distribution of Physicians, Hospitals, and Hos-
pital Beds in the United States” is the title of a
136-page booklet recently released by the American
Medical Association.
A brief introduction of the methods used and an
explanation of some of the data presented precedes
statistical tables, giving information by cities, coun-
ties, etc., throughout the country.
Data on Ohio shows a total of 13,293 physicians,
of which 8,894 are in private practice. Of the num-
ber in private practice, 3,343 are in general practice,
869 in general surgery, 1,146 in internal medicine,
624 in obstetrics and gynecology, 440 in pediatrics,
and 243 in psychiatry.
The report indicates 192 hospitals in Ohio with
35,948 beds. The resident population of the state
is 10,471,200; the per capita income, $2,235 and the
income per household, $7,628.
The report makes this observation: "The fact that
a physician is not in private practice does not preclude
his seeing patients. Indeed, many physicians in this
category, do see and render care to patients con-
tinuously. Interns, residents and other full-time staff
in hospital service, as well as physicians employed
as full-time medical school faculty and those listed
under preventive medicine, do see patients in the
every day activities connected with their salaried posi-
tions. A number of these physicians may even have
small part-time practices of their own.”
The booklet may be purchased from the American
Medical Association, 535 N. Dearborn Street, Chi-
cago, Illinois 60610 at $1.00 for persons in the U. S.
Cincinnati Heart Studies Are Backed
By Seven Year Grant Extension
The University of Cincinnati Medical Center has
received approval of a $1,304,000 grant from the
National Institutes of Health extending the Cardiac
Research Center’s studies for an additional seven
years.
The center will receive from the National Heart
Institute $186,287 each year from October 1, 1968
to October 1, 1974 for costs of its extensive research
program.
This is the second seven-year grant the Cincinnati
center has received from NIH. The project was
started in 1961 and is now in its sixth year. The
initial phase has been backed by $1,204,500 in NIH
funds. Dr. Noble O. Fowler, professor of medicine,
is principal investigator.
Dr. Henry G. Cramblett, chairman of the Depart-
ment of Medical Microbiology in the Ohio State
University College of Medicine, has received an un-
restricted grant of $3,000 for medical research from
Wyeth Laboratories, Philadelphia.
JVppalac Irian Hall
Established 1916
Asheville, North Carolina
An institution for the diagnosis and treatment of psychiatric and neurological illnesses,
rest, convalescence, drug and alcohol habituation. There are ample facilities for classification
of patients
Insulin coma, electroshock, psychotherapy, occupational and recreational therapy are employed. The
hospital is equipped with complete laboratory facilities, including electroencephalography and x-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town in the beautiful Smoky
Mountain Range, an ideal location for rehabilitation.
WM. RAY GRIFFIN, Jr., M. D. MARK A. GRIFFIN, Sr., M. D.
ROBERT A. GRIFFIN, M. D. MARK A. GRIFFIN, Jr., M. D.
For rates and further information write APPALACHIAN HALL, Asheville, N. C.
984
The Ohio State Medical Journal
Soyalac solves the problem
A request on your professional letterhead or prescription form
will bring to you complete information and a supply of samples.
a product of
LOMA LINDA FOODS
MEDICAL PRODUCTS DIVISION
RIVERSIDE, CALIFORNIA
Mount Vernon, Ohio, U.S. A.
...and BABY APPROVES !
Baby has a thing or two to say about a hypo-allergenic, milk-
free diet!
Soyalac is the good-tasting, fibre-free formula that infants read-
ily accept. The exclusive Soyalac process results in a consist-
ency much like milk, with a light, creamy color — and nut-like
flavor but without a trace of sediment.
Soyalac satisfies the infant. Strikingly similar to mother's milk,
it provides protein of high biologic value and balanced nutri-
ents. Clinical data furnish evidence of Soyalac’s excellence in
promoting normal growth and development.
for October, 1966
993
In Our Opinion
Comments
on Current Economic, Social
And Professional Problems
BRAND VS. GENERIC NAMES;
A PHYSICIAN’S COMMENTS
Identification of the source of a product has al-
ways been an advantage for the user and, with a
product of good quality, a matter of pride for the
maker.
Nothing was ever devised by mankind, to provide
the inspiration for and the guarantee of excellence,
to rival the custom of a superior workman to sign
his work or otherwise identify himself with his
creation.
Artisans like Stradivarius have made their names
so famous as to make unnecessary the mention of
their product. Someone in Washington should tell
Heifitz how much money he could save with a "gen-
eric” violin.
It is self-evident that rules for quality apply to
dmgs as well as to all other products; and in the case
of drugs where casual observation, even by an expert,
is of little aid in determining quality, the name,
honor and reputation of the maker is of supreme
importance.
If large sums of money were to be saved by pre-
scribing generic drugs of unidentified origin, the
present suggestions for the universal use of generic
drugs might have some rational basis. However, a
review of several thousand prescriptions written for a
welfare service shows that, if all the drugs were dis-
pensed as generic items, only five per cent of the
cost would have been saved from the cost of brand
name products.
The level of manufacturers’ prices for all prescrip-
tion drugs has been falling for the past several years
while the cost of living index has been rising. Dur-
ing this same length of time, the price of patented
drugs has fallen faster than the price of non-patented
drugs.
Brand name pharmaceuticals are not expensive;
their cost covers the one ingredient without price —
the guarantee of highest quality enjoined by the
pride of workmanship.
In the life-saving business, a cheap drug might be
the most expensive thing in the world. — Editorial
comments in the August issue of The Journal of the
Indiana State Medical Association by Frank B. Ram-
sey, Editor.
GOVERNMENT POLICIES ARE
INCONSISTENT, CONTRADICTORY
When President Johnson recently ordered a study
of rising medical costs, he was condoning at the same
time increases in airline mechanics’ wages, steel prices
and interest rates along with other inflationary
measures.
Since the government has decided to insure the
elder citizen against medical and surgical hazards, ir-
respective of his financial status, and funds for health
care of children up to 21 on a semi-needy basis, why
should the doctor not charge the government his
standard, usual, customary, and reasonable fee for
service.
Doctors are the only vendors of welfare who have
for years given their services either free or at a dis-
count rate. Doctors rarely retire at age 65 and are
paying the full social security tax for benefits they
never will receive. Due to the shortage of physicians,
there is more need than ever for them to stay on the
job.
If quality medical care is what the government
wants the elderly and the needy to receive on the
Health, Education, and Welfare Medicare and medi-
cal assistance programs, then it hardly makes sense
for government to refuse to pay what other patients
pay. When government suggests the medical profes-
sion is profiteering, because it is unwilling to sub-
sidize federal spending for health care, then govern-
ment is blaming the doctor instead of those who
voted for the health care laws, which have never
worked in other countries and always have destroyed
the quality of medical care as well as tremendously
increased the cost to everyone through taxes.
Regardless of the criticisms that fall our lot, it
is the physician’s responsibility to prescribe those
medications which will most effectively aid in the
recovery of the patient. This responsibility cannot
be delegated to any politician, government official, or
pharmacist. If he can minimize the injury to the
patient’s pocketbook, this is desirable. However, it
is false economy to prescribe a drug under its generic
name if there is reasonable doubt about the clinical
acceptability and effectiveness of the brand that will
then be dispensed by the pharmacist. — William M.
Straight, M. D., in Bulletin of Dade County (Fla.)
Medical Association.
994
The Ohio State Medical Journal
Vital Statistics in Ohio . . .
Ohio Department of Health Issues Annual Report
On Number of Births, Deaths, etc., in the State
T
"^HE Ohio Department of Health recently re-
leased the 1965 Annual Report on Vital Sta-
tistics, an 86 page booklet with a narrative
description as well as statistical data. Information
was compiled under direction . of Dr. Emmett W.
Arnold, director of the Department, and William
Veigel, chief of the Vital Statistics Division. Fol-
lowing are excerpts from the report.
Population
In 1965, the July 1 estimate of population for
Ohio was 10,564,144, an increase of 138,969 or 1.3
per cent over the 10,425,175 estimate for July 1
1964. An excess of births over deaths (net natural
increase) accounted for 103,462 or over 74 per cent
of this increase.
The 1965 mid-year population estimates for the
State, counties and cities were used to compute rates
based on population shown in this report.
Live Births
There were 194,927 live children born to mothers
residing in Ohio during 1965, 14,553 fewer than
were born in 1964. This is the eighth consecutive
year that the actual number of births has been less
than the preceding year’s total. The live birth rate
was 18.5 per 1,000 population in 1965, nearly 8
per cent less than the 20.1 rate in 1964 and the
lowest in the State since the rate of 17.7 in 1941.
During 1965, there were 99,497 male and 95,430
female resident births in Ohio. The sex ratio of
1,043 males for every 1,000 females was lower than
the sex ratio of 1,063 males to 1,000 females in 1964.
White births totaled 173,914 in 1965. This is
a decrease of 13,182 from the 187,096 white births
in 1964. Non white births decreased 1,371 in num-
ber from the previous year. The number of nonwhite
births for 1964 and 1965 were 22,384 and 21,013
respectively. The white birth rate decreased from
19.6 in 1964 to 17.9 per 1,000 white population in
1965. The nonwhite rates showed a decrease from
26.2 in 1964 to 24.2 per 1,000 nonwhite population
in 1965. The nonwhite birth rate is over 35 per
cent higher than the white rate for the year 1965.
For the calendar year 1965, the natural increase
in the population (excess of births over deaths) was
96,635 giving a total resident birth rate which ex-
ceeded the death rate by 9.2 per 1,000 population.
For the white population, the rate of increase was
8.7 per 1,000 and for the nonwhite population, 14.4
per 1,000.
In 1965, there were 190,905 single and 4,022
plural resident live births in Ohio; 3,996 were born
in twin deliveries and 26 were born in higher order
deliveries. The plurality rate of 20.6 per 1,000 live
births was similar to the rate of 20.5 in 1964.
Illegitimate live births increased from 12,775 in
1964 to 13,282 in 1965. The illegitimacy ratio of
68.1 per 1,000 live births represents a 12 per cent
increase over the ratio of 6 1.0 in 1964.
Approximately 28 per cent of the total number of
live births to resident mothers of Ohio were first
born children, and over 22 per cent were second
births.
Women between the ages of 20-29 years were re-
sponsible for over 6l per cent of the total number of
live births. Mothers in the age group 20-24 years
represented 36 per cent of this figure, while 25 per
cent is accounted for by those in the age group
25-29- There were 286 births to mothers under 15
years of age and 253 births to mothers 45 years of
age and over.
Premature Births
Premature births, those with a birth weight of
2,500 grams or less, totaled 15,451 or 7.9 per
cent of all Ohio resident live births in 1965. The
premature birth rate of 79.2 per 1,000 live births,
showed no appreciable difference from the 1964 pre-
mature rate of 78.8.
Fetal Deaths (Stillbirths)
In 1965, the number of resident fetal deaths re-
ported was 2,697 — 256 less than were reported in
Ohio during the year 1964. The fetal death rate per
1,000 live births was 13.8.
Infant Deaths
Ohio’s resident infant deaths decreased from 4,6l4
in 1964 to 4,346 in 1965. The infant death rate
per 1,000 live births showed an increase from 22.0
in 1964 to 22.3 in 1965. The nonwhite infant death
rate of 37.2 per 1,000 live births was 81.5 per cent
higher than the white death rate of 20.5 per 1,000
live births.
Deaths peculiar to early infancy accounted for
2,708 or 62.3 per cent of the 4,346 deaths under one
year of age. Congenital malformations were the
cause of 728 infant deaths. There were 514 deaths
due to diseases of the respiratory system, 125 due to
for October, 1966
999
The synthesis of cortisone was
accomplished by Merck Sharp &
Dohme in 1948— the famous “Com-
pound E” used by Dr. Philip Hench
in his historic experiment at the
Mayo Clinic.
But proud as we are of our role in
the development of cortisone and
subsequent corticosteroids, we
have continued to seek a greater
understanding of arthritic disorders
and new drugs for their treatment.
One such drug — INDOCIN® (indo-
methacin), a nonsteroid , anti-
inflammatory agent fundamentally
different in structure and activity
from other drugs in use — was re-
cently made available for the treat-
ment of arthritic conditions. It
opens new possibilities for the long-
term management of arthritis and
inflammatory disease.
© MERCK SHARP & DOHME I where today’s theory is tomorrow’s therapy
Division of Merck &. Co., Inc., West Point, Pa. |
1000
The Ohio State Medical Journal
INDOCIN
INDOMETHACIN
Indications: Chronic and acute rheumatoid arthritis,
rheumatoid (ankylosing) spondylitis, degenerative
joint disease (osteoarthritis) of the hip, and gout.
Contraindications: Active peptic ulcer, gastritis,
regional enteritis, or ulcerative colitis. Safety in
pregnancy has not been established. Not recom-
mended for pediatric age groups.
Warning: Patients who experience dizziness, light-
headedness, or feelings of detachment on
INDOCIN should be cautioned against operating
motor vehicles, machinery, climbing ladders, etc.
Use cautiously in patients with psychiatric dis-
turbances, epilepsy, or parkinsonism.
Precautions and Adverse Reactions: Most com-
monly, headache, dizziness, lightheadedness, G.l.
disturbances. The C.N.S. effects are often tran-
sient and frequently disappear with continued
treatment or reduced dosage. The severity of these
effects may occasionally require cessation of
therapy. G.l. effects may be minimized by giving
the drug with food or with antacids or immedi-
ately after meals. Ulceration of the stomach, duo-
denum, or small intestine has been reported and,
in a few instances, severe bleeding with perfora-
tion and death. Gastrointestinal bleeding with no
obvious ulcer formation has also been noted;
INDOCIN should be discontinued if G.l. bleeding
occurs. As a result of G.l. bleeding, some patients
may manifest anemia, and for this reason periodic
hemoglobin determinations are recommended.
Rare reports of effects not definitely known to
be attributable to INDOCIN include bleeding from
the sigmoid colon (either from a diverticulum or
without a known previous pathologic condition),
perforation of preexisting sigmoid lesions (di-
verticulum, carcinoma), and hematuria. In other
rare cases, a diagnosis of gastritis has been made
while the drug was being given. One patient de-
veloped ulcerative colitis, and another, regional
ileitis, while receiving INDOCIN; when the drug '; ?
was given to patients with preexisting ulcerative
colitis, there was an increase in abdominal pain.
Infrequently observed side effects may include
drowsiness, tinnitus, mental confusion, depression
and other psychic disturbances, blurred vision,
stomatitis, pruritus, edema, and hypersensitivity
reactions. Slight BUN elevation, usually transient,
has been seen in some patients, although the pre-
ponderance of evidence indicates that INDOCIN
does not adversely affect renal function, even in
patients with preexisting renal disease. Neverthe-
less, renal function should be checked periodically
in patients on long-term therapy. Leukopenia has
been seen in a few patients. Transient elevations in
alkaline phosphatase, cephalin-cholesterol floccu-
lation, and thymol turbidity tests have been ob-
served in some patients and, rarely, elevations of
SGOT values-, the relationship of these changes to
the drug, if any, has not been established. As with
any new drug, patients should be followed carefully
to detect unusual manifestations of drug sensitivity.
Before prescribing or administering, read prod-
uct circular with package or available on request.
for October, 1966
accidents, and 81 due to diseases of the digestive
system.
Neonatal Deaths
Necnaral deaths (those occurring within the first
27 days) accounted for 3,217 or 74.0 per cent of all
infant deaths for the year 1965 in Ohio. In 1964,
3,560 or 77.2 per cent of the infant deaths were re-
ported as neonatal deaths.
Maternal Deaths
In Ohio, the 43 maternal deaths in 1965 resulted
in a resident maternal death rate of 2.2 per 10,000
live births, lower than the 58 deaths with the rate of
2.8 per 10,000 live births in 1964.
Deaths — All Causes
There were 98,292 deaths among residents of
Ohio in 1965, an increase of 1,737 over the 1964
total of 96,555. The crude death rate of 9.3 per
1,000 population was the same for 1964 and 1965.
Leading Causes of Death
The leading cause of death in 1965 for all ages was
diseases of the heart with 39,500 deaths, or 40 per
cent of all Ohio resident deaths. Malignant neo-
plasms was the second leading cause with 16,336
deaths, and a death rate of 154.64 per 100,000 popu-
lation. Vascular lesions affecting the central nervous
system with 11,156 deaths was the third and acci-
dents with 5,223 deaths the fourth leading cause
of death.
Accidents continued to be the leading cause of
death for both males and females in each group be-
tween 1-24 years and appears among the five leading
causes of death for both sexes in the 25-44 and
45-64 years age groups.
Heart disease replaced accidents as the leading
cause of death among males in each age group over
35 years. However, malignant neoplasms became
the leading cause of death among women in the
25-44 and 45-65 years age groups, while heart disease
ranked first among the females in the age group 65
years and over.
Marriages and Divorces
The year 1965 showed an increase of 4,003 mar-
riages over the previous year. There were 78,982
marriages performed in Ohio in 1965 representing
a marriage rate of 7.5 per 1,000 population.
Study of Adolescents
Dr. Philip A. Marks, professor in the Department
of Psychiatry, Ohio State University College of Medi-
cine, has received a $27,327 grant from the National
Institutes of Health to develop personality descrip-
tions of emotionally disturbed adolescents.
According to Dr. Marks, the funds will be used
to provide an extensive set of personality descrip-
tions. Included in the study will be over 2300 males
and females in a nationally representative sample
drawn from private, clinic, and hospitalized patients.
1001
Wh<
reserpine
alone
won’t
m «
SQUIBB NOTES ON THERAPY
Breast-feeding
and the
“modern mother”
Despite a mild resurgence of interest in the impor-
tance of breast-feeding a few years ago, many
women today do not choose to nurse their young.
This is for a variety of reasons — social, economic,
cultural and sometimes medical. In such cases the
physician’s task is to find the most suitable means
of preventing lactation and easing the pain of breast
engorgement.
The means of therapy
The value of hormone therapy for this indication is
of course well established. Both androgen and
estrogen are known to inhibit the production and
secretion of the lactogenic hormone by the anterior
pituitary. As estrogen levels decline sharply at par-
turition, lactogenesis is established. When androgen
and estrogen are administered to the patient before
the release of the lactogenic hormone lactation and
breast engorgement are usually prevented.
The time of therapy
The time of administration of this combined medi-
cation is crucial; it must be given early enough to
suppress the pituitary prolactin and last long
enough to permit physiologic readjustment during
the puerperium. Excellent results are most often
seen when therapy is administered before the onset
of the second stage of labor.
However, factors other than effectiveness must
also be considered. The agent selected should not
interfere in any way with parturition, subsequent
uterine involution and the restoration of normal
ovarian cyclic function. Furthermore, it should not
cause rebound breast engorgement or other mani-
festations of hormonal imbalance.
A balanced formulation
Providing single-dose therapy for the prevention of
lactation and breast engorgement, Deladumone OB
is a potent androgen-estrogen combination with a
prolonged action. The optimal balance of andro-
genic and estrogenic hormones achieved in this
preparation minimizes the disadvantages inherent
in single hormone therapy, such as rebound breast
engorgement. Involution of the uterus and resump-
tion of menstrual cycles are not affected.
As reported in a recent published study (Roser,
D. M.: Obstet. & Gynec. 27:73, 1966), Deladu-
mone OB provided good suppression of breast en-
gorgement in 95.3% and suppression of lactation
in 81.1% of 86 obstetrical patients. These results
are in general agreement with those of many earlier
investigations; in several studies this injectable an-
drogen-estrogen combination proved to be superior
to oral medication.
Dosage:
As a single injection of 2 cc. before the onset of the
second stage of labor.
Contraindications:
Established or suspected mammary cancer or geni-
tal malignancy.
Precautions and Side Effects:
Certain patients may be unusually responsive to
either estrogenic or androgenic therapy. In such
individuals virilization, uterine bleeding or masto-
dynia may occur.
Supply:
Deladumone OB, providing 180 mg. testosterone
enanthate and 8 mg. estradiol valerate per cc., is
available in 2 cc. Unimatic® disposable syringes and
in 2 cc. vials. Both preparations are dissolved in
sesame oil, with 2% benzyl alcohol as a preservative.
Before use, consult product literature for full pre-
scribing information.
Deladumone® OB
Squibb Testosterone Enanthate (180 mg./cc.)
and Estradiol Valerate (8 mg./cc.)
Single-dose injection for lactation inhibition
Squibb
‘The Priceless Ingredient’ of every product
is the honor and integrity of its maker.
for October, 1966
1011
The Historian’s Notebook
Health Officers of Cincinnati, Ohio
And the Problems of Their Day
1900 to 1960
KENNETH I. E. MACLEOD, M. D., M. P. H.*
PART IV
(Continued from September Issue)
THE triennial summary published in 1918 by
Cincinnati Health Commissioner, Dr. W. H.
Peters (1916-1934), continued the Child Hy-
giene report as follows:
The health promotion of school children is a function
of the Health Department cooperating with the Board of
Education . . . Open-air rooms for anemic children are
located in the Sands, Guilford, Douglas and Rothenberg
Schools. Tuberculous children are cared for at the Cincin-
nati Tuberculosis Sanatorium. In the operation of school
dental clinics, the splendid cooperation and assistance of
the Oral Hygiene Committee of the Cincinnati Dental So-
ciety is gratefully acknowledged. In Cincinnati the work
undertaken for the first time in 1914 by the Little Mothers’
League has as a primary objective the promotion of
"personal hygiene’’ and is designed "to conserve the health
and lives of infants. School houses are used as meeting
places. Children arriving at the lawful age for employment
are examined by district physicians to determine fitness for
employment . .
Code Enforcement
On enforcement of the codes, Dr. Peters notes that
the use of the courts for enforcing department orders is
an absolute necessity and is unquestionably one of the best
and quickest methods of procedure when the property owner
is within the jurisdiction of the court. During the past
three years, 441 prosecutions were completed. The De-
partment also has long believed that in order to help solve
the housing problem it is necessary to pay more attention
to the tenants. In the past few years the department
inspectors have been instructed to hold tenants responsible,
wherever possible, for minor nuisances. During 1916 the
Housing Committee of the Woman’s City Club published
a primer for the education of tenants ... Ten thousand
placards, notifying tenants of their responsibility for keep-
ing the premises clean, were also posted. The placard
contained the following notice and warning in English,
German, Italian, Yiddish, Hungarian and Roumanian:
NOTICE
This house must be kept clean and free from dirt,
filth, garbage or other matter. The yards, courts, pas-
sages, areas or alleys, and all rooms, stairs, floors,
windows, walls, ceilings, halls, cellars, and water
closets must be kept in a clean condition at all times.
*Dr. Macleod, Cincinnati, is Commissioner of Health, City of
Cincinnati.
Submitted March 16, 1966.
BY ORDER OF
THE BOARD OF HEALTH
Warning: Every person who shall violate or assist in
the violation of this notice shall be subject to penalty
of law . . .
Health Education
This was also a time for health education in a
large way and examples of posters are given in their
annual reports — posters on the dangers of coughing
and sneezing, in the spread of "colds, influenza,
pneumonia and tuberculosis,” posters on the dangers
of the common house fly. "Thousands of people die
every year as the result of diseases transmitted by
flies” the message reads, and further: "Destroy their
breeding places, screen the windows, KILL ’EM . . .”
An interesting side issue is noted:
Owing to the great abuse of the milk bottle, the Milk
Exchange of the Cincinnati Chamber of Commerce employs
an inspector on full time whose duty it is to see that
bottles are not hoarded or destroyed and to prevent one
dealer from using another’s bottles. . .
Meat Inspection
On meat inspection it is noted that "the local ab-
batoirs, under municipal inspection, have made steady
progress along the line of sanitation and improved
methods . .
Rabies
On rabies, Dr. Peters writes,
It is exceedingly unfortunate that the public is not properly
informed. Do not kill the dog doing the damage. Nothing
is to be gained by destroying the animal. A negative lab-
oratory report gives a false sense of security. In 1916,
73 cases of suspect rabies were investigated. Of these 22
were killed and the brain examined. Nine gave positive
reactions for the presence of Negri bodies . . .
1919 - 1930
Dr. Peters’ reports for the year 1919 and for sev-
eral years thereafter, were issued in the form of
monthly bulletins, at first entitled Cincinnati Sani-
tary Bulletin and later changed to Cincinnati’s
Health.
This has the effect of making them more difficult
to research, as many of the articles take the form of
1012
The Ohio State Medical Journal
Galileo needed the leaning tower of Pisa!
For over 1500 years the world believed that a heavy stone fell faster than a light one because
Aristotle said so. Since this made sense, Galileo thought so too. But, being a curious fellow,
he wanted to prove it; he climbed 297 steps to the top of the Leaning Tower of Pisa and
dropped 2 stones, a heavy one and a light one, over the edge. Much to his surprise, and
the surprise of everyone else, both stones struck the ground at the same time. Proof — a 1500
year old dogma destroyed in seconds by a simple experiment. It seemed that Aristotle had
been talking through his ancient hat.
And like Galileo, you probably believe a statement you have heard over and over again. How
many times have you been bombarded with the fact that brand name products are better than
generic name products ? Often enough that no doubt you believe it to be true. But now let’s
do the simple test which, like Galileo’s experiment, will take but seconds.
Send for sample of West-ward’s Prednisone Tablets 5 mg., sold under the generic name, by
returning coupon below, and upon receipt do this simple test and see for yourself: Examine
tablet carefully, break it between your fingers and listen to the snap. A good snap indicates
a hard, well compressed tablet. Then take a tablet, drop it into a glass with about 20 ml.
water and swirl gently. Note that it disintegrates in a matter of seconds into finely divided
particles. Here is what this means:
A. Fast disintegration means more rapid absorption
B. Fine particles mean more complete absorption
C. Result: Optimum physiological availability1-2’3
To determine that West-ward’s Prednisone Tablets 5 mg. are the very best you need not
climb that tower; all you need do is send for sample bottle of 12 tablets and do the test.
SPECIFY ‘‘PREDNISONE TAB. 5 mg. (West-ward)”
so that your patient receives the very best at much lower costs
SEND FOR SAMPLES -DO THE TEST
West-ward, Inc., 745 Eagle Ave., Bronx, N. Y. 10456
I am interested in testing your Prednisone tablet for fast disintegration.
Kindly ship the following at no cost or obligation:
Prednisone Tablets 5 Mg. U. S. P.
Licensed under Patent 3,134,718
vial of 12 (professional sample)
Ship To: M. D.
Zip Code
References :
iMorrison, A. B. ; and Campbell, J.
A., Journal of Pharmaceutical Sci-
ences, 54, 1 (1965)
2Campagna, F. A., Cureton, G.,
Mirigian, R. A., and Nelson, E.,
ibid., 52, 605 (1963)
3Levy, G., and Hayes, B. A., New
England Journal of Medicine ; 262,
1053 (1960)
for October, 1966
1013
health educatory admonitions to the public. The
bulletin for January 10, 1919, starts off with the
brave words: "Sacrifice and cooperation have been the
key words in the Health Department during the past
year. Twenty-four employees, representing all di-
visions, were inducted in the military service and
most of them are 'over there.”’
As to progress, in Cincinnati’s Health, Dr.
Peters adds up these as rungs in the ladder:
1. The Chief Food Inspector has rendered a distinct serv-
ice as Food Administrator for Flamilton County.
2. In the Division of Medical Relief and Inspection the
doctors and nurses have been carrying on a fine piece of
constructive work, examining children of pre-school age in
conjunction with the Child Welfare Committee, and the
Women’s Committee of the Council of National Defense.
3. Cooperating with the United States Public Health
Service and the Ohio State Department of Health, a Bureau
of Venereal Diseases has been established with offices in the
Blymyer Building.
4. The establishment of the Oyler Health Center was a
distinct innovation.
5. Universal pasteurization of market milk undoubtedly
has saved many lives.
6. The Sanitary Division has done effective work in
eliminating or correcting thousands of unsanitary conditions.
Its campaign of education in the tenement districts met with
hearty approval of the landlords and was appreciated by
self-respecting tenants . . .
Public Comfort Stations
On public comfort stations he writes:
Municipalities have begun to recognize the need for first
class comfort stations located in the congested districts. Be-
sides those located in the public parks, three have been
built in business sections; Fifth and Walnut Streets, Mc-
Millan Street near Gilbert, and Spring Grove near Hamilton
Avenue. (But these latter are now closed down alledgedly
because of "ill use” by "certain publics” and cost of super-
vision and maintenance.)
The "Flu” and After
Bemoaning the ravages of the pandemic of influ-
enza, Dr. Peters also notes:
Now that soldiers are returning from overseas, health of-
ficials and local physicians will have to exercise the greatest
vigilence in order that exotic epidemic disease may not be
carried into this country and spread with disastrous re-
sults . . .
With war’s final end, many war buildings, war jobs, and
war institutions will go to the scrap heap. But every item
in the program of venereal disease control is as necessary to
successful peace as in successful war . . .
The Ubiquitous Cuspidor
On cuspidors, Dr. Peters writes:
Human sputum is dangerous. The habit of certain work-
men of expectorating in the corners, on the stairs, in the
toilet rooms, and on the floor of factories is dangerous to
the health of everyone in the vicinity. The ordinary cuspi-
dor is generally very unsightly and is exceedingly repulsive
to clean. The modern flush rim water-supplied cuspidor,
with waste pipe connected to the sewer, offers a solution for
quick and sanitary removal of this possibly infectious mate-
rial. Their installation is recommended . . .
Cost of Health
And once more like his predecessors had stated a
thousand times, he writes :
The yearly toll of nearly a thousand victims of tuberculosis
does not create much concern, and yet it is the one disease
that is robbing the city of its fair name. The per capita
cost for fire protection in 1919 will be $2.24; for police
protection, $2.38; for health protection, 28$. If we could
have a fixed rate for public health purposes — and surely
a per capita of 50$ would not be too much — we could
enlarge our forces so as to provide adequate dispensary
service for tuberculous individuals and suspects . . .
Reporting of Tuberculosis
And on the reporting of tuberculosis, he notes:
It is generally conceded that for every death from tubercu-
losis there are five active cases, which means that approxi-
mately 3,500 cases have not been reported (1,280 were).
The situation is a serious one. Many physicians are not re-
porting their known cases; others are slow in establishing
a diagnosis. Not all diagnostic means are employed to
clear up doubtful cases . . .
Negro Health
In discussing a program for the future he stated
that he would like to stress "particularly the need
for increasing the medical and nursing service so
that we can furnish prenatal and postnatal service
and provide adequate dispensary service for tubercu-
losis, and give a little more attention to the Negro
health problem ...”
On a Variety of Things
On first aid in cases of apparent drowning he
writes: "Barrel rolling is out of date just as punch-
ing a drowning person in the face is unnecessary on
the part of a lifeguard. The Schafer face-downward
method of resuscitation is best ...”
On "cold storage” he notes that this has developed
with amazing rapidity into a gigantic industry . . . that we
have been confronted with some perplexing problems in the
control of our food supply. There is a woeful lack of
federal, state, and municipal legislation for the control of
stored foods. Let us go to the matter with catholic minded-
ness. Cold storage is a great boon to civilized life, which
should not be lost sight of in formulating regulations for
its control . . .
On the value of the Schick Test and Toxin-Anti-
toxin immunization in the control of diphtheria, he
writes :
The efficiency of anti-diphtheritic serum in protecting per-
sons exposed to diphtheria is generally recognized, but for
various reasons serum treatment is not always desirable.
The duration of immunity conferred by the prohylactic
injection of antitoxin being short and there is the possibility
of sensitization. Immunization with toxin-antitoxin mixture
is of no value as an immediate protection as it requires
several weeks to establish immunity, but for general prophy-
laxis in institutions and families it is of great service . . .
Let us see if we cannot develop a 100 per cent immunity
among all children under institutional care. The procedure
is simple and inexpensive.
The dosage of diphtheria antitoxin given as immediate
prophylaxis or for treatment is as follows: A single dose of
the proper amount as indicated on the schedule . . . 500
units for children under 12 and 1,000 units for others
will suffice, etc.
( Continued in November Issue )
1014
The Ohio State Medical Journal
The Many Faces of Depression*
IAN GREGORY, M. D.
IT HAS BEEN remarked that insanity is like the
rain, falling alike upon the evil and the good. So
also do the varied moods to which we are all
subject. Joy and sorrow; fear and anger; each of
these emotions normally arises in response to a parti-
cular kind of event or situation. Attaining a desired
goal usually leads to happiness or joy. Danger or the
anticipation of disaster result in fear. Loss results in
grief and depression. Frustration leads to anger, and
sometimes to impotent rage and depression.
Pathological depression, however, differs from nor-
mal grief in several ways. It may differ in quality
or quantity, intensity or duration, and it may be dis-
proportionate to any external loss or frustration. It
has been remarked that one man’s meat is another
man’s poison, and events that lead to joy in one
household may lead to despair in another. But the
nature of loss and frustration also changes during the
course of an individual’s lifetime, in accordance with
changes in the objects of his love and the goals that
motivate him. The latter in turn result in changing
rationalizations and beliefs. As one example of a
frequent change in conscious attitude and conviction,
consider prevailing attitudes toward premarital chastity
among young adult males, and among the same men
later in life when they have become the fathers of
teenage daughters.
Emotions and conscious attitudes also change
within much shorter periods of time, as witnessed by
the man who was asked, "What do you especially
like about living in this neighborhood?” He replied,
"It is nice and friendly. The folks are always com-
ing to visit us and we visit them; there are lots of
*From a paper presented at the First Ohio Congress on Psycho-
logical Medicine, October 24, 1965.
The Author
• Dr. Gregory, Columbus, is Director, Clinical
Division of Psychiatry, Ohio State University Hos-
pitals; Professor and Chairman, Department of
Psychiatry, The Ohio State University College of
Medicine.
kids around.” Then he was asked, "What are the
things you don’t like about it?” He thought for a
moment and answered, "The same things, I guess.”
In the short space available, I want to paint a few
portraits that may help to give some idea of th°
range of individuals in whom depression is observed
and the extent of its manifestations. Let us think
first of a little child who has been admitted to the
hospital, is surrounded by strangers, and is fearful
of what is going to happen to him. In the absence
of visits by members of his family, it may not be
long before the child seems to wilt and curl up,
sitting quietly and showing no interest in food or in
what is going on around him. He may cry at first,
but then the tears dry up and he just looks empty,
with no variation in expression, clutching to a single
toy that he has brought from home, which represents
something familiar — some straw to prevent him
from drowning in the sea of troubles around him.
Such children may not only show regressive behavior,
but also have a higher mortality than others who do
not experience abandonment.
Next, let us take a look at the other extreme of
life, at an old man who has been left alone after
his wife has died. In earlier years he enjoyed work-
ing hard, but this has been taken from him by retire-
1023
ment and he feels he has been placed on the shelf.
His children have grown apart from him over the
years and he feels they no longer have any time or use
for him. His former friends have moved or have
other interests from which they seem to exclude him.
His life is empty, devoid of satisfaction, and he can
see no prospect of improvement. He sits quietly in
his solitude and despair until one morning he shoots
himself. His depression might have been foreseen
and prevented, or it might have been alleviated by
treatment after it had developed.
The majority of persons, however, who commit
suicide as a consequence of depression have not pre-
viously received psychiatric treatment, although they
have often told other persons of their suicidal inten-
tions beforehand. Successful suicide remains about
three times as frequent in men as in women, and
about three times as frequent among persons over the
age of 60 as in young adults — but it may occur at
various ages and in all walks of life, if the individual
feels sufficiently desperate.
Let us turn now to look at a middle aged woman,
53 years old. The woman grew up on a farm and
learned to live in conformity with the demands and
expectations of her family and society and religion.
She attended church regularly and visited the neigh-
bors, but most of her satisfactions were found at
home with her family. She was a meticulous house-
keeper and very attentive to the care of her husband
and children. Three years previously, her husband
had been admitted to hospital with tuberculosis, and
had remained there ever since. Her sons had con-
tinued to work on the family farm but were now
growing up and spending many of their evenings
away from home. The woman herself no longer
found satisfaction in the simple things she had pre-
viously enjoyed but became increasingly withdrawn
and unnecessarily concerned over their financial affairs.
Housework became a tremendous effort for her, but
she was extremely conscientious.
On the morning that she was finally admitted to
the hospital, she had gotten up at 5:00 A. m. as usual
to cook breakfast for her sons. She was practically
mute by this time, hadn’t been eating, and had lost a
lot of weight. Her lips were dried and parched, and
she responded to questions very briefly or not at all.
She looked the picture of dejection and periodically
moaned, said that she had sinned and that God would
punish her. This was before the days of modern
antidepressive drugs, and she was considered inac-
cessible to psychotherapy. After a few electroshock
treatments, however, there was a dramatic improve-
ment in mood and activity level, and she could now
be involved in individual and group psychotherapy.
After a few weeks she returned home with renewed
inner resources for adaptation, and continuing ef-
forts were directed toward developing further sources
of environmental support in the community.
Paradoxical Grief
The next and final illustrative case history con-
cerns a woman, 20 years younger than the preceding
one, whose overt reaction to the loss of her beloved
husband presents a marked contrast. This woman
had previously been the happy, jolly, relatively care-
free wife of a farmer, with three young children.
She was friendly and out-going, but not hypomanic,
and had not experienced any severe emotional dif-
ficulties. One day her husband was driving her and
four others to a plowing contest. She was sitting in
the back seat of the car and felt car-sick, so her hus-
band suggested that they change places. She took the
wheel of the car and came to a railroad crossing
where a train was approaching and the signal was
flashing. She stopped, but the automobile behind
her didn’t and pushed her car onto the railroad
tracks, where it stalled. She couldn’t start it again,
and at the last minute she called for everyone to
jump out. Everyone was able to do so except her
husband and a sister-in-law, and the husband was
killed instantly.
For a very brief period she was numb with shock,
but within a few days, she seemed to have completely
gotten over the effects of her loss. There was a
complete denial of grief and she became increasingly
euphoric, stating that her husband was far happier
with the angels than he would have been with her.
She lost no time in buying a new car to replace the
one that had been wrecked in the accident, and she
drove this recklessly. She also purchased many other
things beyond her means, including a truck, new
tractor, implements for the tractor, a new coat and
hat, a coat for her mother, an electric blanket, new
beds for her own family and also for a neighbor’s
family. She asked for a private line on the tele-
phone, which she was using at all hours of the night
as well as the day.
When asked how she could pay for all her pur-
chases, she said she was going to get $100,000 from
the driver of the automobile that had pushed hers
onto the railroad track. She became increasingly
overactive, laughed frequently and told vulgar jokes,
and eventually neighbors became so concerned about
her inappropriate behavior that they arranged for
her admission to hospital, at which time she threaten-
ed to sue both the neighbors and the hospital staff.
Here we are confronted with a paradoxical reac-
tion bearing little superficial resemblance to grief.
And yet the latter is evident in the subsequent turn
of events. With phenothiazine therapy, the manic
symptoms disappeared but were replaced by pro-
found depression. After a few electroshock treat-
ments and supportive psychotherapy, her mood stab-
ilized and she returned home. She was able to look
after her three young children, but no financial set-
tlement concerning the accident was forthcoming
without litigation, and it was necessary for her to
sell the farm and equipment. One year after the
1024
The Ohio State Medical Journal
accident, she again became so depressed that one
morning she drove her automobile out to the rail-
road crossing and waited for the train, which ab-
solved her guilt by ending her life.
Internalized versus Externalized Aggression
It is generally recognized that depression may lead
eventually to suicide, but it is frequently overlooked
that the depressed individual may also endanger the
lives of other persons around him. The mother of a
young child who perceives her own life as hopeless
and futile, may also perceive it as equally empty for
the child that she would leave behind her if she
committed suicide. She may therefore kill the child,
and subsequently may either succeed or fail in her
own attempt at suicide. Traditionally, society has
been more lenient toward mothers committing in-
fanticide than others who commit homicide as a re-
sult of mental disorder. There may be little dif-
ference in the symptoms of a depressed person who
takes the life of another, however, whether the
victim is an infant or a much older child of a psy-
chotically depressed woman, or whether there are
several victims such as the wife and children of a
severely depressed man.
In any event, the danger to others does exist and
may also represent the ultimate manifestation of
previously repressed hostility’ or anger or rage. De-
pression is usually associated with anger. The de-
pressed individual is frequently irritable and easily
angered by those with whom he has the closest bonds
of affection. Ambivalence, or love and hate for the
same object (or person), is one of the most promi-
nent dynamic features of depression. While the
anger or impotent rage may be predominantly re-
troflexed (turned inward upon the self), at times
it may be externalized or turned outward on others.
Not all suicidal attempts, however, should be re-
garded as resulting from retroflexed rage. In many
instances, they may represent manipulative gestures
that are consciously or unconsciously intended to
provoke guilt and change the behavior of other per-
sons responsible for the individual’s loss or frustra-
tion. By and large, the . greater the amount of con-
sciously recognized and externally directed anger,
and the briefer the duration of suicidal preoccupa-
tion prior to the attempt, the less likely it is to be a
manifestation of psychotic depression, and the safer
the therapist may be in treating the individual ex-
clusively by psychotherapy and even without ad-
mission to hospital. In this connection, it should
also be recognized that depression is not the preroga-
tive of the conscientious individual with an enlarged
super-ego or internal control system. The impulse-
ridden individual with a sociopathic personality may
also become severely depressed and may make genuine
suicidal or homicidal attempts as well as manipulative
gestures or threats. In evaluating the personality, one
has to consider the tolerance of the individual for
fmstration as well as his super-ego controls.
Association with Somatic Manifestations
A number of manifestations of depression are
somatic and may mimic various bodily illnesses. The
depressed patient frequently consults a general physi-
cian with complaints of fatigue, exhaustion, loss of
energy, constipation, loss of appetite and weight, im-
paired sexual function, dissatisfaction with various
activities he has ordinarily enjoyed, or severe insom-
nia, which may involve not being able to go to sleep,
or waking up in the middle of the night or waking
up very early. In psychotic depression, the early
morning may be the worst time of day, the time when
thoughts of suicide are most prominent. There are
frequent complaints of bodily dysfunction without
obvious organic pathology. The depressed individual
is often hypersensitive to bodily pain, just as the
euphoric individual is "feeling no pain.’’ I recall
having seen a hypomanic woman walking around the
ward singing gaily, happy as a clown, who happened
to mention to an alert nurse that she had a little pain
in her abdomen. Her temperature and white cell
count were both markedly elevated, and she was
found to have a perforated appendix. By contrast,
the patient who is depressed is apt to be unduly sen-
sitive to trivial bodily dysfunctions and may be pre-
occupied with the latter, whether or not he complains
about them spontaneously.
It should not be overlooked, however, that the
causal relationship may be reversed, and that depres-
sion may result from somatic disease in two general
ways. The expression "seeing things through jaun-
diced eyes” implies that toxemia may lead to gloom,
and there are many debilitating illnesses that may
lead to exhaustion and despair. On the other hand,
organic illness may lead to depression primarily for
psychological reasons such as loss of health and
anticipation of death, or fmstrations imposed by lim-
itations on enjoyed activities. Here again, there may
be a paradoxical reaction, so that one may see a first
attack of mania in an individual who has just lost
his eyesight, has just developed tuberculosis, or has
just been told that he is to die from cancer. The
more frequent reaction under these circumstances,
however, is one of grief and depression.
Dynamics and Causation
We come now to the question of what legitimate
generalizations may be made about the development
of depression. We have looked briefly at the indivi-
dual differences in manifestations and they are enor-
mous. Depression may occur in many forms and at
various ages and in different walks of life. During
the last century, many were interested in the descrip-
tive similarities and in systematizing their observa-
tions. French physicians reported having observed
alternating attacks of depression and excitement in
the same individual, and Falret described this occur-
rence as "la folie circulaire.” A few years before the
end of the nineteenth century, Kraepelin was engaged
for October, 1966
1025
in classifying syndromes according to their apparent
similarity and made a distinction between manic de-
pressive psychosis and involutional melancholia. Ad-
ditional diagnostic categories still in current usage
include neurotic and psychotic depressive reactions, al-
though the latter would appear to have no greater in-
trinsic justification than establishing "psychotic manic
reaction" as a separate entity. Attacks of either
mania or depression may follow recognizable exoge-
nous stress or may appear to develop spontaneously
(endogenously) without obvious precipitating factors.
The precipitating factors that lead to affective dis-
orders may be predominantly biological, psychologi-
cal, or socio-cultural. In a high proportion of cases,
the depression develops in a psychological context
involving loss (of a loved object, of health, wealth,
self-esteem, etc.) or of persistent frustration. In
analyzing the nature of frustration, three general
forms may be recognized. External frustrations may
obstruct the achievement of one’s goals, and learning
a tolerance for reasonable external frustrations is one
of the tasks that confronts the child during the nor-
mal course of development. Internal frustrations
involve an inability to obtain one’s goals because of
personal inadequacies, and these frequently confront
the adolescent or young adult. The third common
source of frustration is conflict, which may involve
approach-approach (two mutually exclusive desirable
goals), avoidance-avoidance (of two undesirable con-
sequences), or approach- avoidance conflict (involving
a desirable goal which cannot be obtained without
undesirable consequences). The latter may be the
most difficult to solve, and the one that we most
often encounter clinically.
Predisposition to affective disorder is generally
thought of in terms of personality development, which
may also have biological, psychological, and socio-
cultural determinants. The emphasis in recent years
has been on the childhood learning of maladaptive
patterns of behavior. It has been noted that depres-
sion is commonly associated with ambivalence, and
with a harsh dominant hypercritical super-ego or
internal control system. What kind of childhood
experiences are likely to lead to this situation ? What
kinds of parental behavior are likely to result in the
development of ambivalent relationships with others
or lead to overwhelming conflict, frustration, and
defeat?
Retrospective information suggests that there has
frequently been prolonged exposure to excessive criti-
cism and demands that can never be satisfied; tech-
nics of discipline that involve provoking guilt by
shaming, rather than by direct punishment; threats
to the individual’s integrity and self-esteem, rather
than criticism or punishment directed toward the
action itself. Often it appears that there have been
long years — not isolated traumatic events in child-
hood — but long years of parental over-control, criti-
cism, demands, degradation, shaming, and indirect
technics of punishment. There may have been placed
on the individual high expectations for achievements
beyond his capacities, with minimal rewards for such
attainments as he could make.
The search for predisposing traumatic events or
situations in childhood raises the question of whether
childhood loss can sensitize the individual to depres-
sion in adult life. Loss at all ages may precipitate
grief and depression, and it has been thought that
the loss of a parent during childhood (by death or
divorce) may sensitize that individual so that sub-
sequent situations of loss and fmstration will more
readily lead to the appearance of clinical depression
in adult life. There have been many studies in this
area and a number of positive findings have been
reported, but the statistical evidence is still uncertain.
My own findings suggest that loss of the parent of
the same sex during childhood is followed by an
increased frequency of delinquency but not neces-
sarily by an increased vulnerability to depression or
other forms of psychopathology.
Treatment
After looking briefly at the many faces of depres-
sion and trying to make some valid generalizations
concerning dynamics and causation, let me close by
mentioning a few of the major approaches to therapy.
The latter may be viewed in the same light as the
treatment of other forms of psychopathology, and
hence as either reparative or reconstructive. Symp-
tomatic (reparative) measures are directed toward
relieving the depression itself, toward enabling the
individual and the family to overcome the immediate
problems raised by the depression. But there is also
the question of preventing a recurrence in the future,
improving the life-long adaptation by means of
personality reconstruction, and trying to enable the
individual to lead a more satisfying and rewarding
life in the future.
Symptomatic measures include supportive psycho-
therapy, drug therapy, social or milieu therapy, en-
vironmental manipulation, and electroshock treat-
ment if the latter should become necessary. Recon-
structive therapy designed to strengthen the adaptive
resources of the individual requires a prolonged
period of time and involves the analysis of uncon-
scious motivation. There are some special problems
in undertaking such intensive psychotherapy with
patients known to be prone to severe depression. In-
creased insight or awareness of hitherto unconscious
motivation, or of the external reality situation, may
of themselves mobilize increased depression. The
procedure may be likened in part to holding a mirror
up to the individual so that he may see his own
motives more clearly. It may also be likened in part
to providing him with a pair of glasses that will en-
able him to perceive external reality more accurately.
In either event, the patient may need his blindness
and may be disquieted by his improved vision. It
may be primarily depressing rather than anxiety-
1026
The Ohio State Medical Journal
provoking to the patient so that interpretation and
the acquisition of insight must be accomplished
cautiously.
Apart from the fact that intensive psychotherapy
may be unduly painful or prolonged, there are many
patients with depression whose age or reality situa-
tion make them unsuitable candidates for this form
of therapy. Even if it is contemplated at a later date,
when a patient is currently severely depressed, he
may be more appropriately treated by symptomatic
measures, including supportive psychotherapy de-
signed to boost self-esteem and utilize his adaptive
resources.
Many dmgs have been tried in the treatment of
depression but few have been proven effective over
a period of time. Sedatives and tranquilizers have
some application in reducing associated anxiety, in-
somnia, sleep deprivation, and possible fragmenta-
tion of thinking. Stimulants such as the amphet-
amines have often done more harm than good, since
they are likely to increase anxiety, insomnia, and any
associated thought disorder. Even if the stimulant
produces a temporary elevation of mood, there may
be a rapid rebound depression of even greater inten-
sity, during which the individual is sufficiently
mobilized to attempt suicide. During the past few
years however, there has been a great increase in the
availability of psychotropic drugs, and the more re-
cent antidepressive medications such as Parnate®,
Tofranil®, and Elavil®, appear to be much more ben-
eficial in the symptomatic management of depres-
sion than the earlier stimulants, sedatives, or
tranquilizers.
It has been questioned whether electroshock should
be used in the treatment of depression or any other
psychiatric disorder. The evidence in its favor, how-
ever, is stronger in the case of psychotic depression
than of any other psychiatric syndrome. While
medication and other measures frequently render it
unnecessary, and may in future render it altogether
obsolete, at the present time electroshock may still
produce a remission of psychotic depression more
rapidly and more reliably than any other form of
treatment currently available.
References
1. Gregory, I.: Psychiatry: Biological and Social, Philadelphia:
W. B. Saunders Co., 1961, Chap. 20.
2. Rosen E., and Gregory, I.: Abnormal Psychology, Philadelphia:
W. B. Saunders Co., 1965, Chap. 1 4.
AVIE W OF THE FUTURE — I am going to make an optimistic prediction,
based on my conviction that the medical practitioner must come to play an
increasingly important role in the prevention and treatment of mental disorders.
I will predict that in the years to come, the medical student will be taught psy-
chiatry in its appropriate context — the medical ward and the medical clinic —
and not in the psychiatric hospital and the separate psychiatric clinic. I will
predict that the newer kind of medical interview behavior which will result will
be further reenforced during internship, residency training and postgraduate medi-
cal education. Thus, new medical interviewing techniques will permit the physi-
cian to deal with the whole patient rather than with isolated organ systems.
The role of the psychiatric consultant, as that of other consultants, will be
to advise the family practitioner when asked to do so, and to treat only patients
with complicated psychiatric disorders that are too time-consuming for the cir-
cumstances of family medical practice.
Family physicians will play a vital role in the function of community mental
health centers, both in knowing how and when to make referrals to such centers
and in contributing time to the actual functioning of such centers. With the
necessary knowledge of how to detect psychic disease and how to treat emotional
disorders effectively, the family physician will prevent many of the instances of
progression to chronic psychiatric illness with which we are now plagued. —
Allen J. Enelow, M. D., Department of Psychiatry, University of Southern Cali-
fornia School of Medicine, Los Angeles: ' Prevention of Mental Disorder. The
Role of the General Practitioner,” California Medicine, 104:16-21, January, 1966.
for October, 1966
1027
Hemocholecyst
Report of a Case Associated with Anticoagulation Therapy
JANE BRAWNER, M. D., HARGOVIND TRIYEDI, M. D.,
and LEE R. SATALINE, M. D.
MASSIVE hemorrhage into the gallbladder
(hemocholecyst, hemobilia, hematobilia,
- gallbladder apoplexy) is an uncommon con-
dition usually associated with trauma,1 neoplasms,2- 3
inflammation,4 cholelithiasis,5 or aneurysmal vessels6-7
of the liver or gallbladder. Four cases of "spontan-
eous” hemobilia have been reported8-9 for which
some authors8 postulated that hypertension with
arteriosclerosis may have been responsible. Recently
we observed a case of hemocholecyst in a cardiac pa-
tient taking bishydroxycoumarin (Dicumarol), who
later developed acute cholecystitis while under treat-
ment for acute myocardial infarction. We were un-
able to find a similar case in the literature.
Case Report
A 73 year old man was admitted to Lakewood Hospital
with epigastric pain accompanied by nausea and vomiting.
These symptoms, which began suddenly two days before
admission, gradually increased in severity and were unrelated
to food ingestion or bowel movement. There was no radi-
ation of the pain. The patient had no previous gastroin-
testinal symptoms and he denied food intolerances. There
was no history of trauma or liver disease.
Seven years before this admission, he was started on
treatment with digitoxin and diuretics when he developed
leg edema. Documented myocardial infarctions occurred
five, three, and one year before admission. After his first
infarction, he was placed on long term Dicumarol therapy,
and his prothrombin activity was maintained between 20
and 40 per cent on doses of 50 to 75 mg. daily. There
had been no episodes of abnormal bleeding, and a pro-
thrombin determination two weeks before admission was 18
per cent (Quick, one-stage method). One day before ad-
mission, after the onset of pain, he voluntarily discontinued
the Dicumarol.
On admission, physical examination revealed a well-
nourished afebrile man in no acute distress. His blood
pressure was 180/100 mm. Hg, pulse rate 120, and respira-
tory rate 24 per minute. The ocular fundi showed grade 2
arteriosclerotic changes. The lung fields were clear. The
heart was enlarged, and the apical impulse was felt in the
sixth left interspace at the anterior axillary line. A grade
2/6 soft systolic murmur was heard over the entire precor-
dium. The rhythm was regular. The abdomen was soft,
and an ill- defined small, firm, tender mass was thought to
be present just below the costal margin about 10 cm. to the
right of the midline. Rectal examination revealed prostatic
enlargement, and the stool gave a positive reaction for oc-
cult blood.
The admission hematocrit was 42 per cent, the white
blood cell count 23,400 with 90 per cent neutrophils, 6 per
cent lymphocytes, and 4 per cent monocytes. Urine analysis
From the Department of Medicine, Lakewood Hospital, Cleveland,
Ohio. Submitted March 22, 1966.
Reprint requests to Director of Medical Education, The Toledo
Hospital, Toledo, Ohio 4360 6 (Dr. Sataline).
The Authors
• Dr. Brawner, Cleveland, is First Year Medical
Resident, Lakewood Hospital.
• Dr. Trivedi, Cleveland, is Chief Medical Resi-
dent, Lakewood Hospital; Second Year Resident
in Pulmonary Functions and Cardiology, Y. A.
Hospital, Cleveland, Ohio.
• Dr. Sataline, Toledo, former Director of Medi-
cal Education, Lakewood Hospital, Cleveland,
presently is Director of Medical Education at The
Toledo Hospital, in Toledo.
was unremarkable except for six red blood cells per high
power field. Prothrombin activity was 58 per cent (36 hours
after his last dose of Dicumarol). The serum glutamic
oxalacetic transaminase was 17 units and lactic dehydro-
genase 660 units. On the following day, these enzyme
levels were 78 units and 920 units respectively.
The chest x-ray showed moderate cardiac enlargement
and an abdominal film reportedly showed signs of ileus
but no abnormal masses. (In retrospect, the radiology
staff believes an enlarged gallbladder shadow may be dis-
cernible just below the liver.)
An electrocardiogram showed left ventricular hyper-
trophy and digitalis effect. ST segment elevation in lead
V1-3, with T wave inversion in leads I, AVL and Vi-4
were believed indicative of a recent anteroseptal infarction
superimposed on an old infarction pattern. An electrocardi-
ogram the following day showed the development of a QS
pattern in leads Vi-3.
Because of the electrocardiographic changes, the serum
enzyme increases, and as no definitive lesion was demon-
strated in the abdominal x-rays, the patient was treated for
myocardial infarction. Anticoagulation therapy with Dicu-
marol was restarted, and the prothrombin activity was main-
tained between 20 and 40 per cent of control. The pain
gradually subsided and disappeared completely by the sixth
day.
During the next three weeks the patient’s condition re-
mained stable, and the serum enzymes and white blood cell
count returned to normal levels.
On the 24th hospital day, the patient again began to
complain of epigastric pain and nausea. The abdomen was
tense and a 10 by 5 cm. mass was now definitely felt in
the midclavicular line about 5 cm. below the costal margin.
No areas of subcutaneous hemorrhage were noted. His
temperature rose to 102°, and he vomited bile-stained mate-
rial on several occasions. The white blood cell count in-
creased to 15,900/cu. mm. with 75 per cent neutrophils, 21
per cent stab forms, and 4 per cent lymphocytes. The alka-
line phosphatase was 15 units (normal 4-8), and the
bromsulfalein retention 23 per cent in 45 minutes. The
serum bilirubin, cholesterol, and amylase were normal. Re-
peat abdominal x-rays demonstrated ileus and a mass extend-
1028
The Ohio State Medical Journal
ing below the inferior margin of the liver, which was
believed to be a distended gallbladder.
Tetracycline was begun and anticoagulation therapy dis-
continued. A supplemental injection of vitamin Ki (20
mg.) was administered parenterally. Because his general
condition continued to worsen and his temperature increased,
surgical intervention was deemed mandatory on the 26th
hospital day. At this time, his prothrombin activity was
68 per cent.
At operation, the peritoneal cavity was found to contain
about 300 ml. of blood-tinged fluid. A 20 by 10 cm.
mass was felt in the right upper quadrant, which, after
clearing away the adhering omentum, was found to be an
inflamed gallbladder. After opening the gallbladder, ap-
proximately 300 ml. of both fresh and clotted blood and
18 small faceted gallstones were removed. Because of the
general condition of the patient, only a partial cholecystec-
tomy was performed, and a No. 28 mushroom type catheter
was inserted into the gallbladder remnant.
The postoperative course was stormy and complicated by
bronchopneumonia and pyelonephritis. Cholangiography
performed via the catheter on the 45th day demonstrated a
possible calculus in the distal end of the common duct.
However, another operation was deemed inadvisable at
this time in view of the patient’s poor general condition.
The catheter became dislodged on the 50th hospital day and
was removed. The patient was discharged 10 days later.
The surgical specimen consisted of a section of gallbladder
wall about 10 cm. long and 250 cc. of clotted blood. The
mucosal surface was hemorrhagic, ulcerated, and granular,
and the serosal surface was hyperemic and granular. Micro-
scopically, the gallbladder wall showed evidence of both
acute and chronic cholecystitis. Several large areas of sub-
mucosal hemorrhage with rupture of the mucosa surface
were seen (Fig. 1).
Discussion
We believe the hemorrhage into the gallbladder oc-
curred prior to admission rather than during the
third week of hospitalization. However, the lack of
definitive clinical and radiological signs, coupled
with the electrocardiographic and serum enzyme alter-
ations, prompted us to relate the epigastric pain to
a myocardial infarction with diaphragmatic irritation,
a not uncommon occurrence. In retrospect, it is con-
ceivable that the initial symptomatology was due to
hemorrhage into the gallbladder, and the later ab-
dominal complaints were secondary to the acute
cholecystitis as the presence of a tender abdominal
mass in the absence of fever on admission seems more
consistent with hemorrhage than with cholecystitis.
Reports of anticoagulation therapy complicated by
hemorrhage into the meninges,10 intestine,11 adrenal
gland,12 peritoneum13’ 1 4 muscle,15 pericardium16
pituitary gland adenoma,17 breast,18 and central ner-
vous system19-20 have been published. To our knowl-
edge there has been no previously reported case of
hemorrhage into the gallbladder associated with anti-
coagulants.
Hemorrhage into tissues during anticoagulant ad-
ministration has several outstanding manifestations12:
( 1 ) The demonstration of an overt hemorrhagic
tendency is uncommon; (2) One rarely observes con-
current hemorrhage into the skin and subcutaneous
tissues; (3) Hemorrhage has been associated with
several types of anticoagulants including bishydroxy-
coumarin, warfarin, heparin, and phenindione; (4)
There is no definite relationship with the duration of
therapy or the dosage of anticoagulants given. While
hemorrhage was often related to anticoagulant over-
dosage, in many instances the prothrombin activity
Fig. 1. Photomicrograph of section from gallbladder wall showing extensive submucosal hemor-
rhage (arrow). Original magnification x 430.
for October, 1966
1029
was well within the therapeutic range. Occasionally
drugs which tend to prolong or augment the effect
of the anticoagulant (eg, phenyramidol hydrochloride,
phenylbutazone, salicylates, sulfonamides, etc.)21’22
were involved.
Summary
Massive hemorrhage into the gallbladder is rare
and usually associated with trauma, neoplasm, in-
flammation, calculi, or an aneurysmal vessel of the
liver or gallbladder. Reports of anticoagulation
therapy complicated by hemorrhage into a variety of
tissues have been previously published but this ap-
pears to be the first case of hemocholecyst.
An elderly cardiac patient, on long-term bishy-
droxycoumarin therapy developed epigastric pain. Be-
cause an intra-abdominal lesion could not be definitely
established, and because of the electrocardiographic
and serum enzyme changes, he was treated for a
myocardial infarction with continued anticoagulant
administration. Three weeks later, signs of acute
cholecystitis developed. At operation an inflamed
gallbladder, containing gallstones and 300 ml. of
blood, was found.
Hemorrhage associated with anticoagulants is char-
acterized by: (1) The absence of an overt hemor-
rhagic tendency; (2) The rarity of skin and sub-
cutaneous bleeding; (3) Its occurrence with several
types of anticoagulants; (4) No definite relationship
with duration or administration of dosage.
Generic and Trade Names of Drugs
Bishydroxycoumarin — Dicumarol
Vitamin Ki (phytonadione) — Mephyton ®
Phenyramidol Hcl. — Anal exin®
Phenylbutazone — Butazolidin ®
References
1. Graff, R. J.: Considerations in the Treatment of Traumatic
Hemobilia. Am. J. Suyg., 105:662-666 (May) 1963.
2. Fisher, E. R., and Creed, D. L.: Clot Formation in the
Common Duct; An Unusual Manifestation of Primary Hepatic Car-
cinoma. Arch. Surg., 73:261-265 (August) 1956.
3. Hudson, P. B., and Johnson, P. P.: Hemorrhage from Gall-
bladder. New Eng. J. Med., 234:438-441 (March 28) 1946.
4. Urschel, H. C., Jr., et al. : Hemobilia Secondary to Liver Ab-
scess. JAMA, 186:797-799 (November 23) 1963.
5. Stahl, W. M., Jr.: Gastrointestinal Tract Hemorrhage Due
to Gallbladder Disease. New Eng. J. Med., 260:471-474 (March 5)
1959.
6. Schatzki, S. C. : Hemobilia. Radiology, 77:717-721 (Novem-
ber) 1961.
7. Rosenthal, S. B.: Ruptured Aneurysm of the Cystic Artery of
the Gallbladder as a Result of Toxic Arteritis. Arch. Path., 11:884-
895 (June) 1931.
8. Christopher, F., and Savage, J. L. : Apoplexy of the Gall-
bladder. Surgery, 24:864-866 (November) 1948.
9. Tesler, J., and Cantor, P. J.: Hematoma of the Gall-
bladder. Gastroenterology, 33:308-312 (August) 1957.
10. Eisenberg, M. M.: Bishydroxycoumaria Toxicity. JAMA,
170:2181-2184 (August 29) 1959.
11. Pearson, S. C., and MacKenzie, R. J.: Intestinal Obstruction
due to Bishydroxycoumarin Poisoning. JAMA, 167:455-456 (May
24) 1958.
12. Harper, J. R.; Ginn, W. M., Jr., and Taylor, W. J.: Bi-
lateral Adrenal Hemorrhage — A Complication of Anticoagulant
Therapy. Amer. J. Med., 32:984-988 (June) 1962.
13. Kaden, W. S., and Friedman, E. A.: Obstructive Uropathy
Complicating Anticoagulant Therapy. New Eng. J. Med., 265::283-
284 (August 10) 1961.
14. Weseley, A. C.; Neustadter, M. I., and Levine, W. : Mas-
sive Intraperitoneal Hemorrhage of Ovarian Follicular Origin Dur-
ing Anticoagulant Therapy. Amer. J. Obst. & Gynec., 73:683-685
(March) 1957.
15. Hobbs, M. L., and Harley, J. B.: Hematoma of the Rectus
Abdominus Muscle as a Fatal Complication of Anticoagulant Ther-
apy. W. Virginia Med. J., 52:197-199 (July) 1956.
16. Fell, S. C. ; Rubin, I. L.; Enselberg, C. D., and Hurwitt,
E. E.: Anticoagulant-induced Hemopericardium with Tamponade:
Its Occurrence in the Absence of Myocardial Infarction or Pericar-
ditis. New Eng. ]. Med., 272:670-674 (April 1) 1965.
17. Nourizadeh, A. R., and Pitts, F. W. : Hemorrhage into
Pituitary Adenoma During Anticoagulant Therapy. JAMA, 193:623-
625 (August 16) 1965.
18. Kipen, C. S.: Gangrene of the Breast — a Complication of
Anticoagulant Therapy: Report of Two Cases. New Eng. J. Med.,
265:638-640 (September 28) 1961.
19. Cloward, R. B., and Yuhl, E. T. : Spontaneous Intraspinal
Hemorrhage and Paraplegia Complicating Dicumarol Therapy. Neu-
rology, 5:600-602 (Aug.) 1955.
20. Barron, K. C., and Fergusson, G.: Intracranial Hemorrhage
as a Complication of Anticoagulant Therapy. Neurology, 9:AAl-
455 (July) 1959.
21. Carter, S. A.: Potentiation of the Effect of Orally Admin-
istered Anticoagulants by Phenyramidol Hydrochloride. New Eng. J.
Med., 273:423-426 (August 19) 1965.
22. Eisen, M. J.: Combined Effect of Sodium Warfarin and
Phenylbutazone. JAAIA, 189:64-65 (July 6) 1964.
HYPERVOLEMIA may follow intravenous administration of excessive
volumes of fluid or blood or intravascular absorption of large quantities
of irrigating solution from surgically traumatized venous sinuses. The latter may
occur during transurethral surgical procedures. The following prophylactic
measures have been recommended to minimize intravascular absorption of signi-
ficant amounts of irrigating solution: (1) introduction of irrigating fluid under
moderate hydrostatic pressure, with the reservoir height not over 28 inches above
the bladder; (2) limitation of duration of the procedure to one hour; and (3)
avoidance of dissection extending into the deep-lying sinuses. — The Anesthesia
Study Committee of the New York State Society of Anesthesiologists, Lester C.
Mark, M. D., Chairman: New York State Journal of Medicine , 66:979-980,
April 15, 1966.
1030
The Ohio State Medical Journal
Spontaneous Internal Biliary Fistulas
Report of 12 Cases with Discussion
SHARIF BAIG, M. D.
I FISTULAS between the biliary system and gas-
! trointestinal tract are a serious complication of
diseases involving the biliary system. A review
of the literature reveals many cases of solitary fistulas
and some scattered reports of simultaneous multiple
fistulas. Armory and Barker1 reported the details
of three cases with multiple fistulas. The purpose of
this article is to report the analysis of 12 examples of
internal biliary fistulas and to review important fea-
tures of these fistulas.
Incidence
Marshall and Polk2 reported that the majority of
fistulas occur in the sixth and seventh decades of life.
The age of the patients who have spontaneous internal
biliary fistulas corresponds closely with that of pa-
tients who have chronic cholecystitis and cholelithiasis.
The incidence of fistula formation will vary from
hospital to hospital, depending upon the number of
patients undergoing biliary surgery and the various
factors which lead to a delay in admission and man-
agement of patients with acute biliary conditions.
Puestow3 found 16 instances of fistula formation
in 500 operations for benign biliary disease or 3 per
cent. Dean4 noted that 1.2 per cent of patients with
cholecystitis had fistulas. Mirizzi5 reported 78 cases
of fistulas in 2,613 cases undergoing biliary surgery
or 3 per cent.
Pathogenesis
The occurrence of spontaneous internal biliary
fistulas may be attributed to two principal causes : ( 1 )
chronic cholecystitis with or without concomitant
cholelithiasis or choledocholithiasis and (2) pene-
trating duodenal ulcer.
Carcinoma of the gallbladder, biliary tree, and
other organs rarely causes this condition. The pylorus
and first part of the duodenum lie close to the com-
mon bile duct as it courses through the gastrohepatic
ligament; this explains how a penetrating peptic ulcer
may erode the common bile duct and lead to subse-
quent formation of fistulas.
According to Hicken and Coray,6 90 per cent of
the fistulas between the gallbladder and intestine
follow erosion or perforation by stones and are often
From the Department of Surgery, The Miami Valley Hospital,
Dayton, Ohio. Submitted April 30, 1966.
The Author
• Dr. Baig, Dayton, is Fourth Year Resident in
General Surgery, at The Miami Valley Hospital.
accompanied by acute cholecystitis. In a small num-
ber of cases the gallbladder may rupture leading to
pericholecystic abscess and secondary necrosis of the
adjacent viscus and permanent fistula formation. (Foss
and Sumner7)
Judd and Burden8 analyzed 153 cases and con-
cluded that fistula formation occurred by direct pene-
tration between adherent organs in 148 cases and
via pericholecystic abscess in five cases.
Location of Fistulas
The internal biliary fistulas can be categorized into
four common types: (Fig. 1)
1. Cholecystoduodenal fistulas (70 per cent);
2. Cholecystocolic fistulas (15 per cent);
3. Cholecystogastric fistulas (6 per cent);
4. Choledochoduodenal fistulas (5 per cent).
Waggoner and Lemone11 cited a higher incidence
of choledochoduodenal fistulas in a review of large
series of cases. Rare types of fistulas as cholecysto-
duodenocolic fistula12 and cholecystohepaticochole-
for October , 1966
1031
dochal fistulas account for 4 per cent of biliary
fistulas.
Clinical Features
There are no distinctive findings diagnostic of
spontaneous internal biliary fistulas. Most patients
present a clinical picture of the primary pathologic
process. Judd and Burden8 reviewed the clinical
findings of 153 operated cases. The average duration
of primary disease in the biliary system was ten
years. Recurrent episodes of biliary colic were noted
in 85 per cent of the cases, colic and jaundice in 50
per cent, fever in 45 per cent, and obstruction of the
common bile duct in 20 per cent. These findings
are comparable to those of other series.9
Radiographic Findings
The direct sign of a fistulous connection is the
presence of gas or contrast material in the biliary tree
(Fig. 2). (Borman and Rigler.10) The indirect signs
Fig. 2. Barium and Air in the Common Bile Duct
(Case No. 9) .
are nonfunctioning gallbladder with or without
calculi.
In our series of 12 cases, 11 patients had non-
functioning gallbladder with calculi and three had
air in biliary tree on plain abdominal x-rays. Two
cases had radiopaque contrast medium in biliary
tree after a routine gastrointestinal study.
The gastrointestinal study should be performed
as routine in most patients with long history of biliary
system disease; it would assist in preoperative evalua-
tion of patients for the presence of fistulas. (Pittman
and Davies.13)
Material Studied
A brief summary of 12 cases of internal biliary
fistulas noted in 2500 patients with biliary system
disease operated upon in Good Samaritan and Miami
Valley Hospitals from I960 to 1964 is presented in
Table 1. The fistulas encountered were located as
follows:
Cholecystoduodenal — 8
Cholecystocolic — 2
Choledochoduodenal — 2
Both patients with choledochoduodenal fistula had
chronic duodenal ulcers, and one patient had a normal
gallbladder on double dose cholecystograms. The
second patient presented as perforated duodenal ulcer
with choledochoduodenal fistula.
Management
Oftentimes internal biliary fistulas are not diag-
nosed preoperatively, and in some instances may not
be suspected until the operation is well under way.
Every patient with chronic biliary system disease
and long history of symptoms should undergo radi-
ographic studies of the gastrointestinal tract. An
unexplained shadow of air in the area of biliary
passages and knowledge of the incidence of spon-
taneous fistulas should enhance one’s suspicion as
to the presence of these fistulas. Most patients with
choledochoduodenal fistulas will have evidence of
chronic duodenal ulcer with or without chronic biliary
system disease.
Most cases of cholecystoenteric fistulas can be man-
aged by performing cholecystectomy and closing the
opening in the bowel. In some cases this may not
be feasible due to densely adherent and stenotic gall-
bladder, in which case removal of part of the gall-
bladder and leaving the rest in the liver bed after
chemical treatment to defunctionalize the mucosa will
suffice.
Operative cholangiography can be of help in dif-
ficult cases. (Carlson and Byron.15)
The operation of choice for choledochoduodenal
fistulas due to eroding duodenal ulcer is subtotal gas-
trectomy and gastrojejunostomy. The fistula should
be inspected by performing a duodenostomy. (Walk-
er and Large.16)
The surgeon should be aware of the presence of
more than one biliary fistula and in such cases opera-
tive cholangiograms may be helpful. Patients should
be treated with heavy dosage of penicillin and broad
spectrum antibiotics.
Summary and Conclusion
1. Twelve cases of spontaneous internal solitary
biliary fistulas are presented with review of the
literature.
2. Patients with five or more years of chronic
biliary system disease should have complete radi-
ographic examination of the gastrointestinal tract,
which might lead to an increase in the preopera-
tive diagnosis of this entity.
3. The possibility of multiple internal biliary
fistulas should be kept in mind, and exploration of
the common bile duct and operative cholangiog-
raphy should be considered in selected cases.
References
1. Armoury, R. A., and Barker, H. G.: Multiple Biliary En-
teric Fistulas. Amer. ]. Surg., 111:181-185 (Feb.) 1966.
2. Marshall, S. F., and Polk, R. C. : Spontaneous Internal
Biliary Fistulas. Surg. Clin. N. Amer., 38:679-91 (June) 1958.
( Continued)
1032
The Ohio State Medical Journal
3. Puestow, C. B.: Spontaneous Internal Biliary Fistula. Ann.
Surg., 115:1043-1054 (June) 1942.
4. Dean, G. O.: Internal Biliary Fistulas; Discussion of Internal
Biliary Fistulas based on 29 Cases. Surgery, 5:857-864 (June) 1939.
5. Mirizzi, M. P. L.: Fistulae Biliares Interne Spontanee au
cours de la Iithiasis biliaire. Quatorzieme Congres de la Societe Inter-
nationales de Chirugie. Paris, September 23-29, 1951. Bruxelles,
Imprimerie Medicale Scientifique (S. A. ) 1052. pp. 531-558.
6. Hicken, N. F., and Coroy, Q. B.: Spontaneous Gastrointes-
tinal Biliary Fistulas. Surg., Gynec. Obstet., 82:723-730 (June)
1946.
7. Foss, H. L., and Summers, J. D.:Intestinal Obstruction from
Gallstones. Ann. Surg., 115:721-735 (May) 1942.
8. Judd, E. S., and Burden, V. G.: Internal Biliary Fistula.
Ann. Surg., 81:305-312 (Jan.) 1925.
9. Wakefield, E. G.; Vickers, P., and Walters, W.: Cholecys-
toenteric Fistulas. Surgery, 5:674-677 (May) 1939.
10. Borman, C. N., and Rigler, L. G.: Spontaneous Internal
Biliary Fistula and Gallstone Obstruction, with particular reference
to Roentgenologic Diagnosis. Surgery, 1:349-378 (March) 1937.
11. Waggoner, C. M., and LeMone, D. V.: Clinical and Roent-
gen Aspects of Internal Biliary Fistulas; Report of 12 Cases. Radi-
ology, 53:31-41 (July) 1949.
12. Nemhauser, G. M., and Thompson, J. C. : Cholecystoduoden-
ocolic Fistula due to Gallstones. Case Report. Ann. Surg., 163:81,
1966.
13. Pitman, R. G., and Davies, A.: The Clinical and Radiologi-
cal Features of Spontaneous Internal Biliary Fistulae. Brit. J. Surg.,
50:414-425 (Jan.) 1963.
14. Epperson, D. P., and Walters, W. : Spontaneous Internal
Biliary Fistulas. Proc. Staff Meet. Mayo Clinic , 28:353-360
(July 1) 1953.
15. Carlson, E.; Gates, C. Y., and Novacovich, G. : Spontan-
eous Fistulas between Gallbladder and Gastrointestinal Tract. Surg.,
Gynec., Obstet., 101:321-330 (Sept.) 1955.
16. Walker, G. L., and Large, A.: Choledochoduodenal Fistula,
Its Surgical Management; Including a Report of 3 Cases. Ann. Surg.,
139:510-51 6 (April) 1954.
17. Cowley, L. L., and Harkins, H. N. : Perforation of Gall
Bladder; A Study of 25 Consecutive Cases: Surg. Gynec. Obstet.,
77:661-668 (Dec.) 1943.
18. Byrne, J. J. : Biliary Fistulas. Amer. J. Surg., 86:181-187
(Aug.) 1953.
19. Chamberlain, B. E.: Incomplete Cholecystogastric Fistula.
Amer. J. Surg., 90:153-154 (July) 1955.
20. Altman, W. S., and Field, E. A.: Spontaneous Internal Bili-
ary Fistulas: A Review and Report of Two Cases. New England J.
Med., 216:199-202 (Feb. 4) 1937.
Table 1. Summary of 12 Cases of Internal Biliary Fistulas in Patients Operated Upon at Good Samaritan and Miami Valley
Hospitals from I960 to 1964.
No.
Age
Sex
Clinical Features
X-Ray Findings
Operative Findings
Management
Complications
1
64
F
Right upper quadrant
pain, tenderness RUQ,
fat intolerance
Nonfunctioning
gallbladder with calculi
Cholecystoduodenal
fistula
Cholecystectomy and
closure fistula
None
2
75
F
Right upper quadrant
pain, heartburn, fat
intolerance for 5 yrs.,
obesity
Nonfunctioning
gallbladder; no stones
Cholecystoduodenal
fistula
Cholecystectomy and
closure fistula
None
3
78
F
Fat intolerance,
indigestion, nausea —
8 yrs., obesity
Nonfunctioning
gallbladder with calculi
Cholecystoduodenal
fistula
Cholecystectomy and
closure fistula
None
4
58
F
Pain right upper
quadrant jaundice,
fever, tenderness RUQ
Nonfunctioning
gallbladder with calculi
and choledocholithiasis
Cholecystoduodenal
fistula
Cholecystectomy,
choledocholithotomy,
closure fistula,
T. tube in C.B.D.
Ascending
cholangitis
5
69
F
Pain RUQ, obesity,
mass RUQ
Nonfunctioning
gallbladder with stones
Cholecystoduodenal
fistula
Cholecystectomy and
closure fistula
Atelectasis
rt. lung base
6
54
F
Pain in epigastrium,
fat intolerance —
6 yrs.
Nonfunctioning
gallbladder
Cholecystoduodenal
fistula
Cholecystectomy and
closure fistula
None
7
72
F
Pain RUQ, mild
jaundice, chills and
fever
Nonfunctioning
gallbladder and stones
Cholecystoduodenal
fistula
Cholecystectomy and
closure fistula
None
8
69
M
Indigestion and fat
intolerance, epigastric
distress
Nonfunctioning
gallbladder; no stones
Cholecystoduodenal
fistula
Cholecystectomy and
closure fistula.
None
9
48
F
Postprandial
epigastric pain,
hematemesis
Normal gallbladder;
no calculi; air in
biliary tree
Choledochoduodenal
fistula and chronic
duodenal ulcer
Billroth II; subtotal
gastrectomy, T. tube
in C.B.D.
None
10
64
M
Mass in epigastrium,
episodes of chills and
fever, jaundice
Nonfunctioning
gallbladder; air and
barium in biliary tree
Choledochoduodenal
fistula; chronic
duodenal ulcer —
perforated and
localized
Gastroj ej unostomy;
T. tube;
choledochostomy
Hepatic failure;
died
11
58
F
Temperature, RUQ
pain, and tenderness
RUQ
Nonfunctioning
gallbladder and calculi;
air in biliary tree
Cholecystocolic
fistula and pericolic
abscess; perforated
diverticula
Drainage abscess
None
12
60
F
Pain RUQ, diarrhea
Nonfunctioning
gallbladder and calculi
Cholecystocolic
fistula
Cholecystectomy and
closure fistula
None
for October, 1966
1033
Anomaly of the Gallbladder
Case Report of an Unusual Location
J. L. BILTON, M. D., and C. L. HUGGINS, M.D.
7\ NOMALIES of the gallbladder occur in num-
ber, form, type, and position. Gross,1 in
-A. TA. presenting 50 cases from the available litera-
ture up to 1936, stated that congenital anomalies of
the gallbladder itself, bile ducts and vasculature ex-
cluded, were rare. Haines and Kane2 reported only
76 present in the available literature, as late as 1946.
Davis and Trower,3 on agenesis of the gallbladder,
after an exhaustive search of the literature, revealed
the number of recorded cases to be no larger than 63,
yet these were not all documented as to how thorough
a search had been made to find the gallbladder in
anomalous positions.
Anomalies of form and number are surgical curi-
osities which, with rare exception, seldom alter the
natural course of gallbladder disease, or present any
technical difficulty in removal, a possible exception
being a double gallbladder in which the second un-
suspected organ is buried in the liver itself. Gall-
bladders have been absent or found in the liver, the
falciform ligament, and the abdominal wall. Reed,
et al,7 report a double gallbladder with two ducts.
Considering anomalies of position, the most often
cited in the literature is the left-sided gallbladder.
Next in frequency is the "floating gallbladder.” Due
to kinking of the cystic duct this anomaly is most
often encountered as an emergency.
Regen and Poindexter6 reported one such case in
which the "free floating” cystic duct permitted a
floating gallbladder (surrounded by peritoneum) to
be located on top of the right lobe of the liver.
Given a patient with gallbladder symptoms and
x-ray diagnosis of no function, the operating surgeon
must be aware of the existence of these abnormalities
of location to avoid closing the abdomen in confused
ignorance.
The purpose of this paper is to review a case
wherein the gallbladder was located in the mesocolon.
Case Report
Mrs. — , a 59 year old Negro woman, was admitted to
the hospital with a one year history of upper left quadrant
abdominal pain, which was nonradiating, sharp, and con-
stant. There was no positional relief of pain. The patient
From the Department of Surgery, Huron Road Hospital, Cleveland,
Ohio.
Submitted March 10, 1966.
The Authors
• Dr. Bilton, Cleveland, is a member of the At-
tending Staff, and Director of Surgery, Huron
Road Hospital.
• Dr. Huggins, Cleveland, is a member of the
Active Staff, Forest City Hospital, and the Associate
Staff of Huron Road Hospital.
complained of intolerance to greasy foods and several epi-
sodes of nausea, with vomiting of bilious material. There
was no history of jaundice, dark urine, or clay-colored stools.
There was a history of a weight loss of 18 lbs. within the
past year, and increased frequency of urination, with inter-
mittent shooting pains down the posterior aspect of both
legs.
Thirteen years ago the patient had x-ray therapy followed
by a total hysterectomy for carcinoma of the cervix with
no subsequent evidence of recurrence or metastasis. Inci-
dental appendectomy was done.
Physical Examination: The patient was well developed
and well nourished in spite of the weight loss. With the
exception of tenderness to deep palpation in the left upper
quadrant along the costal margin and fist-percussive tender-
ness in the left costovertebral angle, the physical examina-
tion was not remarkable.
Laboratory: Hemogram was within normal limits. Uri-
nalysis showed 30 to 40 white blood cells, and many epi-
thelial cells, with few bacteria. Blood chemistry was within
normal limits. Intravenous pyelograms were within normal
limits. Gallbladder series revealed nonvisualization.
Hospital Course: Following the diagnostic evaluation
and clearing of the urinary infection, the patient was taken
to surgery with a preoperative diagnosis of chronic chole-
cystitis and cholelithiasis. Where the gallbladder is usually
found was a smooth undersurface of the right lobe of the
liver. Palpation behind the liver did not reveal the gall-
bladder. A search of the falciform ligament was unfruit-
ful. To rule out a gallbladder buried in the liver, the
proximal portion of the common duct was exposed, in search
of the cystic duct leading to this gallbladder. None was
found. The common duct was then exposed down to the
point where it becomes retroduodenal, and here a cystic
duct was encountered that ran medially into the transverse
mesocolon. This was hidden by the right half of the
transverse colon. The mesocolon was opened and the gall-
bladder exposed (Fig. l). Operative cholangiograms were
taken, and there were no stones in the common duct. A
cholecystectomy was performed in routine fashion and the
patient had an uneventful postoperative recovery.
Discussion
The finding of the gallbladder in this position was
interesting. Embryologically, according to Hamilton
and Boyd,4 the caudal portion of the original hepatic
1034
The Ohio State Medical Journal
Fig. 1. (A) Represents fundus of gallbladder; (B) Repre-
sents transverse colon; (C) Edge of mesocolon.
bud becomes demarcated from the main hepatic mass.
This portion (pars cystica) lies in the ventral mesen-
tery and gives origin to the gallbladder and cystic
duct. The single hollow stalk of attachment of the
pars hepatics and the pars cystica to the duodenum
elongates to form the bile duct and lies in the free
edge of the ventral mesentery.
According to Arey,5 the liver is enclosed by the
ventral mesentery, and since the gallbladder was orig-
inally an analog of the liver, it can be suspended
below the liver on a free mesentery. Gross postulates1
it is this free state of suspension that allows migration
of the gallbladder into its anomalous positions (left-
sided behind the liver and free floating) .
To reach a position in the mesocolon would neces-
sitate migration through the epiploic foramen and
into the omental bursa. (Arey5 states that the open-
ings are different, but for practical anatomic relations,
they are the same.) Had this been the case, the
cystic duct would have been found coursing through
the foramen of Winslow, which was not the case.
Conclusion
Although anomalies of the bile ducts and vascula-
ture are quite common, those of the gallbladder are
not frequently reported.
Given a symptomatic patient with nonvisualization
of the gallbladder, the operating surgeon must be
aware of possible anomalous locations if the gall-
bladder is not found in its usual location.
In this case, it is conceivable that this symptomatic
gallbladder might have been missed without a thor-
ough exploration for a point of origin along the
common duct.
References
1. Gross, R. E.: Congenital Anomalies of the Gallbladder. Arch.
Surg., 32:131-162 (Jan.) 1936.
2. Haines, F. X., and Kane, J. T.: Acute Torsion of the Gall-
bladder. Ann. Surg., 128:253-256 (Aug.) 1948.
3. Davis, C. F., Jr., and Trover, C. B.: Congenital Absence of
the Gallbladder in the Adult. Arch. Surg., 83:652-656 (Nov.) 1961.
4. Hamilton, W. J. ; Boyd, J. D., and Mossman, H. W.: Human
Embryology, Baltimore, Williams & Wilkins Co., 1952.
5. Arey, L. B.: Developmental Anatomy, ed 5, Philadelphia,
W. B. Saunders Co., 1946.
6. Regen, J. F., and Poindexter, A.: Suprahepatic Position of the
Gallbladder: A Report of an Unusual Case. Arch. Surg., 90:175-176
(Jan.) 1965.
7. Reed, E. S., and Carlberg, D.: Gallbladder Anomalies, with
a Report of a Double Gallbladder. /. Indiana Med. Ass., 54:1780-
1783 (Dec.) 1961.
GALLBLADDER DYSPEPSIA. — An attempt has been made to determine
what association, if any, exists between chronic dyspepsia and the presence
of gallstones, determined radiologically in women aged 50 to 70 years. The sur-
vey was conducted in a general practice to avoid the selection inevitable in a
hospital population. The women were interviewed before being x-rayed, so
that their histories were not biased by any knowledge of whether gallstones were
present or not.
A history of dyspepsia was obtained from 12 (50 per cent) out of 24 sub-
jects with gallbladder disease. Of those with normal cholecystograms 63 (53 per
cent) out of 118 had similar symptoms. The dyspepsia suffered by those with
gallstones was not distinguishable from that experienced by those with normal
gallbladders.
It is concluded that among women aged between 50 and 70 the occurrence
of chronic dyspepsia and gallbladder disease is coincidental. These symptoms
cannot assist in diagnosis of gallbladder disease and should not influence its
treatment. — W. H. Price, M. B., B. Sc., M.R.C.P. Ed., Eastern General Hospital,
Edinburgh, Scotland: British Aledical Journal, pp. 138-141, July 20, 1963.
for October, 1966
1035
Hyperglobulinemic Purpura
Report of a Case and Review of the Literature
C. JOSEPH CROSS, M.D., W. A. MILLHON, M. D„ J. S. MILLHON, M.D.,
and D. E. HOFFMAN, M. D.
IN 1943 WALDENSTROM first described the co-
existence of purpura and hyperglobulinemia as
a possible specific clinical entity.1-2 The num-
ber of reported cases has increased rapidly since that
time and a recent critical review of the literature has
raised the question as to the validity of this concept.3
It is the purpose of this report to review the clinical
course of this condition, to report a case, and to
consider the differential diagnosis with the intent of
further establishing it as a distinct clinical syndrome.
Clinical Course
This condition has been described in all age groups
and in both sexes with females predominating. It
has an insidious onset, appearing first as an intermit-
tent purpuric rash on the lower extremities, often
after the wearing of constrictive clothing and after
prolonged walking or standing. Purpuric areas may
also occur on the arms, especially after mild traumatic
episodes, on the lower trunk, and rarely on the soles
of the feet.4 The attacks may be entirely asympto-
matic but more often they are associated with mild
itching and burning and occasionally with pain and
edema. Over a period of years the attacks occur
with increasing frequency and severity but always fol-
low a similar stereotyped pattern.
The rash is petechial, occasionally showing slight
erythema, and develops in crops and patches which
often become confluent. It progresses rapidly and
reaches its maximum intensity within a few hours.
Ecchymoses have not been observed. The area of the
lesions develops a brown discoloration which may
persist or gradually fade away. Little or no trophic
change occurs in the skin, although the intensity of
the discoloration may simulate a marked vascular
deficiency.
The rise in the globulins is due to an increase in
the gamma fraction of the S-7 type, the electropho-
retic pattern showing the gamma fraction to have a
wide base and a rounded apex. The albumin frac-
tion is normal or low, the total protein is normal or
high. There is no reported elevation in cryoglobulins
and macroglobulins. The blood count may show mild
Submitted March 17, 1966.
The Authors
• Dr. Cross, Columbus, is a member of the Sen-
ior Attending Staff, Riverside Methodist Hospital;
Clinical Instructor, Department of Medicine, The
Ohio State University College of Medicine.
• Dr. W. A. Millhon, Columbus, is a member of
the Attending Staff, Riverside Methodist Hospital;
Clinical Instructor, Department of Medicine, The
Ohio State Uiversity College of Medicine.
• Dr. J. S. Millhon, Columbus, is a member of
the Attending Staff, Riverside Methodist Hospital;
Clinical Instructor, Department of Medicine, The
Ohio State University College of Medicine.
• Dr. Hoffman, Columbus, is a member of the
Provisional Staff, Riverside Hospital; Clinical In-
structor, Department of Medicine, The Ohio State
University College of Medicine.
anemia or leukopenia; the platelet count and coagula-
tion studies are usually normal. A recent report has
indicated an abnormality in the thromboplastin gener-
ation test as measured by the quantitative assay for
platelet factor 3. 5 Capillary fragility may be normal
or increased, and bone marrow studies are usually
within normal limits, although benign increases in
reticuloendothelial cells and plasma cells have oc-
casionally been noted.
Histologically, the changes occurring during the
early phase of the attack are those of a perivascular
infiltration of small vessels in the dermis with acute
and chronic inflammatory cells, associated with spotty
arteriolar necrosis. Red cells are free in the dermis.
After several days, the perivascular cuff is composed
mostly of mononuclear cells, and there is iron in
the macrophages and also free in the dermis.6
The following case is presented as fulfilling the
diagnostic criteria for Waldenstrom’s purpura hyper-
globulinemia.
Report of Case
A 53 year old dental assistant was first seen on January
11, 1963 with a chief complaint of chills, fever, and increas-
ing edema of her feet and ankles. This had had a rather
acute onset 11 days before and was associated with marked
1036
The Ohio State Medical Journal
frequency, dysuria, and nocturia. She stated that her "dis-
colored” legs became a "brighter” red before the onset of
the edema.
On questioning her about the history of this discoloration,
she stated that she had had episodes of spotty purpuric erup-
tions on both legs below the knees for about 35 years. Initi-
ally they had been imperceptible, and she remembered them
as being most pronounced when she was fatigued or after
prolonged standing. These episodes were first noted in her
late teens. She had been working as a dental assistant for
17 years and had noted a progressive increase in the dis-
coloration during this period. The episodes were origi-
nally intermittent and asymptomatic and later were asso-
ciated with mild tingling sensations. Her work at this
time required her to stand for most of her working day.
She had increasing discomfort, manifested by paresthesias
and occasional stinging sensations. During the past six years
the discoloration had persisted and remained as a perma-
nent spotty, brown pigmentation, diffusely and symmetrically
distributed over both lower extremities below the knees.
Prior to her present illness she had no episodes of
edema. She had no cold sensitivity, no joint pain, and no
known allergies. She admitted to no gastrointestinal or
cardiorespiratory symptoms. She had had a right upper
lobe segmental resection for a benign pulmonary cyst in
1953 with an uncomplicated recovery. Cessation of the
menses occurred uneventfully in 1951.
Physical examination revealed an alert, asthenic 53 year
old white woman. Temperature was 99.6, pulse rate 80
per minute, respiratory rate 24, and blood pressure 134/76.
A right thorocotomy scar was present. There were no
pulmonary or cardiac abnormalities. Abdominal examina-
tion was relatively normal except for mild tenderness over
the suprapubic area. There was moderate to marked right
costovertebral angle tenderness. Pelvic examination was
normal except for slight inflammatory changes around the
urethral meatus. Extremities demonstrated a diffusely
symmetrical purpuric and slightly atrophic rash character-
ized by lightly scaling, pigmented areas in a somewhat an-
nular arrangement. This phenomenon was present over the
entire lower extremity below the knees. Neurological ex-
amination was normal, and there was a 2 plus pitting edema
of the ankles, nontender and symmetrical.
Laboratory study revealed hemoglobin 13.8 Gm. per 100
ml., hematocrit 40 per cent, and leukocyte count 3,450
with 62 per cent neutrophils and 38 per cent lymphocytes.
The erythrocyte sedimentation rate was 44 mm. per hour.
Urinalysis showed a specific gravity of 1.026, pH of 7.2,
protein 10 mg., glucose negative, and numerous leukocytes
and epithelial cells, many bacteria, scattered erythrocytes
and rare granular casts. Culture of urine yielded Staphy-
lococcus aureus, which was sensitive to tetracycline and
Gantrisin®. Repeat examination and urine cultures after
10 days of treatment were within normal limits. Blood
urea nitrogen was 14.4 mg. per 100 cc., creatinine was
1.2 mg. per 100 cc., and urinary creatinine was 1.9 Gm.
in 24 hours. Total protein (Howe method) was 8.2 Gm.
with the albumin fraction 4.0 Gm. and globulin 4.2 Gm.
Serology was nonreactive by the Kolmer, Kahn, and VDRL
methods. The latex fixation test for rheumatoid factor
was negative, the alkaline phosphatase measured 4.9 King-
Armstrong units, the cephalin flocculation test was 1 plus,
and the thymol turbidity measured 1 to 4 units. Urinary
Bence-Jones protein was negative. The Sia test was negative.
Bone marrow examination was normal, showing no in-
crease in plasma cells or reticuloendothelial elements. Coag-
ulation studies were entirely within normal limits: the
bleeding time (Duke) was 3 minutes, the clotting time was
8 minutes, platelet count was 196,000 prothrombin time
of 90 per cent of normal, and the tourniquet test was nor-
mal. Electrophoresis of the serum at pH 8.6 gave the
following values: albumin 4.8 Gm. per 100 ml., alpha 1
globulin 0.08 Gm. per 100 ml., alpha 2 globulin 0.20 Gm.
per 100 ml., beta globulin 0.39 Gm. per 100 ml., and
gamma globulin 2.48 Gm. per 100 ml. This was 38 per
cent of the total (normal 12 to 18 per cent). Chest x-ray,
electrocardiogram, upper gastrointestinal series, electroen-
cephalogram and intravenous pyelogram were normal. Skin
biopsy and ultracentrifuge studies were not performed.
The patient’s presenting complaints rapidly cleared on
antibiotic therapy. The edema disappeared, but the purpuric
lesions remained unchanged.
Differential Diagnosis
The usual causes of hemorrhagic or purpuric dis-
ease include vascular weakness, defective function or
number of blood platelets, faulty coagulation mechan-
isms of the blood, and abnormalities of the serum
proteins. Except for certain rare or recently recog-
nized disturbances which require special methods of
study, the recognition of most purpuric conditions
seen in clinical practice can be determined with six
basic tests: (1) clotting time; (2) bleeding time;
(3) clot retraction; (4) tourniquet test; (5) pro-
thrombin time; and, (6) prothrombin consumption.
In the differentiation of hyperglobulinemic purpura
from other purpuric syndromes, both laboratory and
clinical evidence must be used, and these are suf-
ficiently clearcut to warrant the identification of this
condition as a specific syndrome.
Vascular purpuras may be congenital (hereditary
telangiectasia, pseudohemophilia) or acquired. Most
of the acquired forms are readily recognized (defec-
tive tissue support, allergy, infectious and nutritional,
ie, scurvy), but two of these especially warrant fur-
ther discussion. In the nonthrombocytopenic form
of purpura associated with joint or abdominal pain
known as Schoenlein-Henoch’s purpura, the cause is
presumed to be allergic. There have been several
reports indicating that serum globulins may be ele-
vated.7-9 It has been stated that these two conditions are
not distinguishable on a laboratory basis,3 and there
may indeed be an overlap. However, by definition,
Schoenlein-Henoch purpura involves mucous and syn-
ovial membranes, while hyperglobulinemic purpura
does not, and skin involvement with Schoenlein-
Henoch purpura is often more severe, appearing as
erythema multiforme, bullous lesions, urticaria, and
even tissue necrosis. Dermatologic changes in hyper-
globulinemic purpura are more benign.
The other vascular conditions which should be dis-
cussed are those generally classified as the pigmented
purpuric dermatoses of Schamberg and Majocchi.
There are actually four closely related dermatological
conditions included in this group: (1) Schamberg’s
progressive pigmentary dermatitis10; (2) angioma
serpiginosium11’ 12 ; (3) purpura annularis telangiec-
todes of Majocchi13; and, (4) pigmented purpuric
lichenroid dermatitis.14 All of these have been sep-
arately described, but there have been questions raised
as to whether these are simply variants of the same
condition.
As protein studies have not been included in the
reports on these conditions in the dermatologic liter-
ature, it is possible that many of these might be
more properly classified as hyperglobulinemic pur-
puras of Waldenstrom. They have been character-
ized as benign and asymptomatic purpuric and pig-
mented lesions with obscure causative factors, and
for October , 1966
1037
even the most expert dermatologists admit that it is
seldom possible clinically to determine the anatomic
nature of the visible punctate lesions and that the
primary vascular abnormality in each of these condi-
tions is usually indistinguishable.15 Certainly, fu-
ture reports on these pigmented purpuric eruptions
should include protein studies.
The laboratory manifestations of thrombocytopenic
purpura, both in its primary and secondary classifica-
tions, are too well known and easily recognized to
warrant further discussion in the differential diagnosis.
Blood coagulation factors are usually normal in
reported cases of hyperglobulinemic purpura, al-
though there appears to be some variability in the
capillary fragility, and there has been one report
previously mentioned of an abnormality in thrombo-
plastin generation.4
In the category of dysproteinemias, there are
again two diseases important in the differential diag-
nosis. The first is the purpura associated with
cryoglobulinemia. The frequent coexistence of these
two phenomena has suggested the term "purpura
cryoglobulinemia.’’16 These conditions are usually
asymptomatic and may be accompanied by cyanosis,
numbness of severe degree, Raynaud’s phenomenon,
vascular occlusions, hemolytic anemia, hemoglobin-
uria, chills, and fever. The presence of cryoglobulins
in the blood and the history of precipitation by cold
will usually easily differentiate this condition.17
It is interesting to note that cryoglobulins have
been found associated with the other causes of hyper-
globulinemia and purpura, which must be included
in our list of differential diagnostic possibilities. They
are identifiable by specific diagnostic tests and need
only be listed. These include collagen diseases (sys-
temic lupus erythematosis, polyarteritis nodosa, rheu-
matoid arthritis, and Sjogren’s syndrome), chronic
infections (syphilis, kala-azar, subacute bacterial en-
docarditis), chronic lymphatic leukemia, lymphosar-
coma, sarcoidosis, and multiple myeloma. One case
reported as purpura hyperglobulinemia subsequently
terminated as multiple myeloma.18
The second dysproteinemia which must be con-
sidered is the macroglobulinemia of Waldenstrom.
The eponym and similarity of name are confusing,
but it is only rarely associated with purpura and is
characterized by specific symptomatology. It is a
disease of an older age group, ranging from 50 to
70 years, and is manifested by weight loss, undue
susceptibility to infection, hepatosplenomegaly, lym-
phadenopathy, retinal hemorrhages, and bleeding
from mucous membranes. Increased blood viscosity
due to the macroglobulin may lead to congestive
heart failure and certain neurologic disturbances
Fig. 1. The serum electrophoretic pattern demonstrates the characteristic wide base and rounded apex of the markedly increased
gamma fraction.
1038
The Ohio State Medical Journal
(Bing-Neel). It may be identified by ultracentrifu-
gation, and, if this is unavailable, the macroglobulin
may be indicated by the Sia test and the dark "M”
spot marking the paraprotein on paper electrophoresis.
Pathogenesis
The pathogenesis of the bleeding tendency in dys-
proteinemia remains obscure. Certain postulated
mechanism can be readily ruled out, ie., thrombocy-
topenia due to the invasion of bone marrow by path-
ologic cells with subsequent crowding of the mega-
karocytes, as is seen in multiple myeloma. Specific
abnormalities of the process of blood congulation are
easily recognized and excluded by appropriate tests.
A possibility that has been theorized is the infiltra-
tion of the vascular wall by the abnormal protein
resulting in increased capillary fragility.19 This al-
teration may be due to an allergic mechanism in the
small vessel wall20 or to the allergen altering the
normal stmcture of the gamma globulins, which in
turn affects the capillary endothelium.21 Another
theory has been that a chronic virus infection may
stimulate the production of antibodies and increase
the gamma globulin fraction of the serum.22 This
immuno-allergic mechanism is attractive but unproven.
Summary
The case of a 53 year old white woman with more
than a 30-year history of purpura of the lower ex-
tremities and a relatively benign and asymptomatic
course is presented. The presence of a marked in-
crease in the gamma globulin fraction of the serum
protein together with the absence of any apparent
abnormalities in the coagulation mechanism coincide
with the findings of Waldenstrom, who described
this condition in 1942. The differential diagnosis
and possible pathogenesis are briefly discussed. Al-
though the validity of this syndrome has been ques-
tioned, the increasing number of reported cases with
a distinct and reproducible clinical picture and labor-
atory findings appear to qualify this condition as a
distinct clinical entity.
References
1. Waldenstrom, J.: Incipient Myelomatosis or "Essential’’ Hy-
perglobulinemia with Fibrinogenopenia: New Syndrome? Acta Med.
Scand., 117:216-247, 1944.
2. Waldenstrom, J.: Zwei interessante Syndrome mit Hyper-
globulinamie. (Purpura Hyperglobulinaemica und Makroglobul-
inamie). Schweiz Med. Wschr., 78:927-928 (Sept. 25) 1948.
3. Strauss, W. G.: Purpura Hyperglobulinemia of Waldenstrom:
Report of Case and Review of the Literature. New Eng. J. Med.,
260:857-860 (Apr. 23) 1959-
4. Mielke, H. G. : Purpura Hyperglobulinaemica (Walden-
strom). Arztl. Wchnschr., 8:241-244 (Mar. 13) 1933.
5. Weiss, C. H.; Demis, D. J.; Elgart, M. L.; Brown, C. S.,
and Crosby, W. H.: Treatment of Two Cases of Hyperglobulinemic
Purpura with Thioguanine. New Eng. J. Med., 268:753-756
(Apr. 4) 1963.
6. Fleischmajer, R.; Rein, C. R.; Pascher, F., and Sims, C. F.:
Purpura of Idiopathic Hyperglobulinemia. Arch. Derm., 76:575-
583, 1957.
7. Pribilla, W.: Purpura Schoenlein-Henoch. Arztl. Wchnschr.,
6:1044-1048 (Nov. 2) 1951.
8. Jadassohn, W., et al. : Demonstrationen. 2. Purpura de
schonlein-Henoch et Purpura Hyperglobulinemique. Dermatologica,
110:353-362, 1955.
9. Bernard, J., Mathe, G., and Israel, L.: Etudes Clinques et
Bioiogiques sur le Syndrome de Schoenlein-Henoch. Presse Aled.,
65:759-763 (April. 24) 1957.
10. Shambey, J. R.: A Peculiar Progressive Pigmentary Disease of
the Skin. Brit. J. Derm., 13:1-5, 1901.
11. Hutchinson, J.: A Peculiar Form of Serpiginous and Infective
Navoid Disease. Arch. Surg., London, 1:275, 1889-1890.
12. Montgomery, H., and Bailey, R. J.: Angioma Serpiginosum.
Brit. J. Derm., 47:456-463 (Nov.) 1935.
13. Majocchi, D.: Sopra una Dermatosi Telangiectode non
Ancora Descritta "Purpura Annularis.” Giorn. Ital. Mai. Ven.,
31:263-264, 1896.
14. Guogerot, H., and Blum, P.: Purpura Angiosclereus Prurigi-
neux avec. Elements Lichenoids. Bnl. Soc. Franc. Dermat. et
Syph., 32:161-163, 1925.
15. Randall, S. J.; Kierland, R. R., and Montgomery, H.: Pig-
mented Purpuric Eruptions. Arch. Derm. & Syph., 64:177-191
(Aug.) 1951.
16. Lerner, A. B., and Watson, C. J.: Studies of Cryoglobulins;
Unusual Purpura Associated with the Presence of a High Concentra-
tion of Cryoglobulin (Cold Precipitable Serum Globulin). Amer.
J. Aled. Sci., 214:410-415 (Oct.) 1947.
17. Ritzmann, S. E., and Levin, W. C. : Cryopathies: A Review.
Arch. Intern. Aled., 107:754-772 (May) 1961.
18. Rogers, W. R., and Welch, J. D.: Purpura Hyperglobu-
linemica Terminating in Multiple Myeloma. Arch. Intern Aled.,
100:478-483 (Sept.) 1957.
19. Stefanini, M., and Dameshek, W. : The Hemorrhagic Dis-
orders, a Clinical and Therapeutic Approach. New York: G.une
and Stratton, 1955, p. 235.
20. Lindeboom, G. A.: Purpura Hyperglobulinemica. Dermatol-
ogica, 96:337-341, 1948.
21. Schmengler, F. E., and Esser, H.: Zur Pathogenese der
Purpura Hyperglobulinaemica. Klin. W chnschr., 30:30-33 (Jan. 1)
1952.
22. Waldenstrom, J.: Three New Cases of Purpura Hyperglobu-
linemica: A Study in Long-Lasting Benign Increase in Serum Glo-
bulin. Acta Mea. Scand., suppl. 226, 142:931, 1952.
THE ART OF MEDICINE during the past decades has been crowded into
a role of less and less participation. This element pertains to the personal
application of the science of medicine and that delicate, but so important, reac-
tion brought into play by the physician-patient relationship; and, in contra-distinc-
tion to the science of medicine, the art cannot be passed on accumulatively from
generation to generation. Rather, it must be learned anew by each neophyte of
the medical profession. Just as the great artist carries with him to his grave the
genius of those masterful strokes of brush on canvas, so is the art of medicine
enfolded in the shrouds of the physician. — Melvin A. Casberg, M. D., Long
Beach, (From an address at the installation of Granger E. Westberg as the first
Dean of the Institute of Religion, Texas Medical Center, Houston, Texas, April 2,
1965), California Medicine, 104:381-386, May 1966.
for October, 1966
1039
Adenoma of Brunner’s Glands
A Case Report
NOEL PURKIN, M. D.
ONE HUNDRED years ago, Cruveilhier pub-
lished the first report of a duodenal tumor.
Since that time, according to current reports,
there have been only approximately 70 cases of
adenoma of Brunner’s glands of the duodenum re-
corded in the literature.* 1 Hoffman1 states that in a
series of 66 cases of benign tumors of the duodenum,
10.6 per cent arose from Bmnner’s glands.
The etiology of this lesion is not known, but many
theories have been conjectured. Cohnheim, for ex-
ample, contended that these tumors arise from mis-
placed embryologic tissue with delayed new growth.
Another hypothesis proposes that irritation and in-
flammation results in duodenitis followed by hyper-
plasia and thickening. A review of the literature
reveals that there is usually a symptom triad of (a)
hemorrhage, ie, melena and/or hematemesis; (b)
irritation, resulting in epigastric pain and cramping;
and (c) obstruction. The predominant sign is a
duodenal filling defect on radiological examination,
and the accepted treatment is surgical extirpation.2
Case Report
A 52 year old white man was admitted to the hospital
complaining of shortness of breath. He stated that he had
been having tarry stools, approximately two to three daily,
for one month before admission. For the week previous to
admission, he had experienced postural dizziness, light-
headedness, and dyspnea. He denied epigastric pain, nausea,
emesis, or any previous ulcer history or radiologically
proven ulcer. In addition, he denied that he was a chronic
alcoholic, but this was later contradicted by a sister.
Physical examination revealed an alert, white man of
stated age, apprehensive and well oriented. His skin, con-
junctivae, and mucous membranes appeared pale, but he
was not perspiring unduly. His oral temperature was
97.8°F., respiratory rate 20/minute, pulse 96 per minute and
regular, and blood pressure 198/78 mm. Hg (left arm,
dorsum recumbent). The abdomen was soft and nontender,
with no masses palpable. The spleen and kidneys were
non-palpable, and the liver was felt to be firm, 5 cm.
below the right costal margin, with the dome of the liver
percussed at the sixth interspace. Rectal examination re-
vealed the presence of tarry stool, which was guaiac positive.
His admission hematocrit was 14 per cent with a hemo-
globin of 4 Gm/100 cc. He received 4 units of blood
shortly after admission, 2 regular units and 2 of packed
cells, and his hematocrit rose to 24 per cent and then
levelled off to 22 to 24 per cent over the next 48 hours.
Submitted December 16, 1965.
The Author
• Dr. Purkin, former Co-Chief Resident, Depart-
ment of General Surgery, Mount Sinai Hospital of
Cleveland, Cleveland, Ohio, presently is in private
practice in Calgary, Alta., Canada.
Treatment with an acute ulcer diet was begun and he was
given anticholinergic drugs and antacids.
Radiologic studies revealed a tumor mass in the upper
duodenum, possibly having herniated from the stomach into
the duodenum and thus being mucosal or submucosal (Figs.
1 and 2). The fasting blood sugar was 98 mg/ 100 cc,
blood urea nitrogen 15 mg/ 100 cc, direct bilirubin 0.1
mg/ 100 cc and total bilirubin 0.7 mg/ 100 cc, albumin
globulin ratio 4.0/2.0 Gm per 100 cc, alkaline phosphatase
1.1 units, and a bromsulphalein test showed 5 per cent re-
tention in 45 minutes. After another 1000 ml blood trans-
fusion, his hematocrit was 26 per cent, and he was taken
to surgery nine days after admission.
At operation, a pedunculated globular mass, palpable at
the pyloroduodenal junction was found. It was felt to be
intraluminal. A longitudinal incision was made in the
gastric antrum, and the tumor, measuring 2.5 inches in
diameter, was delivered into the incision. Inspection of the
tumor revealed marked nodularity and an ulcerated surface.
The stalk was found to be on the gastric side of the pyloro-
duodenal junction, and it was severed at its base. The base
was oversewn with 3-0 gastrointestinal chromic catgut.
The gastric incision was closed in a transverse manner in
two layers, using catgut and silk. The abdomen was closed
without drains, with 2-0 braided wire interrupted sutures
to the fascia.
The patient made an uneventful postoperative recovery,
except for a rather wild episode in the immediate recovery
room phase, which was felt to have caused a partial fascial
dehiscence, noted and repaired under general anesthesia
on the ninth postoperative day. He was discharged com-
pletely well on the seventeenth postoperative day.
Pathologist’ s Report: The surgical specimen consists of
a grossly recognizable part of the duodenum, which is
covering a pinkish tan solid tumor. The tumor and wall of
the duodenum are densely attached to each other. One
pole of the tumor (which is uncovered) appears to be red-
dish tan and somewhat lobulated, and this area is slightly
friable. The specimen measures 5.7 cm long and 3.4 cm in
average diameter. The duodenal wall is somewhat wrin-
kled and reddish tan in color. The cut surface is pinkish
pale, and there are a few cystic areas which range from
0.4 to 0.9 cm in average diameter. Some mucoid material
is seen on the cut surface. Microscopic examination of all
sections reveal that there are numerous islands formed by
an orderly proliferation of Brunner’s glands with a scanty
supporting stroma. The islands are separated from each
other by loose, edematous, fibrotic tissue. In the islands,
the acini are lined by a single layer of columnar cells
1040
The Ohio State Medical Journal
having flattened basal nuclei, pale granular eosinophilic
cytoplasm, and a sharply demarcated basement membrane.
Some acini are dilated, and evidence of cyst formation is
present. The ducts are located in the interspace and are
lined by cuboidal cells. In some areas, there is lymphocytic
accumulation. The duodenal mucosa appears to be edema-
tous. One section shows a thin capsule around the margin,
implying that the tumor is completely removed.
Discussion
The occurrence of gastrointestinal hemorrhage in-
vokes a wide differential diagnosis as to etiology.
Providing intensive therapy early will allow specific
diagnostic procedures; and many of the teleologic fac-
tors may be ruled out. In this case, the x-rays greatly
enhanced the opportunity of making a more definitive
diagnosis prior to operation. A review of the litera-
ture shows that this type of lesion is 100 per cent
benign.
A middle-aged white man was admitted with evi-
dence of gastrointestinal hemorrhage and signs and
symptoms of marked anemia. There was an asso-
ciated history of chronic alcoholism. He was given
supportive therapy (intensive) allowing adequate
investigation to be carried out. A duodenal mass
was manifested on x-ray. At operation, a peduncu-
lated, globular mass, intraluminal, was found at the
pyloroduodenal junction. The tumor was markedly
nodular and had an ulcerated surface. Following
extirpation, the patient recovered and was discharged.
With current advances in surgical, radiological and
Fig. 1. Gastrointestinal radiograph showing filling defect
along lesser curvature of superior duodenum.
Fig. 2. Close-up of the duodenal filling defect.
Fig. 3. The tumor partially covered by duodenum.
for October, 1966
1041
Fig. 4. Cut surface of tumor showing cystic areas.
therapeutic techniques, it is felt that an increasing
proportion of duodenal tumors can be diagnosed and
subjected to curative treatment. It is emphasized that
frequently the presenting sign is gastrointestinal
bleeding, either massive or prolonged, requiring in-
tensive conservative therapy. The treatment, if ef-
fectual, can allow for elective surgery after the diag-
nosis has been established.
Microscopic section of tumor.
Fig. 5
Summary
A case of adenoma of Brunner’s glands has been
presented with a review of the pathogenesis, symptom
triad and treatment, plus the literature on this entity.
201 Medical Centre, 8th Ave. & 8th St., S. W., Calgary,
Alta., Canada.
References
1. Moffat, F., and Anderson, W. : Adenoma of Brunner’s Gland.
Brit. ]. Surg., 43:106-107 (July) 1955.
2. Barnett, W. O.: Benign Tumors of Duodenum. Amer. Pract.,
13:625-632, (Sept.) 1962.
PROCTOLOGY IN ANCIENT EGYPT. — Since physicians are men of
learning, knowledge of medical history is a necessity, not a luxury. In the
absence of a history of proctology, this essay hopefully provides some insight into
the management of anorectal disorders mentioned in the medical papyri. Testifying
to the quality of medicine practiced and recognizing the antiquity of the specialty
of proctology, some of the knowledge passed along from ancient Egypt con-
tinues to influence present-day medicine. Enemas and suppositories are
still in fashion. To unload their colons, people continue to take fruit, senna,
colocynth and castor oil. The ancient Egyptians treated diarrhea, round and
tapeworm infestations and bilharziasis; the medical specialists who treated anorectal
disorders were held in especial esteem.
All these little known historical facts of our medical heritage should be better
publicized to promote respect for the antiquity of our profession, to inspire a
greater appreciation of this legacy from the past, and to provide moderation in
evaluating our progress. — Leon Banov, Jr., M. D., Charleston, South Carolina:
Southern Medical Journal, 58:1366-1369 (November) 1965.
The Ohio State Medical Journal
1042
A Clinicopathological Conference
From The Ohio State University Hospital, Columhus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
J. B. McMILLAN, M. B., Ch. B., President
T
PRESENTATION OF CASE
PHUtHIS white woman, aged 31, was in an auto-
mobile accident shortly before her admission
to the hospital. She had been riding in the
right seat of a half-ton pickup truck that was struck
by a car on the driver’s side. The truck overturned,
landing on the right side. The patient remembered
being thrown about in the truck and thought that she
was struck in the left side of her abdomen. She
did not lose consciousness. Immediately after the
accident she vomited two or three times. When she
was seen in the emergency room she complained of
severe abdominal pain, the location of which was ill-
defined. Initially it seemed to be in the left upper
quadrant, then moved to the right lower quadrant,
and then to the left lower quadrant. She also at
times complained of back pain.
Her past history was significant in that she had
poliomyelitis at the age of 3. This left her with
multiple deformities, the most severe of which were
a kyphorotoscoliosis of the spine and multiple de-
formities of the lower extremities. She had had at
least 13 orthopedic procedures over the years, in-
cluding multiple spinal fusions and multiple teno-
plasties of her lower extremities. Other surgical
procedures included three cesarean sections and one
salpingectomy. She told of vomiting once or twice a
week for the past seven years because of "sick head-
aches.” Several months ago she had been seen at an-
other emergency room claiming that she had vomited
"coffee-ground” material.
Physical Examination
Her temperature was 98.6°F., her pulse rate 100
per minute, the respiratory rate 25 per min., and the
blood pressure 120/80 mm. Hg. There was a severe
left thoracolumbar scoliosis. The abdomen was pro-
tuberant and tympanitic. The patient complained of
diffuse tenderness to palpation. There was no local-
ization of the tenderness and no rebound tenderness.
The bowel sounds were hypoactive. The rectal ex-
amination was negative; the stool was light brown
and guaiac-negative. There were hematomas over
Submitted July 21, 1966.
Presented by
• N. R. Thomford, M. D., Columbus, and
• Emmerich von Haam, M. D., Columbus;
Edited by Dr. von Haam.
the left lower tibial area and over the left olecranon
process. Peripheral pulses were good. Numerous
surgical scars were noted on the abdomen, the back,
and on the lower extremities.
Laboratory Data
The initial laboratory studies showed a white blood
cell count of 7,450 with a normal differential count;
the hemoglobin was 13.7 Gm., the hematocrit 45
per cent. Urinalysis showed 3 plus sugar and posi-
tive acetone. The fasting blood sugar was 189
mg./lOO ml. The blood urea nitrogen was 12
mg./ 100 ml. The serum electrolytes and amylase
and the prothrombin time were normal.
X-ray films of the chest showed the previously
noted marked scoliosis. The lung fields were clear,
and no subdiaphragmatic abnormalities were identi-
fied. Supine and erect views of the abdomen showed
the old spinal fusion grafts. It was felt that the
pelvis was homogeneously dense, which was sugges-
tive of a fair amount of peritoneal fluid. No free air
was identified. A four-quadrant abdominal tap was
negative.
Hospital Course
The patient was treated with nasogastric suction,
intravenous fluids, and analgesics. As the nasogastric
tube was passed, the patient vomited a small amount
of dark material that was guaiac-positive.
There was little change of her vital signs through-
out the night of her admission and by morning it was
felt that she was stable. Her abdominal distention
was somewhat less and there was less pain. The
nasogastric tube was removed and she was given
some oral fluids. As the day progressed, however,
her pulse gradually increased until by afternoon it
for October, 1966
1043
was 140 per minute; her blood pressure was 90 mm.
Hg systolic. The hemoglobin at that time was 15.5
Gm. The serum amylase was 580 units. The naso-
gastric tube was reinserted and intravenous colloid
and electrolytes were started. She did not respond
to this treatment. Several hours later there was a
rapid onset of respiratory distress. Her blood pres-
sure was maintained at about 90 systolic with Neo-
Synephrine®. Thoracentesis yielded a small amount
of serous fluid from the left chest. The urinary out-
put wras 5 cc./hr. (specific gravity 1.022). Films
of the abdomen taken at this time showed free air
under the right diaphragm and it was felt that the
pelvis was still homogeneously opaque.
Approximately 30 hours after admission the pa-
tient was taken to surgery. She died approximately
15 minutes after completion of the operation.
CLINICAL DISCUSSION
Dr. Thomford: This is the case of a 31 -year-
old white woman who was injured in an auto accident
and was admitted immediately thereafter to this hos-
pital. Although the position in which the patient
was seated in the automobile at the time of an ac-
cident and the direction from which the vehicle was
struck are always of some importance, it seems that
the most reliable information here is the fact that she
herself thought the blow was to the left side of her
abdomen. It became apparent that her problem
could be looked upon as one of abdominal trauma
and more specifically of blunt abdominal trauma as
there was no open wound.
Blunt Abdominal Trauma
It is always disturbing to find that someone so
young arrives in the emergency room with reasonably
normal vital signs and then dies within 24 hours.
However, one must recall that although the mortality
rate of penetrating abdominal wounds has decreased
from something like 65 per cent prior to World
War I down to the present rate of approximately 5
per cent, the mortality from blunt abdominal trauma
is still significant and if all cases of blunt abdominal
trauma are included is as high as 40 to 50 per cent.
This rather frightening mortality rate can be, in
part at least, attributed to the fact that multiple organ
systems are usually involved in a blunt abdominal
trauma, that is, there is often also trauma to the
head and chest. In one series reported by Dr. De-
Bakey, 95 per cent of patients who had blunt abdomi-
nal trauma and who were dead on admission had as-
sociated trauma to the head or thorax or both. It is
also true that blunt abdominal trauma usually in-
jures more than one organ, and the mortality rate
increases directly with the number of organs involved.
Before analyzing the case, I would just like to
make a few additional comments regarding blunt
injury to the abdomen. Liver trauma is probably
the most common one sustained with a blunt abdomi-
nal injury. Other injuries well known to you all are
traumatic pancreatitis, ruptured bladder, renal contu-
sion, injury to the great vessels within the abdominal
cavity, rupture of the diaphragm, and of course in-
jury to the spleen. Injuries to the gastrointestinal
tract as the result of blunt abdominal trauma tend
to occur at points of fixation, that is, the duodenum,
the ligament of Treitz, and the distal ileum. In
addition, of course, there may be rupture of the
stomach or perforation of the colon. Pain is the
most reliable single symptom of abdominal injury.
In general persistent, increasing pain — localized or
spreading — is an indication for abdominal surgical
exploration, as is the pain which occurs immediately,
disappears, and then recurs.
Her past medical history suggests that she had a
migraine type of headache and certainly she had had
a number of operations to correct the deformities
produced by poliomyelitis. We are not told whether
or not she was pregnant at the time of her accident,
but we presume that she was not. She also had a
history of possible hematemesis on one occasion and
one might conclude from her past medical history that
she might have had a peptic ulcer in the past.
Immediately following the accident she vomited
two or three times and complained of severe abdomi-
nal pain. She also complained of back pain, but
one might attribute her back pain to the fact that
she had had numerous operations on the vertebral
column and now was involved in a serious and
severe accident. Her pulse was 100, but her other
vital signs might be considered normal. She did
have severe left thoracolumbar scoliosis, and the
abdomen was protuberant, tympanitic, and diffusely
tender to palpation but without any masses.
The negative rectal examination is of some im-
portance since, as you know, patients with blood
within the peritoneal cavity sometimes have rectal
tenderness as one of the manifestations of this blood.
The white blood count was within normal range,
and this is of course of interest. In approximately
80 per cent of patients with injuries to the liver and
spleen there will be leukocytosis. The hemoglobin
and hematocrit would be considered normal. The
fasting blood sugar was 189 mg., I believe, the
BUN 12 mg., and the urinalysis was reported as
showing 3 plus sugar and positive acetone. The
electrolytes, prothrombin time, and the serum amylase
were normal.
X-Rays
The chest films were said to be unremarkable, and
in the x-rays of the abdomen the only abnormalities
pointed out were those that were secondary to her
operations upon her spine, showing the old spinal
fusion grafts. However, it is said that the pelvis
was homogeneously dense and suggestive of a fair
amount of intraperitoneal fluid. No free air was
identified, apparently. A four-quadrant abdominal
tap was negative, and the patient was admitted to
1044
The Ohio State Medical Journal
the hospital for observation at that time. May we
see the x-rays taken at the time of admission?
Dr. Harris: There was some increased density
in her pelvis which was of questionable significance
since intraperitoneal fluid wasn’t proved by the four-
quadrant tap. Of interest was the film taken on the
next day, at which time there was a large amount of
free air under the diaphragmatic leaflet. Another
bunch of gas bubbles seems to be fairly well localized
in the right upper quadrant in a somewhat perirenal
distribution, suggesting either an abscess or the
presence of retroperitoneal and intraperitoneal air.
The distribution of the air over the right perirenal
area suggests perhaps a rupture of the third portion
of the duodenum. A film taken post mortem on
the next day showed similar findings.
Now just a few words about the intraperitoneal
free air. This of course would be most common
with a perforation such as has been already described.
It is essentially the same as in mesenteric infarction
although the gas pattern otherwise is not diagnostic
of such.
In summary then, this patient had a fairly normal
looking abdomen on the day of admission, but on the
second day developed free intraperitoneal and re-
troperitoneal air in the right perirenal area suggest-
ing a possible intraperitoneal as well as retroperi-
toneal perforation.
Dr. Thomford: Thank you. She was started
on nasogastric suction and given intravenous fluids,
of what type and amount we are not sure, nor are we
told what type of analgesics she had. There was little
change in her vital signs throughout the night of
admission. I think one should bear in mind in
patients with blunt trauma that the pulse tends to
remain normal when the liver has been ruptured. I
do not know the physiologic explanation for this,
but it has been pointed out by more than one ob-
server. By morning it was felt that her condition
was reasonably stable, but later in the day she devel-
oped tachycardia and hypotension. Her hemoglobin
had increased rather than decreased, and the serum
amylase was now elevated.
Respiratory Distress
She did not respond to intravenous colloids and
nasogastric suction and suddenly respiratory distress
developed. I suppose in anyone who has been in an
auto accident, even though the admission films were
normal, the appearance of sudden respiratory distress
should suggest the possibility of a pneumothorax.
She did not respond to the administration of Neo-
Synephrine, and a thoracentesis yielded only a small
amount of serous fluid from the left chest. We can
only speculate as to why this thoracentesis was done.
Perhaps they considered the possibility that she might
have lacerated or ruptured her esophagus secondary
to the retching on the day of admission. Her urinary
otitput decreased to 5 cc. per hour, and x-rays of the
abdomen revealed free air under the diaphragm. An
operation was performed but the patient died 15 min-
utes following completion of the operation.
It always seems safest to me when seeing a pa-
tient with blunt abdominal trauma to consider injury
to any and all of the major intra-abdominal struc-
tures and I did this in this case. It seemed unlikely
that there was any injury to the major vessels within
the abdomen since there was no definite evidence of
blood within the peritoneal cavity and there was no
palpable mass. The peripheral pulses remained nor-
mal and the hemoglobin increased rather than de-
creased during the first 24 hours. It seemed also
unlikely that there was any extensive damage to the
liver or spleen since again there was no definite
evidence of blood within the peritoneal cavity and
the hemoglobin did not decrease, and there was no
shoulder pain or rectal tenderness, and there was no
leukocytosis.
Injury to the urinary tract I think is reasonably
well ruled out by the fact that there was no hematuria
and there was no flank mass and no external evidence
of flank injury. I think it unlikely that there was
any traumatic pancreatitis. The amylase was normal
on admission, the blow was to the left abdomen
rather than to the epigastrium, and I would tend to
explain the elevated amylase on the day following
admission by the fact that the contents of the proxi-
mal gastrointestinal tract had been leaking out into
the retroperitoneum or into the peritoneal cavity.
It does seem certain that there was a rupture of
the gastrointestinal tract, and with the severe pain
that was described and also since the pain appeared
in the upper abdomen initially, I would speculate
that the perforation probably occurred in the proxi-
mal gastrointestinal tract. This would be supported
too by the fact that the fluid aspirated from the pa-
tient’s stomach or the fluid she vomited was guaiac-
positive. The fact that the pain was severe suggests
to me that it was high in the gastrointestinal tract be-
cause the intraluminal contents there are more irritat-
ing to the peritoneal cavity than are those in the lower
gastrointestinal tract.
We postulated that she had a perforation of the
duodenum or proximal jejunum, but it seems unlikely
that she should have died so rapidly from this injury
alone since she was young and I would have thought
that she would at least have been resuscitated tem-
porarily. However, her clinical course immediately
prior to operation suggests to me that her injury
may have been complicated by one or both of two
things — either diabetic acidosis with coma or by a
Gram-negative septicemia and bacteremic shock. We
are not given any information whether she was
thought to be a diabetic or whether she was treated
with insulin, but she did have sugar and acetone in
the urine and the symptoms of tachycardia, hyper-
tension, and Kussmaul respirations suggestive of
for October, 1966
1045
diabetic acidosis. And of course since she did have
a perforation of the gastrointestinal tract one would
have to consider bacteremic shock. So I would sum
up this woman’s injury, clinical course and death by
saying that she did have traumatic perforation of the
duodenum which secondary diabetic acidosis and/or
Gram-negative bacteremic shock.
General Clinical Discussion
Question: It is not particularly applicable to
this particular case, but how often would you see the
next day after four-quadrant taps enough free air to
make it questionable whether it was introduced at the
time of paracentesis or was due to rupture?
Dr. Thomford: Well, she had a large amount
of free air in the peritoneal cavity. Had there been
a small amount — I suppose one-fourth the amount
we saw on her x-ray — I would have thought that it
was just possible that the air might have been in-
troduced by the abdominal tap.
Question: What did you make of the opacifica-
tion in the pelvis? Would you have considered a
culdocentesis ?
Dr. Thomford: No, I would not have con-
sidered a culdocentesis. I do not know the signifi-
cance of what I see there, but I do not think that it
is pathognomonic of anything and apparently our
radiologists did not either. It was noted but it was
not thought to indicate any particular pathology. It
might be suggestive of intraperitoneal fluid.
Question: Maybe it was retroperitoneal hemor-
rhage ?
Dr. Thomford: Yes, although I would think
that unlikely. She did not have a fracture of the
pelvis. If it was retroperitoneal hemorrhage I
would have expected that there might have been
some red blood cells in her urine as the result of
contusion of the ureter or bladder.
Question: Why wouldn’t you have considered
culdocentesis after the x-ray?
Dr. Thomford: I think probably because there
seemed to be enough symptoms, signs, and laboratory
information to direct your therapy without doing
culdocentesis.
Question: Dyspnea was given as the important
symptom terminally. I wonder whether the x-ray
sufficiently eliminated the possibility of a ruptured
bronchus or a spontaneous pneumothorax.
Dr. Harris: The chest film showed free air
beneath the diaphragm only. The compression on
the lung by the elevated diaphragm and her scoliosis
were considered sufficient reason for her respiratory
distress.
Question: I was concerned with her spleen.
Dr. Thomford said there was no blood in the peri-
toneum and no leukocytosis, and I wasn’t sure what
he meant. I wondered if it would be possible to
have a symptomless rupture or tear of the spleen.
Dr. Thomford: Yes, I think it is perfectly
possible that she had an injury to the spleen but I
do not think that it caused her death. I think that
if she had a splenic injury with hemorrhage into
the peritoneal cavity sufficient to cause hypotension
and produce the peritoneal signs that were described,
we might well have found blood on the peritoneal
tap. I think it unlikely that a splenic injury was the
cause of her death.
Question : How often would you get rupture of
a viscus after you have a negative x-ray for air under
the diaphragm and 24 hours later get this large
amount ?
Dr. Thomford: I can’t answer that in terms
of percentage. Perhaps someone in the audience
knows of a recent paper or statistic.
Dr. Nick: There are no recent papers, but there
have been reports that with perforated ulcer up to 50
per cent of the people may not show free air.
Dr. Thomford: That’s true of perforated ulcer,
but I think traumatic rupture of the gastrointestinal
tract would probably be a different problem.
Question: What do you think of the possibility
of a volvulus or a diaphragmatic hernia in a person
with multiple operative incisions having a blunt
trauma to her abdomen?
Dr. Thomford: I don’t think that diaphrag-
matic hernia should be any more likely in this patient
than in any other. She did not have a congenital ab-
normality of her skeleton but one produced by polio-
myelitis.
CLINICAL DIAGNOSIS
1 . Abdominal trauma due to automobile accident :
(a) Ruptured abdominal viscus.
(b) Severe generalized peritonitis.
(c) Septicemia.
2. Diabetes.
PATHOLOGIC DIAGNOSIS
J. Traumatic perforation of the duodenum.
2. Infarction of the ileum, cecum, and ascend-
ing colon.
3. Acute pumlent peritonitis.
4. Diabetes mellitus.
DISCUSSION OF PATHOLOGY
Dr. von Haam: Since the patient was operated
on, it would be wise to learn first what the findings
were when they opened up her abdomen.
Dr. Blackwood: Under local anesthesia a left
paramedian incision was made. The cavity was
opened and contained a large amount of free air and
fecal material. During this time the patient was
moribund. On examination of the bowel, the small
1046
The Ohio State Medical Journal
bowel appeared dead from the proximal jejunum to
the midtransverse colon. There were several loops
of black bowel. Examining the distal duodenum,
they did not find a perforation. The pancreas ap-
peared to be free of any injury. There was a hema-
toma at the root of the mesentery. The surgeon felt
that she probably hemorrhaged into the mesentery
and that this caused vascular occlusion of the small
bowel and proximal colon. They did not resect any
bowel but closed her up.
Dr. von Haam: This is a very interesting case,
which we could discuss ad infinitum. The autopsy
showed two lesions in this patient; one of them was
the lesion discovered at surgery, which consisted of a
severe gangrene of the ileum, the cecum, and the
ascending colon, and the other lesion was a perfora-
tion of the first portion of the duodenum at the place
where most of the injuries occur by bursting from
increased pressure. The mesentery showed a hemor-
rhage which was really not severe. There were 300
cc. of liquid fecal material in the peritoneal cavity,
and there was obviously a recent peritonitis. No
severe hematoma was present.
Duodenal Perforation and
Ischemic Bowel
The perforation of the duodenum was small and
located on the posterior wall of the first loop of the
duodenum. It was covered by fibrin and led into a
sac which was walled off by fibrinous exudate. It
was a rather sharply demarcated perforation, and
there was no excessive bleeding. It had obviously
occurred some time before the rest of the intestinal
lesions. The latter can be classified as recent gangrene
of the bowel. The wall of the bowels had a mottled
appearance which extended over the entire jejunum,
cecum, and part of the ascending colon. The process
was not sharply demarcated but sort of gradually
started at the lower jejunum and faded out towards
the hepatic flexure of the colon. Although the
jejunum was completely gangrenous, its wall was not
congested at all. It was an ischemic necrosis as you
find in typical mesenteric artery thrombosis.
The same lesion was present in the colon. Again
there was complete ischemia with very early necrosis
suggesting an interference with the arterial rather than
with the venous circulation. The mesentery of this
area showed marked distention of all small vessels
but very little hemorrhage. There was no free blood
or blood clots present, and the dusky discoloration
of the mesentery could only be explained by the
severe congestion in those very dilated vessels. The
pancreas was normal, although ischemic, but there
was no traumatic pancreatitis.
The patient died in severe shock and developed
pulmonary edema, each lung weighing over 800
grams. The bronchi and the larynx contained gastric
material from aspiration during her frequent vomit-
ing, but the lungs did not show the typical aspiration
pneumonia. The adrenal glands also showed the
changes of severe shock. The patient was an old
polio patient and section of her spinal cord showed
vast empty areas of gliosis. The lesion was very
extensive, bilateral, and involved the entire thoracic
spinal cord and extended upward into the cervical
cord. Her muscles showed the changes typical of
extensive poliomyelitis.
To comment on the relative importance of the two
abdominal lesions, we can state that either lesion was
fatal. The perforation of the duodenum was in the
process of being walled off and it was not discovered
by the surgeons because it was located in the posterior
wall of the duodenum. This type of injury is quite
common in blunt trauma to the abdomen; in fact,
10 per cent of all blunt injuries to the abdomen will
injure the intestine. The jejunum is the bowel most
frequently injured, followed by the loose part of the
duodenum. We have three different explanations
for its occurrence: It can be due to crushing of the
bowel against a solid mass, usually the vertebral
column. This is observed more frequently in thin
people than in obese individuals, and our patient had
definitely a predilection for it because of her scoliosis.
This kind of crushing injury leads to very ragged,
large lesions which often produce a complete transec-
tion of the duodenum.
The second type of injury is produced by bursting
whenever the sudden increase in the intraluminal
pressure causes a bursting of the intestinal wall. This
leads to small perforations resembling a "blow-out.”
These lesions can be found after bombing accidents
where the pressure wave is definitely transmitted to
the air in the intestinal tract. The lesion is usually
characterized by a symptom-free interval which may
sometimes last as long as two days. This mechanism
looks the more likely explanation in our case, partic-
ularly since the patient’s kinked bowel may very well
have predisposed her to this type of injury. The last
and rarest type of lesion is that produced by stretch-
ing of the intestine due to distortion of the body.
Typical lesions occur principally in the esophagus and
the rectum.
Traumatic Vasomotor Dysequilibrium
Although our patient had this perforation, we do
not consider it the fatal lesion. Definitely fatal,
however, was the gangrene of the large bowel. A
very careful investigation at the autopsy table revealed
no thrombus either in the veins or in the arteries. Of
course we would not expect any thrombus in the
veins because in that case the bowel wall would have
been hemorrhagic rather than ischemic. So it must
have been an arterial injury and have been caused
by a so-called traumatic vasomotor dysequilibrium.
This consists of either severe post-traumatic angio-
spasm or post-traumatic vasodilatation. The post-
traumatic angiospasm is of sudden onset. It may
last for hours at a time, and it may lead to lesions of
ischemia. It has been blamed for certain lesions in
for October, 1966
1047
concussion of the brain and in trauma to the kidneys.
Certain individuals are more sensitive than others to
this type of condition. The post-traumatic vasodila-
tation is less common and has been particularly ob-
served in cases of crushing trauma to the legs.
Another type of lesion which may follow trauma is
of course thrombosis caused by dilatation of the ves-
sels, drop in the blood pressure during shock, com-
pressional injury to the vessels by hematomas, and by
certain changes in the clotting mechanism such as
hemoconcentration. Post-traumatic thrombosis is less
frequent than post-traumatic angiospasm or vasodi-
latation, and I feel that we are dealing here indeed
with a case of such post-traumatic vasomotor dysequi-
librium. We realize that when we make such a diag-
nosis we must be sure that everything else has been
excluded.
Positive proof of this diagnosis is extremely difficult
since spastic vessels look exactly like normal vessels
after death. However, in the absence of a hematoma
of any kind or of any thrombosis, I can only explain
her bowel gangrene as the result of post-traumatic
angiospasm, particularly since the mucosal necrosis
was so rapid and so complete. However, if some-
body disputes this diagnosis I cannot disprove his
argument. Postmortem culture showed normal in-
testinal flora in the peritoneal exudate and no organ-
isms in the blood stream. The patient did not have
any septicemia and obviously died of shock; first, pri-
mary shock and then secondary shock due to the
onset of her gangrene.
So in conclusion, I feel that the patient had a
traumatic perforation of the posterior wall of the
first portion of the duodenum and extensive gangrene
of the bowels due to the post-traumatic angiospasm.
EDEMA OF THE ARM following radical mastectomy is due to a combination
of factors rather than to a single cause. The primary factors seem to be
lymphatic obstruction due to surgical excision or destruction by radiotherapy or
phlebitis with perivenous lymphangitis and infection. Postsurgical edema must
be differentiated from edema due to recurrence of cancer in the axilla.
Clinically, postmastectomy edema manifests itself in one of four types, each
of which has different etiologic factors, therapy, and type of response: (1) acute
transient, mild edema occurring immediately postoperatively; (2) acute, painful,
transient edema manifesting itself usually two to six weeks after operation; (3)
acute, painful, recurrent, febrile, erysipeloid edema occurring at any time after
surgery; and (4) insidious, painless (except when severe), persistent edema,
which is the most important type and which develops weeks or even years after
surgery.
When edema develops, early intensive care is mandatory to avoid the devel-
opment of permanent pathologic changes. In appropriate cases, lymphangiography
and venography are valuable aids in determining the specific etiology of the
edema.
Each clinical type of edema has different therapy and type of response. The
most important type of insidious, painless, persistent edema has been treated by
numerous surgical procedures with variable reported results. We have had excel-
lent results using a pneumatic compression machine followed by the use of a
custom-fitted, pressure-gradient elastic sleeve in 27 patients with significant to
severe edema. — Henry Patrick Leis, Jr., M. D.; Warner F. Bowers, M. D., Ph. D.,
and Joseph Dursi, M. D., New York: New York State Jotirnal of Medicine,
66:618-624, March 1, 1966.
BROTH EDEMA. — Two infants had generalized edema after treatment of
i diarrhea with bouillon broth. The hazards of feeding large amounts of
such broth to infants are considered to be related to its high sodium content. —
Captain Fred M. Nomura, Jr., M. C., USAR: The New England Journal of Medi-
cine, 274:1077-1078, May 12, 1966.
1048
The Ohio State Medical Journal
Disaster Institute Program . . .
Planning for Management of Mass Medical Emergencies
To Be Theme at Columbus Meeting, Sunday, October 30
A Diaster Institute Program is scheduled in Co-
lumbus on Sunday, October 30, for all per-
sons interested in the specific theme "Plan-
ning for the Management of Mass Medical Emer-
gencies.” Sponsoring organizations are the Ohio
State Medical Association, the Ohio Hospital Asso-
ciation, Ohio Department of Health, the Ohio Osteo-
pathic Association of Physicians and Surgeons, the
American Red Cross, and the Ohio Civil Defense
Sendee.
Place is the Neil House, downtown Columbus
hotel, with registration opening at 8:00 A. M. and
the first program feature at 9:30. Adjournment time
is 4:00 p. M. The program has been announced as
follows :
Morning Session
Registration
Greetings
William Slabodnick, President, Ohio Hospital As-
sociation, Administrator, Fisher-Titus Memorial
Hospital, Norwalk
Introduction and Setting the Theme
Roger Marquand, Chairman, Ohio Hospital Asso-
ciation Disaster Preparedness Planning Commit-
tee, Administrator, Polyclinic Hospital, Cleveland
"My Organization’s Role in Disaster Management”
Medicine
Lawrence C. Meredith, M. D., President, Ohio
State Medical Association, Elyria
Civil Defense
Dr. Alfred E. Diamond, Ohio Civil Defense,
Columbus
Hospitals
James O. Helland, Administrator, Defiance Hos-
pital, Defiance
Red Cross
Alfred L. Baron, Executive Director, Franklin
County Chapter of Red Cross
Ohio Department of Health
Albert E. Dyckes, Chief, Division of Adminis-
tration
Ohio Department of Public Welfare
Robert B. Canary, Assistant Director, Ohio De-
partment of Public Welfare
"What Are the Problems?”
Keynoter
Roger Marquand will be noting that speakers
to follow will be talking on disasters which
could occur in Ohio (i. e. Tornado or plant
explosion) .
Jackson, Mississippi Tornado
C. E. Wallace, M. D., Chairman, Disaster Plan-
ning Committee, Central Medical Society, Jack-
son, Mississippi
Mr. Richard H. Malone, Administrator, Hinds
General Hospital, Jackson, Mississippi
Morning Break
DuPont Explosion, Louisville, Kentucky
William Rumage, M. D., Member, Committee
on Disaster Medical Care, American Medical
Association, Chicago
"Here’s How Your Problems Can Be Solved”
Communications
Lt. William H. Hildebrand, Asst. Director of
Civil Defense, Alameda, California
Transportation
Franklin V. Wade, M. D., F.A.C.S, Chief,
Section for the Surgery of Trauma, Hurley
( Continued on Next Page)
for October, 1966
1049
(Disaster Institute — Contd.)
Hospital; Chairman, Committee on Trauma,
American College of Surgeons, Flint, Michi-
gan
Medical Authority
Francis C. Jackson, M. D., F. A. C. S., Chief
Surgeon, Veterans Administration Hospital,
Pittsburgh, Pennsylvania; Chairman, Commit-
tee on Disaster Medical Care, American Medi-
cal Association
Lunch and Exhibit Break
Four Workshops
(Faculty will rotate every half hour)
How One Committee Does it
Franklin County Disaster Program, Philip Tay-
lor, M. D., Group Leader
Ben Carlisle, Ohio Hospital Association
Communications
Lt. William H. Hildebrand, Group Leader
Max E. Knickerbocker, OHA
Medical Authority
Francis C. Jackson, M. D., Group Leader
W. Michael Traphagan, OSMA Staff
Transportation
Franklin V. Wade, M. D., Group Leader
Andreas Heuser, Red Cross Staff
For additional information and registration forms,
contact W. Michael Traphagan, Secretary, Committee
on Disaster Medical Care, Ohio State Medical Asso-
ciation, 17 South High Street, Suite 500, Columbus,
Ohio 43215.
Sixth District Postgraduate Day
Scheduled in Akron, Oct. 19
The Sixth Councilor District Postgraduate Day
clinical sessions, comprised of nationally renowned
medical educators will be held at the Sheraton-May-
flower Hotel in Akron, on Wednesday, October 19.
Registration will be from 8:30 to 9:30 a.m. on the
first floor of the hotel, and the remainder of the
program will be conducted completely on one floor.
Cost of registration will include luncheon and park-
ing facilities.
Advance registration is being arranged via a mail-
ing of programs and advance registration cards to
members of the Sixth Councilor District. The pro-
gram has been announced as follows:
9:40-10:30 A. m.
Inguinal Hernia, Dr. Chester B. McVay, clinical
professor of surgery, University of South Dakota —
Cincinnati Room;
Heart Failure, Dr. James V. Warren, professor
(Sixth District — Contd.)
and chairman, Department of Medicine, Ohio State
University School of Medicine — Ballroom;
Pediatric Panel, Dr. Morris Green, associate pro-
fessor of pediatrics, Indiana University Medical Cen-
ter; Dr. Ernest K. Cotton, assistant professor of pedi-
atrics, University of Colorado Medical School; Dr.
Robert H. Parrott, director, Childrens Hospital,
Washington, D. C. and clinical professor of pedi-
atrics, George Washington University — Ohio Room;
10:40-11:30 A. m.
Amniocentesis for Prediction of Erythroblastosis
Fetalis, Dr. Richard W. Stander, associate professor,
Department of Obstetrics and Gynecology, Indiana
University Medical Center — Cincinnati Room;
Medical Surgical Panel, Dr. McVay; Dr. Edmund
B. Flink, professor of medicine and chairman of
Department of Medicine, West Virginia School of
Medicine; Dr. Roger B. Hickler, assistant professor
of medicine and director of Hypertension Laboratory,
Peter Bent Brigham Hospital; Dr. Lester Dragsted,
research professor of surgery, University of Florida;
Dr. James V. Warren, professor and chairman, De-
partment of Medicine, Ohio State School of Medi-
cine; Dr. Desiderius Emerick Szilagyi, head, Division
of General Surgery, Henry Ford Hospital — Ballroom.
Behavorial Problems of Childhood, Dr. Cotton
- — - Ohio Room.
11:40-12:30 P. M.
High Risk Obstetrics, Robert E. L. Nesbitt, Jr.,
professor and chairman, Department of Obstetrics
and Gynecology, College of Medicine, State Uni-
versity of New York, Upstate Medical Center — Cin-
cinnati Room;
Duodenal Ulcer, Dr. Dragsted — Ballroom;
Respiratory Distress Syndrome in Newborn, Dr.
Cotton — Ohio Room.
12:40-2:00 p. m. — Luncheon - Ballroom
2:10-3:00 P. M.
Endometriosis, Dr. Carl T. Javert, professor, clin-
ical obstetrics and gynecology, Columbia University
— - Cincinnati Room;
Diagnosis, Treatment and Prevention of Viral
Diseases, Dr. Parrott — Ballroom;
Renin and Aldosterone Relationships in Hyper-
tension, Dr. Hickler — Ohio Room.
3:10-4:00 p. m.
Abortion — Body Types — Emotional Factors —
Preventive Drugs — Long-Term Counseling, Dr.
Javert and Dr. Richard W. Stander — Cincinnati Room.
Vascular Surgery, Dr. Szilagyi — Ballroom;
Theoretical and Practical Considerations of
Magnesium Deficiency in Man, Dr. Flink — Ohio
Room.
1050
The Ohio State Medical Journal
St. Rita’s of Lima Schedules
Inhalation Therapy Seminar
St. Rita’s Hospital, of Lima, has announced an In-
halation Therapy Seminar to be held at the hospital
on Saturday, October 29. Registration opens at 8:00
a. m. with the first program beginning at 8:45
o’clock. The seminar has been approved for credit
to members of the American Academy of General
Practice.
Morning and afternoon sessions will be held with
time to view equipment of supply houses supplying
equipment in the inhalation field. A dinner to
honor seminar speakers will be held at Milano’s
Club, beginning at 6:00 p. m.
The program has been announced as follows:
Welcome by Sister Mary Caroline, R. S. M.
Introductions by Russell L. Wiessinger, M. D.,
medical director, St. Rita’s Hospital.
Organization and Concept of Inhalation Therapy
Department, Bernard Kew, head of R. I. T. at St.
Alexis Hospital, Cleveland.
Humidification and Nebulization, Harold Stevens,
M. D., anesthesiologist and medical director of the
Inhalation Therapy Department at Toledo Hospital.
Emphysema; Detection and Maintenance, Joseph
Tomashefski, M. D., Cardio-Pulmonary Laboratory,
University Hospital, Columbus.
Cardiac Emergencies and Inhalation Therapy,
Michael Orlando, M. D., director of the cardiology
service associated with the Cardio-Pulmonary Labora-
tory, Miami Valley Hospital, Dayton.
Management of the Post-Resuscitation Patient,
Robert Ditmar, R. I. T., Miami Valley Hospital,
Dayton.
Post-Operative Ventilation, Marion Connerley,
M. D., Terre Haute, Indiana, diplomate of the Ameri-
can College of Surgery and the American College of
Thoracic Surgery.
OSU Third Symposium on
Diabetes Mellitus
Ohio State University College of Medicine and the
Central Ohio Diabetes Association are jointly spon-
soring the third symposium in this specialty field on
Wednesday, October 26. Under the general title,
"Diabetes Mellitus: Past, Present, Future,” the theme
of this symposium is "Vascular Disease and Diabetes.”
The place is the Fort Hayes Hotel, 31 West Spring
Street, in downtown Columbus. Registration opens at
8:00 a. m. with the first program feature at 9 o’clock.
A $15.00 registration fee should be sent to the Center
for Continuing Medical Education, A-352 Starling
Loving Hall, 320 W. Tenth Ave., Columbus, Ohio
43210.
The program has been announced as follows:
(Continued in Next Column)
(Diabetes Symposium — Contd.)
Welcome by Dr. James V. Warren, professor of
medicine and chairman of the Department of Medicine
at OSU.
Tecumseh Report — The Prevalence of Abnor-
mal Carbohydrate and Lipid Findings and Their
Association with Coronary Artery Disease — Dr.
Leon D. Ostrander, Jr., associate professor of internal
medicine and research associate in epidemiology, Uni-
versity of Michigan.
Diabetes and Vascular Disease Including a Gen-
eral Classification with Specific Emphasis on Ath-
eromatosis — Dr. Campbell Moses, associate profes-
sor of medicine and director of the Addison H. Gib-
son Laboratory, University of Pittsburgh School of
Medicine.
Capillary Basement Membrane Thickening in
Diabetes and the Pre-Diabetic State — Dr. Marvin
D. Siperstein, professor of internal medicine, Univer-
sity of Texas Southwestern Medical School.
Panel Discussion, moderator, Dr. George J.
Hamwi, professor of medicine and director of the
Division of Endocrinology and Metabolism, OSU.
Diabetes Mellitus, Lipids, and Coronary Disease
— Response to Diet — Dr. Margaret Albrink, pro-
fessor of medicine, West Virginia University School
of Medicine.
Diabetes Mellitus, Lipids, and Coronary Disease
— Response to Pharmacological Agents — Dr.
Manuel Tzagournis, instructor in medicine, OSU.
Prevention — Dr. Laurance W. Kinsell, director,
Institute for Metabolic Research, Highland General
Hospital, Oakland, Calif.
Panel Discussion, moderator, Dr. Thomas P. Shar-
key (Dayton), clinical assistant professor of medi-
cine, OSU.
❖ * *
Other postgraduate courses offered at Ohio State
University in the near future include the following:
October 20 — Pediatric Invitational Clinic.
October 31 - November 23 — Board Refresher
Course in Psychiatry.
November 17 — Muscular Dystrophy.
November 30 — Orthopaedic Seminar.
Details may be obtained from the Center for Con-
tinuing Medical Education, at the foregoing address.
Dr. John R. Seesholtz, Canton, a past president
of the Canton Rotary Club, was guest speaker at a
luncheon meeting of the Salem Rotary Club, where
his topic was "Humor in the Practice of Medicine.”
/or October, 1966
1051
Physicians in State Mental Hygiene
Schedule Program October 14
The Association of Physicians of the Department
of Mental Hygiene and Correction of the State of
Ohio will meet on October 14 at the Columbus State
School, Columbus. Joining them will be the Associ-
ation of Directors of Out-Patient Clinics of the De-
partment.
Dr. Rudolph A. Buki, president, will present Dr.
Judith Rettig, superintendent of Columbus State
School, who will welcome the Associations. "The
Community Service Unit” will be the subject of the
paper of Dr. Abdon E. Villalba following which a
business meeting will be held prior to lunch.
Dr. Julius Nemeth, in the afternoon, will present
a paper, coauthored by Dr. M. Petrovich on "Four
Years of Clinical Experience with combined Chlor-
promazine and Trifluoperazine Treatment.”
Guest and principal speaker will be Dr. William
Grater, clinical assistant professor of allergy in the
Southwestern Medical School, Dallas, Texas, who
will address the session on "Common Sense in Drug
Allergy.”
Cleveland Clinic Foundation
Announces PG Courses
The Cleveland Clinic Educational Foundation, has
announced a number of postgraduate courses of in-
terest to physicians and allied groups.
Details on these and other activities of interest may
be obtained from Walter J. Zeiter, M. D., director
of education, Cleveland Clinic Educational Founda-
tion, 2020 East 93rd Street, Cleveland, Ohio 44106.
The following courses have been announced:
October 19 — Update 1966 — Selected Topics in
Nursing.
November 4 — Medical Technology.
November 16 and 17 — Diagnosis and Treatment
of Neuromuscular Disorders.
December 7 and 8 — Postgraduate Course in Oph-
thalmology.
January 11 and 12 — Advances in Dermatology.
January 18 and 19 — Controversies in General
Surgery.
February 1 and 2 — General Practice.
Dr. James Z. Scott, Scio, won his silver wings
during a training tour at Volk Field, Wisconsin, this
summer. He is a lieutenant commander in the Ohio
Air National Guard and commander of the 121st
Tactical Hospital Squadron.
Dr. W. Hugh Missildine, was principal speaker at
a fellowship dinner meeting at the Boulevard United
Presbyterian Church in Columbus. His topic was
"The Challenge of Change in Self.”
moving thing
Debtors move from one end of
your town to the other. They
move into town from neighbor-
ing and distant towns — from
other states. Even your estab-
lished and longtime residents
go to other cities to buy on
credit, to borrow. Good business
demands that you keep up with
this moving credit — for the
time when the movers come to
you for goods or services on
credit, for money on loan. And,
you can keep up with it . . .
through your local or nearest
Credit Bureau. That bureau’s
thousands of creditor records
are backed by those of eighty-
six associated member bu-
reaus in Ohio alone — by the
records of more than two thou-
sand such bureaus in the U.S.
— all exchanging vital-to-
business credit information.
ASSOCIATED
CREDIT BUREAUS
OF OHIO
P. 0. Box 1114, Lima, Ohio 45802
1052
The Ohio State Medical Journal
Many overweight patients
can benefit from the appetite
control provided by the sustained
anorexigenic-tranquilizing
action of BAMADEX SEQUELS:
anorexigenic action of
amphetamine; tranquilizing
action of meprobamate;
prolonged action through
sustained release of
active ingredients.
Bamadex Sequels®
DEXTRO-AMPHETAMINE SULFATE (IS mg.) SUSTAINED RELEASE CAPSULES
WITH MEPROBAMATE (300 mg.)
to help establish
a new dietary pattern
Contraindications.- Dextro-amphetamine sulfate: in
hyperexcitability and in agitated prepsychotic
states. Previous allergic or idiosyncratic reactions
to meprobamate.
Precautions: Use with caution in patients hypersensi-
tive to sympathomimetic compounds, who have
coronary or cardiovascular disease, or are severely
hypertensive.
Dextro-amphetamine sulfate: Excessive use by un-
stable individuals may result in psychological
dependence.
Meprobamate: Careful supervision of dose and
amounts prescribed is advised, especially for pa-
tients with known propensity for taking excessive
quantities of drugs. Excessive and prolonged use in
susceptible persons, e.g. alcoholics, former addicts,
and other severe psychoneurotics, has been re-
ported to result in dependence on the drug. Where
excessive dosage has continued for weeks or months,
reduce dosage gradually. Sudden withdrawal may
precipitate recurrence of preexisting symptoms such
as anxiety, anorexia, or insomnia; or withdrawal re-
actions such as vomiting, ataxia, tremors, muscle
twitching and, rarely, epileptiform seizures. Should
meprobamate cause drowsiness or visual distur-
bances, reduce dosage and avoid operation of
motor vehicles, machinery or other activity requir-
ing alertness. Effects of excessive alcohol consump-
tion may be increased by meprobamate. Appropri-
ate caution is recommended with patients prone to
excessive drinking. In patients prone to both petit
and grand mal epilepsy meprobamate may precipi-
tate grand mal attacks. Prescribe cautiously and in
small quantities to patients with suicidal tendencies.
Side Effects: Overstimulation of the central nervous
system, jitteriness and insomnia or drowsiness.
Dextro-amphetamine sulfate: Insomnia, excitability,
and increased motor activity are common and ordi-
narily mild side effects. Confusion, anxiety, aggres-
siveness, increased libido, and hallucinations have
also been observed, especially in mentally ill pa-
tients. Rebound fatigue and depression may follow
central stimulation. Other effects may include dry
mouth, anorexia, nausea, vomiting, diarrhea, and
increased cardiovascular reactivity.
Meprobamate: Drowsiness may occur and can be
associated with ataxia; the symptom can usually be
controlled by decreasing the dose, or by concomi-
tant administration of central stimulants. Allergic or
idiosyncratic reactions: maculopapular rash, acute
nonthrombocytopenic purpura with petechiae, ecchy-
moses, peripheral edema and fever, transient leu-
kopenia. A case of fatal bullous dermatitis, following
administration of meprobamate and prednisolone,
has been reported. Hypersensitivity has produced
fever, fainting spells, angioneurotic edema, bron-
chial spasms, hypotensive crises (1 fatal case),
anuria, stomatitis, proctitis (1 case), anaphylaxis,
agranulocytosis and thrombocytopenic purpura, and
a fatal instance of aplastic anemia, but only when
other drugs known to elicit these conditions were
given concomitantly. Fast EEG activity, usually after
excessive dosage. Impairment of visual accommo-
dation. Massive overdosage may produce drowsi-
ness lethargy, stupor, ataxia, coma, shock, vaso-
motor and respiratory collapse.
LEDERLE LABORATORIES
A Division of American Cyanamid Company,
Pearl River, New York
695-6
for October, 1966
1057
The Future of General Practice
By ROBERT E. CARTER, M. D.
WITH YOUR PERMISSION, I will introduce
this talk with several questions: "Why is
there such concern about general practice?”
"What has prompted your medical school to invite
me to travel a thousand miles to talk about general
practice when I am a specialist and not even in prac-
tice at the present time?” "What is your motivation
in coming to hear what I have to say?”
In attending and in giving this lecture, both you
and I are aware of a greater issue. We know that
a complete solution is not presently available, but we
realize that the issue will figure prominently in our
professional futures.
For several years, general practice has been the
subject of a national debate, a controversy which will
continue for years to come and which involves more
than the issues inherent in learning a scientific dis-
cipline. It involves the structure of a science, our
method of delivering medical care to our citizens,
many of our educational methods, and even some
parts of medical research. I refer to the extent of
specialization and the extent of generalization in
medicine. The debate concerns the life or death of
general practice.
How the Argument Developed
Before I present my arguments in favor of retain-
ing a significant amount of generalization in medi-
cine, I want to trace how the argument started, since
it illustrates many parts of the problem.
At the end of the Second World War, leaders of
the medical profession in this country embraced
specialization as the method for delivering medical
care to our population. It looked easy and correct.
The problem of mastering rapidly increasing scientific
knowledge was solved. The millennium of scientific
biology applied to a grateful population was almost
at hand, and the total specialty system promised that
each of us could find an area where we might ap-
proach complete professional competence.
To justify this delightfully naive view of science
and of medical practice, specialty advocates cited
cases from other disciplines. Had not the physicists
seemed to completely specialize, the chemists, the
geologists, and everyone else? Medicine was late in
catching on, they said, and pointed to preliminary
This is the text of Dr. Carter’s discussion as Guest Lecturer in
Family Medicine at the Ohio State University College of Medicine.
The journal is publishing this manuscript with the knowledge that
it represents one side of a moot question of considerable interest to
the medical profession, and with the observation that Dr. Carter’s
presence demonstrates willingness on the part of a leading medical
school to consider the problems involved. Dr. Carter is assistant
dean. State University of Iowa College of Medicine.
evidence that total medical specialization seemed to
be a successful system for delivering care in some
communities.
A second factor led us to project this model of
specialty practice. America went from rags to riches
between 1933 and 1950. Just enough people could
afford specialists, and the ratio of physicians to
total population was high enough to maintain a
balance between demand for service and the ability
to pay for special consideration. The desperately
poor went to charity institutions, and we heard it
said that they got better medical care than did our
richer citizens.
This was simply not true in many instances. We
ignored the lessons to be learned from overworked
house staffs, deteriorating hospitals, and increasing
demands for better service from the indigent and the
old, while we concentrated on perfecting the total
specialty care system for the affluent and for medical
education. I think, most important, we failed to
realize that the total specialty system for medical care
was not successfully applied at most large charity in-
stitutions. It succeeded only where large student,
intern, resident, and fellowship groups existed. It
was present in name only in some hospitals, or as a
cumbersome and inefficient method in others.
Some Justifiable Complaints
You know the complaints as well as I do — patients
treated as diseases rather than as people; interminable
delays in outpatient clinics and the emergency room;
incorrect utilization of emergency rooms; confusion;
lack of identification, no one really responsible for a
particular patient; and, questionable medical practices
— the old joke about the safest place for a carcinoma
of the rectum to develop unmolested being in the
cardiac clinic.
These problems were apparent in our charity medi-
cal practices long before they appeared in the care of
our better classes, and we chose to ignore them.
Now, as the pressures of population mount, and as
specialization increases, we hear them everywhere.
They must be recognized for what they are, and we
must be very analytical in our evaluation of the total
specialty medical practice model. It has not per-
formed well where the ratio of physicians to patients
is low.
Let me go on to a third point which led us to-
ward complete specialization, the influence of scientific
progress on medical practice in the two decades from
1940 to I960. Stop for a moment to think what
1058
The Ohio State Medical Journal
happened when we combined effective antibiotics,
diuretics, and psychotherapeutic drugs. Medical prac-
tice seemed invincible. We kept abreast of our ex-
panding population and increasing demand for serv-
ice through an actual increase in therapeutic efficiency,
through a remarkable and possibly quite singular
combination of scientific discoveries.
But there has not been a penicillin for 25 years,
nor a chlorothiazide for 15, or a chlorpromazine for
10, and I am sure none of us wish to gamble on a
future, as yet unknown, scientific discovery to pull
us out of a current social dilemma until we have ex-
plored and been forced to discard more realistic alter-
nate solutions.
The Extension of a Model
But before we indulge in too much retrospection,
let’s add up the picture in 1950 as it was viewed then.
Combine affluence, remarkable scientific advance, and
increased therapeutic effectiveness, and it is not hard
to see how people were encouraged to make the last
bold step, the extension of a model to the universal
state. In effect, the decision was made that each of
us would eventually specialize in some branch of
medicine. Specialty residency positions were in-
creased to a total of 39,000 - 7,000 more than the
total number of medical students enrolled in all four
years of all medical schools in this country. Specialty
boards multiplied faster than legitimate disciplines
could be identified, and we began to speak of geron-
tologists, abdominal surgeons, and pediatric allergists.
The number of physicians entering general practice
declined precipitously !
There are many indications that we must examine
the concept of total specialty practice more closely,
for the contradictions and inconsistencies which
seemed insignificant at first have assumed greater im-
portance as time goes by. This is typical of any
scientific theory. They represent extensions of preli-
minary information to fit all circumstances. At first,
such generalizations seem logical. The exceptions,
the few facts which don’t fit the theory are either
ignored or are considered to be bad observations
and poor data. The theory isn’t wrong according to
its proponents the facts are ! But, eventually, the
inconsistencies increase in number until the theory
comes tumbling down. A new one must be created
to take its place, a fresh model which more accurately
describes reality. It happened to the older theories
of gravity, of relativity, and of parity, and it will
happen to the concept of total medical specialty prac-
tice as surely as you and I are in Columbus, Ohio,
this afternoon.
Flaws in the Model
The flaws in the total specialty model can be listed
very simply. First, no other scientific discipline has
ever approached total specialization in the context
that it was proposed for medicine. Second, total spe-
cialization with its attendant isolated knowledge in
depth may apply uncommon information to common
occurrences, information which may not actually per-
tain, a fact escaping the intellectually isolated scien-
tist. Finally, integration of knowledge shares equal
importance with the discovery of new information.
It is a different type of synthesis, but without such
correlation, segments of knowledge disperse on hope-
lessly separate courses.
Until now, the debate on generalization and spe-
cialization has been argued on scientific principles
Slide 1
alone. General practice has been eclipsed because
our attention was focused only on the "impossibly
large amount of information to be mastered.’’ We
succumbed to the convenience of a system which said,
"Stay here, isolate yourself, learn only this and treat
what you choose.” In recognizing the contribution
that specialization makes to progress in any scientific
discipline, we ignored the correlary requirement,
breadth of knowledge.
Let me make it perfectly clear at this point that
I recognize the rapid increase in total medical knowl-
edge and that I recognize the advantages which can
accrue from intensive study in isolated areas. My
argument is not to return to total generalization but
to halt the current progress toward total specializa-
tion. It is scientifically essential that we retain a
proper ratio between generalism and specialism in
medicine.
But, there are events outside the scientific realm
which will also decide our future and which will
force us to retain a significant number of generalists
in our total force of physicians. The first is the rapid
growth of the population, the second is our inability
to train enough new physicians.
You are aware of the population growth. In the
first slide (see illustration — Slide 1), I have taken
for October, 1966
1059
available data from the last four national censuses and
from the quite accurate estimate of the present United
States population. The message in this graphic is
crystal clear. The only argument at the present time
is a relatively narrow range in the rate of growth and
its effects for the next ten years. Optimistic predictions
indicate a population of approximately 220 million by
1975. Pessimistic predictions indicate about 240 mil-
lion. Numerous factors enter into calculation of the
ranges in these predictions, and we are aware that a
small change in our fertility could cause a quite large
absolute population change, albeit a small relative
figure at our present level of abundance.
Now, let’s take a quick look at the effect which
this population growth has had on statements of
principle from our total specialty practice advocates
and their remarkable change over the past 15 years.
Take, for example, the obstetricians (see illustration
— Slide 2) — or the pediatricians (Slide 3) — or
even the internal medical specialists (Slide 4) — .
Cracks in the Fortress
I think it is apparent that cracks are beginning to
appear in the walls of the specialists’ fortress. The
image does not seem as attractive as it was at one
time. And, look at the solutions ! Perhaps there
are answers other than midwives and technicians and
the host of paramedical personnel which are now
projected as both dispensers of medical care and as
diagnostic assistants. I hope so, because the history
of problems of this type indicates that the master-
servant relationship is difficult to maintain.
I will return to this point in a moment, but, next,
let’s consider the second variable — the rate at which
we are able to produce new physicians. The present
ratio of physicians to total population is shown in
the next slide (Slide 5). I especially like this
one because it presents both sides of the argument,
the optimistic view in the top curve, also known as
the American Medical Association position, and the
pessimistic outlook at the bottom, possibly identified
with the Association of American Medical Colleges.
The top curve is the ratio of total physicians to popu-
lation and it is constant and has continued to be con-
stant to the present time. It includes all physicians
who are alive, every one that’s breathing, and it is
dependent on a high input of foreign graduates.
The lower curve are people actually treating the sick,
and, as you can see, it is falling steadily and has con-
tinued to fall since this curve was made in 1964.
If we are to maintain the ratio indicated in the
top curve, it will be necessary to continue the high
input of foreign physicians into the permanent Ameri-
can talent pool. It will be necessary to increase the
number of American graduates from our present
8,000 to 11,000 by 1975, and considering inevitable
attrition, this means 4,000 new freshman positions
by 1971. Present schools would have to increase
their enrollment by nearly 20 per cent by 1971, and
we would have to matriculate nearly 2,000 fresh-
men in brand new medical schools by 1971, schools
which really do not exist in 1966.
This will be a neat trick, and all it will accom-
plish is the maintenance of the ratio in the top curve
of the slide just projected (Slide 5). It may have no
effect on the decline in the lower curve for some years
after 1975. Can we accomplish these goals? I per-
sonally doubt it very much at the present time. Monies
made available by federal and state sources for expan-
sion and new construction are not equal to the task,
and every indication is that significant inflation will
reduce both the actual and relative amounts of federal
money available to medical schools.
How Many Treating Patients?
Let me spend another minute on the difference
between the total number of physicians and effective
physicians. An increasing number of persons holding
the M. D. degree will be diverted into positions
where they do not treat patients. They are essential
in these jobs, and since this drain cannot be stopped,
we must look at the efficiency of the physicians still
treating our population. We have already alluded
to increased efficiency of care resulting from singular
scientific discoveries from 1940 to 1955.
Has the trend toward specialization also resulted
in any increase in efficiency for the individual spe-
cialist? Here the answer is not as apparent and very
little data actually exist. It seems obvious that increased
skill in diagnosis and increased total knowledge will
result in better patient care, but it is equally ap-
parent that effective care to large numbers of per-
sons may actually suffer with increased specializa-
tion of each physician. Perhaps I can illustrate this
a little more clearly in the next slide (Slide 6). As a
physician’s depth of knowledge in a specialty area in-
creases, and as he limits himself to these increasingly
esoteric pursuits, there are a smaller number of the
total population to whom this knowledge applies. A
simple analogy is the physician who, upon completing
his internship, takes a residency in ophthalmology
and later limits his practice to the highly rewarding
and interesting treatment of retinal detachment. The
contribution to the care of the total population goes
through a very predictable change. His medical use-
fulness, as measured by the highest quality of care
given to the greatest number of people, increases to
a maximum and then decreases again.
The figures on this graphic are relative, of course.
It is schematic but it does illustrate where we are
with much of our thinking about specialization and
generalization in medicine. Beset with ever increas-
ing numbers of persons to be treated, with a possible
limit on the number of physicians we can train, and
with an ever increasing body of total scientific knowl-
edge, we must actively seek that combination of
events which will give us the greatest amounts of
everything we want, the most people treated with
1060
The Ohio State Medical Journal
I i 1950 ISO MILLION PEOPLE
Let the certified Obstetrician deliver the infants.
Close the hospital staff !
1965 200 MILLION PEOPLE
We must train midwives again !
There will never be enough Obstetrician !
Slide 2
1950 150 MILLION PEOPLE
Pediatricians will be the general practitioners
for our little folks !
1965 200 MILLION PEOPLE
If you want a Pediatrician for every child,
alf medical school graduates for the next five years
must become Pediatricians I Preposterous!
Slide 3
for October , 1966
1061
1950
150 MILLION P50PLE
1965 200 MILLION PEOPLE
— - —
Train lay assistants !
Preserve the special talents of physicians !
Slide 4
the most sophisticated form of our science, and the
most rapid progress toward new information. Maxi-
mum in these situations does not mean all of every-
thing. It means as much of each desirable as we can
afford.
Recapitulation
Before I suggest a solution for your consideration,
let me briefly recapitulate the points I have attempted
to make. First, our population will increase at a
rapid rate despite all reasonable attempts to control its
growth. Second, to maintain present ratios of physi-
cians to total population, we will have to produce a
sharply increased number of graduates. It does not
seem likely at this time that we can achieve this goal.
Third, while a portion of our shortage can be cor-
rected by importing foreign graduates, we must be
aware of the world-wide effect of this course of ac-
tion. The United States is the world leader in sci-
ence and medicine. We should export physicians
rather than import them. Developing nations realize
this more than we do. Fourth, while increased medi-
cal knowledge may increase the efficiency of individ-
ual physicians, the very act of intensive specialization
may reduce a physician’s effectiveness in meeting the
total needs of the population. Fifth, our present
experience with the model of total specialization as a
method of delivering medical care to our population
is not encouraging. Finally, no other science has
specialized to the extent that we appear to be heading
in medicine.
Significant Alternatives
What, then, is to be the solution? Only two sig-
nificant alternatives have been suggested. The first
is the suggestion of some that we create a large num-
ber of paramedical personnel, people who will ac-
tually provide first-contact care for much of the popu-
lation. They will be the nurses, the technicians,
probably even social workers, possibly even the phar-
macists. They will screen and, in effect, treat many
common ills. They will diagnose, and conduct ther-
apeutic trials.
Let’s not deceive ourselves, it is happening more
and more today, with office nurses and with many
others. While the majority of these persons at
present operate under quite close supervision, and
with instant recourse to the consultation of a physi-
cian, future plans suggest that they will be much more
independent. I am not referring to the admonition
on the TV screen that if a headache persists, you
should see a physician. I am suggesting that these
individuals will give both first contact triage and
occasional continuing supervision in many cases.
This will leave the physician free to devote his at-
tention to only those cases needing advanced skills.
It postulates that there will be continued increased
specialization. In essence, it creates two levels of
medical care and two levels of medical practitioners.
Don’t be fooled for a minute about this. No mat-
ter what we call him, the health technician will func-
tion as a physician and will eventually demand and
1062
T he Ohio State Medical Journal
receive both from us and from society the recognition
as a physician. Such a two level system can work,
but only when there is a common base of instruc-
tion. This is what other scientific disciplines do, and
it is what we did in medicine successfully for a num-
ber of years with generalization and specialization.
The system is under stress now partly as the re-
sult of the forces which I listed earlier, and partly
because of our inability to maintain a sufficiently
large supply of physicians. A two-level system based
on different levels of basic training will not be suc-
cessful and will eventually convert to one basic level
of instruction. This is what is happening with oste-
opathy and conventional medicine today.
Second Alternative
The second solution to our problem is the inten-
tional retention of general physicians and the train-
ing of these physicians to meet the needs of the
majority of our population. By no means do I mean
that specialization should be eliminated, but we must
keep physicians with a broad viewpoint and hence a
singular diagnostic ability, physicians competent in
several areas of medicine and performing in these
areas to the limit of their ability. These are the cor-
relators of medical information identified by Magraw,
and they are much more - — - they are active therapists.
At this point we must answer a specific question.
You hear repeatedly that there is too much to learn
to be a general practitioner. Most of this comment
comes from our medical educators. Is it really true,
or does it represent a viewpoint influenced by a
singular patient population and demands not encoun-
tered in private practice?
An unhealthy influence has pervaded a number
of medical schools and has resulted in an oddly biased
view of the practice of medicine. This suspicion is
not original with me; it has been identified by others
in academic pursuits. They can show that only one
patient in 700 ever is treated in a University Hospital,
and that the total of these singular patients represent
a profile of disease unrelated to any in private prac-
tice and probably unsuited for undergraduate training.
The internist, the surgeon, or the pediatrician func-
tioning in such an atmosphere must view medical
practice as a series of complexities requiring tremen-
dous depth of knowledge, and a necessary constriction
of interest. Since medical students receive the major-
ity of their instruction from such faculty and from
such patient material, how can they do otherwise
TOTAL USEFUNESS OF THE PHYSCIAN
Patients treated X Quality of care
Slide 5
for October, 1966
1063
than assume that comparable cases may appear in
their office day after day.
The Commonplace and the Rare
The fact is, of course, that they do not. Most
patients have diseases which are adequately treated
by physicians with sound basic training and who re-
tain interest in many facets of medicine. Morbidity
studies bear this out and support what you already
know intuitively: rare diseases are rare. It is both
unnecessary and impossible to train a generalist to
care for these complexities. But you ask: can such
patients be identified and directed to proper care?
Isn’t there a danger of missing them for too long?
Adequate generalists can both treat the common-
place and refer the unusual when necessary. This
system has worked in the past. Despite what many
students may hear in school, the majority of physi-
cians practice excellent medicine. The reasons rare
cases are in University Hospitals is that private prac-
titioners have sent them there.
But, you say today is really different. Now there
really is too much to learn for even a core. People
have always felt this. I would like to refer to a
speech by a famous medical educator from the Har-
vard Medical School in March.1 He said, "In modern
times, the constituent advances of medical science
are so expanded that they are not to be acquired by
any physician in a lifetime and still less by any stu-
dent in his pupilage.” The only trouble is that this
was not said by Dr. Ebert but by Dr. Jacob Bigelow,
and the year was 1850, not 1966. In 1850 this
statement was as true as it is today, but it still does
not preclude the intentional identification and mastery
of those core facets of medicine which will be of
such service to all of mankind.
Let’s consider one additional point. Nearly every
person receives his medical care from a physician in
private practice, or will very shortly. The majority
receive it in a physician’s office rather than in a hos-
pital emergency room or clinic. The majority still
receive their care from physicians whom they iden-
tify as their doctor, and we must not forget this essen-
tial ingredient in the physician-patient relationship.
When the patient first comes to his physician with
a complaint, he views that doctor in a singular way.
To the patient, he embodies the sum of medical
knowledge, a person who can either apply a portion
of this knowledge or find someone who can. As
diagnostic steps in this initial evaluation proceed, the
point is reached where the patient may accept a
referral, if necessary, but only for a particular area or
problem, always something less than his total self.
Let me answer a common statement today. Why
can’t specialists also do some general practice? We
know some can and do, quite successfully. But I
am concerned about several things for the majority:
the complacency of certified success, the lack of
constant need to know in areas other than their own,
lack of complete identification with many patients.
As a solution to our present problem, recommended
by some in the form of increasing internists and
pediatricians and having every other specialist do a
little general work on the side, it falls short of a
logical goal.
A Look to the Future
What then is the future of general practice in this
country? I think that no matter what our point of
view, it is very promising indeed. It is desirable
to retain general practice if we are to provide really
adequate, integrated medical care for the majority
of people. General practitioners must be good
enough to be supported by specialists, and we must
have specialists good enough to support them. They
must be produced in adequate numbers so that they
( Continued on page 1068)
$
£
&
O.
150-
Physicians ( M.D. ond D.O. ) :
Total
® .... a....
From Pennell, M. Y. : Statistics on Physicians,
1950-63, Public Health Reports, 79:905, 1964
Slide 6
-1064
The Ohio State Medical Journal
Dialog
(allobarbital and acetaminophen CIBA)
Indications: For relief of pain and discomfort of
simple headache; neuralgia, myalgia, and musculo-
skeletal pain; dysmenorrhea; bursitis; sinusitis;
fibrositis. Also indicated to reduce fever and to
relieve discomfort due to respiratory infections, influ-
enza, and other febrile conditions.
Contraindication: Not recommended during pregnancy.
Caution: May be habit-forming. Do not use in patients
sensitive to barbiturates or in those with moderate
to severe hepatic disease.
Side Effects: Nausea, transitory dizziness, rash. Over-
dosage of allobarbital produces symptoms typical
of acute barbiturate excess.
Dosage: Adults: 1 or 2 tablets every 4 hours. Not to exceed
8 tablets in 24 hours. Children 6 to 12: V2 to 1 tablet every
4 hours. Not to exceed 4 tablets in 24 hours.
Supplied: Tablets (white, scored), each containing
15 mg allobarbital and 300 mg acetaminophen; units of
3 bottles of 30.
For your convenience — prescription-size bottle of 30.
CIBA Pharmaceutical Company, Summit, N. J.
CIBA
(Continued from page 1064)
have enough time to appreciate their patients and
their patients can appreciate them. They must treat
the majority of disease and supply patients to a
sophisticated specialist superstructure. We must
produce a sharply increased number of physicians of
many types in this country, but principally generalists.
If total physician production must be less than
optimum, all the more reason for concentrating on
the product who can most efficiently meet the needs
of most people. The alternative is an array of health
technicians and a hopelessly fragmented specialty
practice.
Retention of general practice is inevitable if we
are to provide the medical care we want for our
burgeoning population.
Not let’s consider our general practitioner in a little
more detail. Will he be a family medicine man?
Of course — he will need the public health, psy-
chological, and sociological information to correlate
and apply medical data. But this alone is not enough,
it is not the total body of knowledge singular to fam-
ily practice. It could be common to any specialty.
Our general practitioner will need as well a con-
stantly updated core of medical information which
applies to the majority of human ills. And he will
need to keep his wits sharp by facing multiple chal-
lenge.
Should he be trained after medical school? Both
you and I know he should — for two or even three
years in key medical, pediatric, and psychiatric areas.
He should have latitude for individual interest and
expression.
Will he do surgery? Occasionally. Not the big
operations but certainly some less complicated ones.
But what about the surgeon’s view that every opera-
tion is potentially a major one? Come on now —
this is just not true! If a first year surgical resident
can do an appendectomy with as little supervision
as so many get, so can a conscientious and trained
generalist. Let’s be honest ! ! I could go on down
a rather long list!
Should a generalist deliver a baby? If a midwife
can, so can he, with comparable training.
If we must have general practice, then who will
be these generalists? Which students? You or the
fellow next to you? Or, should we leave it for
the chap at the bottom of the class?
We need the top half of the students in this
room — the students smart enough, secure enough,
and sufficiently dedicated to the principles of medi-
cine that they will both accept and meet a genuine
challenge. We need good enough personality struc-
tures to be comfortable with less than complete
knowledge and to concentrate on necessary knowl-
edge. We need physicians whose reward is meeting
the genuine needs of others, not written certificates
of success. We need the best of you to practice su-
perior medicine on as many people as you can.
Those of you who cannot accept such challenges
or aspire to these goals should specialize.
Reference
1. Ratner, Herbert: Deficiences in Present-Day Medical Education.
GP, 32:185-188 (July) 1965.
American Academy of Pediatrics
Features Ohioans on Program
A number of Ohioans are on the 35th Annual
Meeting Program of the American Academy of Pedi-
atrics, scheduled in Chicago, October 22-27. Head-
quarters hotel is the Palmer House.
Dr. Thomas E. Shaffer, Columbus, will participate
in a panel discussion on the subject, "Athletics for
the Growing Child."
Dr. Sylvia Richardson, Cincinnati, will present a
round table discussion on "School Readiness.”
Dr. Lester W. Martin, Cincinnati, will present the
second of two round table discussions on "Visual
Diagnosis."
Dr. Lester Persky, Cleveland, will tell about "Ex-
periences with Childhood Vesical Tumors,” in a
panel discussion on "Urinary Tract Infections in
Children." He also was moderator of a panel on
"Scrotal Masses in Children."
Dr. John P. Smith, Columbus, will discuss "Tes-
ticular Tumors in Children,” during a panel presen-
tation on the subject, "Scrotal Masses in Children.”
Among alumni meetings are luncheons sched-
uled by Children’s Hospital of Columbus (Ohio
State University College of Medicine), Western Re-
serve University and Allied Hospitals Alumni, and
Cincinnati Children’s Hospital Alumni. A reception
is scheduled by Akron Children’s Hospital Alumni
Association.
Executive officers of the American Academy of
Pediatrics are at 1801 Hinman Ave., Evanston, Illinois
60204.
As to the evaluation of medicines for efficacy and
safety, the computer is not the final and perfect an-
swer, useful though it is. What the physician feels
and perceives at the bedside of his patient may not
fit into the square, or oblong or round hole of the
punch card; but his observations are often a surer
guide to the usefulness of a particular medicament for
a particular patient. In the interest of the patient —
that individual is so unique that there is not another
entirely like him in the whole wide world — we
must be careful lest the scientific pendulum swing
too far in the direction of mechanistic technology. —
J. Mark Hiebert, M. D., to University of Kansas
Pharmacy Colloquium.
1068
The Ohio State Medical Journal
*SS0CMf'o^
..••i0TH CLI»'c,
££S\£ 7(B(B
LAS VEGAS
Convention site “extraordinaire” that’s Las Vegas. America’s entertainment
capital becomes the classroom for America’s practicing physicians — offer-
ing you a comprehensive, compact, postgraduate course in recent develop-
ments in medical science. A magnificent Convention Center, fine hotels
and motels, excellent restaurants plus star studded entertainment await
you and your family.
The AMA’s first clinical convention in Las Vegas offers a top notch scientific
postgraduate program.
Scientific sessions will be held on the following topics: Scintillation Scan-
ning • Radiation and Cancer • Clinical Pulmonary Physiology • Gastroenter-
ology • Futuristic Diagnostic and Therapeutic Tools • Neck Pain • Anti-
biotics • Urology • Aerospace Medicine • Unconsciousness • Dermatology
• Juvenile Diabetes • Endocrine and Metabolic Diseases • Pediatrics •
Surgery • Hematology • Psychiatry • Otolaryngology.
Three Postgraduate Courses will be presented: Obstetrics and Gynecology
• Fluid and Electrolyte Balance • Cardiovascular Disease. Each Course will
consist of three half-day sessions, and there will be a registration fee of
$10.00 for each course, payable with your advance registration.
Four Breakfast Round Table Conferences will be held on the following
topics: The Management of Metabolic Bone Disease • Indication for Cardio-
version • The Problems and Potential of L.S.D. • An Agonizing Reappraisal
of Cancer Chemotherapy • Closed Circuit Television • Medical Motion
Picture Programs • Over 275 Scientific and Industrial Exhibits.
The complete scientific program, plus forms for advance registra-
tion and hotel accommodations, will be featured in JAMA October 24.
for October, 1966
1069
Outstanding Scientific Exhibits
At the OSMA Annual Meeting
OUTSTANDING FEATURE at the 1966 OSMA Annual Meeting in Cleveland, May 24-28,
was the Scientific and Health Education Exhibit. In keeping with a policy recommended
by the Committee on Scientific Work and approved by The Council, awards were authorized
for certain exhibits designated as outstanding by the judging committee. This year seven exhibits
were selected to receive the special honors which included mounted and engraved plaques, certifi-
cates and monetary awards. The committee designated three exhibits in the field of teaching, and
three in the field of original investigation to receive respectively the gold, silver and bronze awards,
and named a seventh exhibit to receive a special award. Following are brief descriptions of two
of these award-winning exhibits.
Gold Award Goes to Exhibit on
Circulation in Bone Repair
The Gold Award in the field of Original Investiga-
tion was presented at the 1966 OSMA Annual Meet-
ing to sponsors of the exhibit entitled "Stereoscopic
Microangiography : Observations on the Microcircula-
tion in Bone Repair.’’ Sponsors were Dr. F. W.
Rhinelander, Dr. R. S. Phillips, and Dr. W. M. Steel,
Western Reserve University School of Medicine and
Cleveland Metropolitan General Hospital, Cleveland.
Principal investigator in the research presented by
the exhibit is Dr. Rhinelander who is professor of
orthopaedic surgery and chief of the Orthopaedic
Service, Cleveland Metropolitan General Hospital.
The work presented in the exhibit covered some of
the aspects of the studies being carried out in the local
laboratory on the microcirculation of healing bone.
Two articles on this investigation have appeared
in the literature. "Microangiography in Bone Heal-
ing; Undisplaced Closed Fractures,” appeared in
The Journal of Bone and Joint Surgery, 44-A, 1273-
1298, October 1962. "Some Aspects of the Micro-
circulation of Healing Bone,” appeared in Clinical
Orthopaedics, #40, 12-16, 1965. An article on
"Displaced Closed Fractures” is in press. Reports
of the investigation on internal fixation of bone and
on bone grafts are in preparation.
A resume of points covered in the exhibit was pub-
lished in the Proceedings of the American Academy
of Orthopaedic Surgeons, Scientific Exhibits, in the
issue of The Journal of Bone and Joint Surgery, July
1964, 46-A, 1151-1152.
The reason for preparation of this particular scien-
tific exhibit was to demonstrate the microangiograms
in stereoscopic viewers. Three dimensional views are
much more striking where the blood supply of frac-
tures and bone grafts is concerned, compared with
the flat illustrations in published articles.
All of the work portrayed has been supported by a
National Institutes of Health research grant, which
has recently been renewed for an additional five years.
The sponsors point out that the studies of healing
bone are far from complete.
Different panels of the exhibit illustrated selected
experiments from various studies on dogs. Micro-
angiograms revealed in detail the complex arteriolar
and capillary vascular pattern present in one-milli-
meter-thick slices of bone and periosteal tissue.
Illustrations showed (1) normal blood supply of
the long bones; and circulation and bone repair of
(2) undisplaced closed fracture in which the main
medullary artery was not disrupted at fracture; (3)
displaced closed fracture in which the medullary blood
supply was dismpted; (4) transverse osteotomy and
fixation with medullary rod; (5) transverse oste-
otomy and fixation with Lane plate and screws; (6)
transverse osteotomy and fixation with angle plate
and wires; and (7) vascularization of the grafted
area in a bone graft with autogenous cancellous
chips.
Exhibit on the Geriatric Patient
Is Winner of Bronze Award
The exhibit entitled "Office Evaluation of the Geri-
atric Patient,” sponsored by a team from the Ohio
Department of Health and the U. S. Public Health
Service Gerontology Branch, won the Bronze Award
in the field of Teaching at the 1966 OSMA Annual
Meeting.
Among individuals who participated in preparation
and presentation of the exhibit were Dr. Emmett W.
Arnold, director of the Ohio Department of Health,
Dr. Aileen L. MacKenzie, Frances Williamson, Rich-
ard W. Orzechowski, and Dennis Webb.
The exhibit was developed by Dr. Austin B. Chinn,
Gerontology Branch, Division of Chronic Diseases,
U. S. Public Health Service. It was a large display
which included a screen for the presentation of color
slides and an accompanying narration. Audience
participation was encouraged by means of a push-
button device and earphones for listening.
The presentation dealt with the basic requirements
( Text Continued on Page 1072)
1070
The Ohio State Medical Journal
Views of Award Winning Exhibits
This is the Gold Award winning exhibit in the field of Original Investigation entitled " Stereoscopic Microangiography:
Observations on the Microcirculation in Bone Repair ,” as it was shown at the 1966 OSAIA Annual Meeting. Placing the
Gold Award plaque on the exhibit is Dr. Lawrence C. Meredith. OSAIA President. ( See facing page for additional
information.)
Dr. Eleanor Smith, of the U. S. Public Health Service Gerontology Branch in Washington, is shown holding the Bronze
Award in the Teaching Field, presented to sponsors of the exhibit entitled "Office Evaluation of the Aging Patient."
The exhibit was jointly sponsored by the Ohio Department of Health and the Gerontology Branch of USPHS.
for October, 1966
1071
( Outstanding Exhibits Contd.)
for an annual physical examination of the geriatric
patient by the private physician in his office. On
either side of the exhibit were panels with built in
desks, chairs and literature racks with pertinent mate-
rial displayed and order blanks available.
Available publications were widely varied in scope
and included the Cornell Medical Index Health Ques-
tionnaire by Keeve Brodman, M. D., Albert J. Erd-
man, Jr., M. D., Harold G. Wolff, M. D.; Automated
Multiphasic Screening and Diagnosis by Morris F.
Collen, M. D., BEF, Leonard Rubin, M. D., Ph. D.,
Jerzy Neyman, Ph. D., George B. Cantzig, Ph. D.,
Robert M. Bair, Ph. D., A. B. Siegelaub, M. S.; Geri-
atric Nutrition by Geraldine M. Piper and Emily M.
Smith.
Dr. Arnold reported that there were many requests
for literature besides the literature available at the
exhibit.
The exhibit portrayed the opportunities open to the
practicing physician for total health care of the aged
patient. It pointed out that if there is any single
characteristic about illnesses in older people, it is
their multiplicity and interrelatedness.
Additional requests for literature on this subject or
for information in regard to the geriatric patient
may be addressed to the Ohio Department of Health,
P. O. Box 118, Columbus, Ohio 43216.
In addition to local persons who manned the ex-
hibit, was Dr. Eleanor Smith, now associated with
the Gerontology Branch of the U. S. Public Health
Service in Washington, and formerly attached to the
Ohio Department of Health.
Cleveland Pathologist Shares
First of Stouffer Awards
Dr. Harry Goldblatt, well-known pathologist of
Cleveland, is one of two physicians to share the first
annual $50,000 Stouffer Prize, for his pioneer re-
search in the field of hypertension and hardening of
the arteries. The other recipient is Dr. Ernst Klenk,
of the University of Cologne, Germany.
Dr. Goldblatt is emeritus professor of experimen-
tal pathology at Western Reserve University School
of Medicine, and director of the Louis D. Beaumont
Memorial Research Laboratories, Mount Sinai Hos-
pital, Cleveland.
Announcement was made by Dr. Irvine H. Page,
Cleveland, chairman of the Stouffer Prize Commit-
tee. The award was established by Vernon Stouf-
fer, head of the chain of restaurants which bear his
name.
The Stouffer Prize, established earlier this year,
was founded to help track down the cause, preven-
tion or treatment of high blood pressure and harden-
ing of the arteries.
Dr. L. Harold Martin, Ashland, an alumnus of
Ashland College, has been named to the college
Board of Trustees.
12 Hospitals Designated in Ohio
As Needed for TB Patients
Dr. Emmett W. Arnold, director of the Ohio De-
partment of Health, recently announced the designa-
tion of 12 tuberculosis hospitals in the state as needed
to provide sufficient beds for all persons requiring
hospitalization for the maintenance, care, and treat-
ment of tuberculosis.
This action was taken in accordance with a new
law passed by the 106th General Assembly last year,
which also provides that the state subsidy to assist
counties in the hospitalization of tuberculosis pa-
tients shall be raised from $2.50 a day to $5 a day,
effective October 1, 1966.
The increased subsidy, under the new law, may be
paid only for patients placed in the designated hospi-
tals. After October, there will be no state subsidy for
tuberculosis patients in non-designated hospitals.
The designated hospitals are: Benjamin Franklin
Hospital, Columbus; Dunham Hospital of Hamilton
County, Cincinnati; Edwin Shaw Sanatorium, Akron;
Lowman Pavilion, Cleveland Metropolitan General
Hospital, Cleveland; Sunny Acres, Cuyahoga County
Tuberculosis Hospital, Cleveland; Mahoning Tuber-
culosis Sanatorium, Youngstown; Molly Stark Hospi-
tal, Canton; Ottawa Valley Hospital, Lima; Stillwater
Sanatorium, Dayton; William Roche Memorial
Hospital, Toledo; Ohio Tuberculosis Hospital, Co-
lumbus; Southeast Ohio Tuberculosis Hospital,
Nelsonville.
Those hospitals not included are: Pleasant View
Sanatorium, Amherst; Mount Logan Hospital, Chil-
licothe; St. Francis of Oak Ridge, Green Springs;
Edwin H. Hughes Memorial Hospital, Hamilton;
Richland Hospital, Mansfield; Rocky Glen Sana-
torium, McConnelsville; Licking County Tuberculosis
Sanatorium, Newark; and Trumbull County Sana-
torium, Warren.
A nine member advisory board named by the gov-
ernor last April assisted in the designation of the
needed hospitals. This board met several times and
submitted recommendations to the Director of Health,
who is authorized under the law to make the decision
on designations after giving due consideration to the
recommendations.
Commenting on the designations, Dr. Arnold said
the 12 hospitals will supply 1,948 beds. Recently,
the average number of hospitalized tuberculosis pa-
tients in Ohio has been 1,400.
Dr. Harvey C. Knowles, Jr., of Cincinnati, was
named president-elect of the American Diabetes As-
sociation at the organization’s 26th annual meeting
in Chicago. Dr. George J. Hamwi, Columbus, was
re-elected treasurer.
1072
The Ohio State Medical Journal
Statement of Ownership,
Management and Circulation
(Act of October 23, 1962; Section 4369, Title 39, United States
Code)
1. Date of filing: Sept. 19, 1966
2. Title of Publication: The Ohio State Medical Journal
3. Frequency of issue: monthly
4. Location of known office of publication: 17 South High St.,
Suite 500, Columbus, Ohio 43215.
5. Location of headquarters or general business offices of the
publisher (not printer); 17 South High St., Suite 500, Columbus,
Ohio 43215.
6. Names and addresses of Publisher, Editor, and Managing
Editor (Executive Business Manager).
Publisher: The Ohio State Medical Association, 17 South High St.,
Suite 500, Columbus, Ohio 43215
Editor: Perry R. Ayres, M. D., 17 South High St., Suite 500, Co-
lumbus, Ohio 43215.
Executive Business Manager, R. Gordon Moore, 17 South High St.,
Columbus, Ohio 43215.
7. Owner: The Ohio State Medical Association, 17 South High
St,. Suite 500, Columbus, Ohio 43215, a non-profit corporation
with no stock outstanding.
8. Known bondholders, mortgagees, and other security holders
owning 1 percent or more of total amount of bonds, mortgages,
or other securities: None
9. Paragraphs 7 and 8 include, in cases where the stockholder
or security holder appears upon the books of the company as
trustee or in any other fiduciary relation, the name of the per-
son or corporation for whom such trustee is acting, also the
statements in the two paragraphs show the affiant’s full knowl-
edge and belief as to the circumstances and conditions under
which stockholders and security holders who do not appear upon
the books of the company as trustees, hold stock and securities
in a capacity other than that of a bona fide owner. Names and
addresses of individuals who are stockholders of a corporation
which itself is a stockholder or holder of bonds, mortgages or
other securities of the publishing corporation have been included
in paragraphs 7 and 8 when the interests of such individuals
are equivalent to 1 percent or more of the total amount of the
stock or securities of the publishing corporation.
10. This item must be completed for all publications except
those which do not carry advertising other than the publisher’s
own and which are named in sections 132.231, 132.232, and
132.233. Postal Manual (Sections 4355a, 4355b, and 4356 of
Title 39, United States Code)
I certify that the statements made by me above are correct and
complete.
R. Gordon Moore, Executive Business Manager.
New Executive Secretary Is Named
For State Board of Pharmacy
The State Board of Pharmacy has announced the
appointment of Frank E. Kunkel, of Cincinnati, as
executive secretary7 to replace Dr. Rupert Salisbury
effective September 1.
Mr. Kunkel has completed two five-year terms as a
member of the Board of Pharmacy, his last term end-
ing in March, 1966.
Mr. Kunkel was a Pharmacist in the Geisler Phar-
macy from 1931 to 1932, and in the Benet Pharmacy
from 1932 to 1937. He was a professional rep-
resentative for Eli Lilly & Company from 1937 to
1940. He has been the owner of the Kunkel Apothe-
cary since 1941. He is also a hospital pharmacist at
Our Lady of Mercy Hospital, a position he has held
since 1950.
SYMPOSIUM ON ADOLESCENCE
New Orleans, Louisiana December 1-3, 1966
Approved for 15 hours credit by the American Academy of General Practice
Sponsored by the
DIVISION OF PSYCHIATRY and COMMUNITY MENTAL HEALTH CENTER OF TOURO INFIRMARY
supported by a National Institute of Mental Health Grant
GUEST LECTURERS INCLUDE:
Dana Farnsworth, M. D., Director of Student Health Serv-
ices at Harvard University, Cambridge, Mass.
Irvin Kraft, M. D., Professor of Child Psychiatry at Baylor
Medical School, Houston, Tex.
John Schimel, M. D., Associate Director of William Alan-
son White Institute of Psychiatry, Psychoanalysis and
Psycholog}7, New York, N. Y.
George Tarjan, M. D., Professor of Psychiatry and Program
Director of Mental Retardation Project at University of
California in Los Angeles, Calif.
Carroll Witten, M. D., President-Elect of American Academy
of General Practice, Louisville, Ky.
Symposium will be held at the Fontainebleau Motor i
Hotel, 4040 Tulane Ave. Early hotel reservations are 1
recommended.
AMONG TOPICS TO BE DISCUSSED:
"The Physician’s Role in Mental Retardation"
"Parents of Problem Children"
"Handling of Adolescents by General Practitioners”
"Sexual Morality — A College Dilemma"
"Drugs in the Treatment of Children and Adolescents”
"Learning Problems of the Adolescent”
"Adolescence and Social Mores”
"Talking About Sex with Adolescents"
"Religious — Psychological Conflicts”
Gene L. Usdin, M. D. ,
Director of Psychiatric Services
Touro Infirmary
1400 Foucher Street
New Orleans, Louisiana 70115
Enclosed is my registration fee of S20 for the
SYMPOSIUM ON ADOLESCENCE to be given I
December 1-3, 1966 at the Fontainebleau Motor Hotel.
(Checks should be made payable to Touro Infirmary.)
Name
Address
I
I I
for October, 1966
1073
Executives of Ohio’s Medical Societies
Attend Second Chicago Conference
For the second consecutive year,
executive secretaries of County Medical Societies
in Ohio and the Executive Staff of the Ohio State
Medical Association, met in Chicago with personnel
of the American Medical Association to develop
better understanding of the medical organization field
and to promote better working relationships among
medical groups on the national, state, and county
levels.
Seventeen persons from the executive staffs of
County Medical Societies in Ohio, and four members
of the OSMA Executive Staff, were present at the
August 23 meeting in the Board Room of the Ameri-
can Medical Association headquarters office.
Dr. Lawrence C. Meredith, Elyria, President of
the Ohio State Medical Association, accompanied the
Ohio group to Chicago and participated in discus-
sions. The conference was sponsored by the OSMA
and part of the expenses of county medical society ex-
ecutives were paid by the Association. Persons at-
tending the Ohio conference also attended the Medical
Society Executives’ Association Eighth Annual Insti-
tute, held on August 24, and the AMA Public Rela-
tions Institute held on August 25 and 26, both in
Chicago.
Closer Ties for Executives
Following the first such meeting in Chicago last
year, members of the executive staffs of Ohio County
Medical Societies voted to form a more closely knit
organization. At a subsequent meeting in Columbus
on February 26, the Association of County Medical
Executives (ACME) was organized. Elected of-
ficers are Edward F. Willenborg, executive secretary
of the Academy of Medicine of Cincinnati, president;
W. "Bill” Webb, executive secretary of the Academy
of Medicine of Columbus, vice-president; and Sidney
Mountcastle, executive secretary of the Summit County
Medical Society, secretary-treasurer.
Executive staff members of County Medical So-
cieties have been meeting for many years informally
with the executive staff of the Ohio State Medical
Association for discussion of matters of common in-
terest. Formation of the organization is to promote
closer working relationships between executive staffs
on the county and state levels and to establish more
definite goals for future consideration.
1074
At the Chicago conference, Dr. F. J. L. Blasingame,
Executive Vice-President of the AMA, held an in-
formal discussion on new developments in the medi-
cal organization field.
William C. Stronach, executive director of the
American College of Radiology, spoke about the much-
discussed direct billing procedure.
Oliver J. Neibel, Jr., executive director of the Col-
lege of American Pathologists, discussed the rela-
tionships that pathologists and certain other physi-
cians are facing in regard to policies of practice.
Dave Powers, administrative assistant, associated
with the American Medical Political Action Commit-
tee, discussed the actions of AMPAC and those of
related political action committees on the state level.
Bill Ramsey, assistant director of the AMA Field
Service Division, described the functions of the field
service.
Ohioans in Attendance
Attending the Conference of Ohio Executives in
Chicago were the following persons:
J. H. Austin, Stark County; A. Dana Whipple,
Medina County; Mrs. Patsy Jo Askins, Sandusky
County; Robert F. Freeman, Earl E. Shelton, and
Arlo Ragan, Montgomery County; Edward F. Willen-
borg, Hamilton County; Sidney H. Mountcastle,
and Gerald Union, Summit County; W. "Bill” Webb,
and Miss Jean Armour, Franklin County; Howard
Rempes, Mahoning County; Mrs. Gladys Davidson,
Lorain County; Charles G. Greig, Butler County;
Mrs. Barbara Wolfert, Erie County; Mrs. C. K. El-
liott, Greene County; Robert A. Lang, Cuyahoga
County;
Hart F. Page, W. Michael Traphagan, Herbert
E. Gillen, and Jerry J. Campbell, of the OSMA staff;
James S. Imboden, AMPAC district representative
stationed in Columbus; David Weihaupt, of the
AMA Field Service; plus the persons previously
named as participants in the program.
Ohio is among the leading states as far as number
of County Medical Societies which maintain either
full-time or part-time executive staffs. In addition
to those previously named, executive staffs are main-
tained in Lucas, Defiance, Clark, Lake, Richland,
Trumbull, and Geauga Counties.
The Ohio State Medical Journal
*
Ohio Executives in Chicago Conference
This photo shows part of the group which met in the Board of Trustees Room at the AMA Headquarters in Chicago.
Extreme right, with hack to camera, is Dr. Lawrence C. Meredith, OSMA President; left, with back to camera, Edward
Willenhorg, President of the Ohio Executives’ group; extreme left, AMA Executive Vice-President F. J. L. Blasinga?ne.
Others, from left, are Howard Rempes, Mahoning County, Robert Freeman, Earl Shelton, and Arlo Ragan, Montgomery
County; Patsy Jo Askins, Sandusky County; Barbara Wolfert, Erie County; Mrs. C. K. Elliott, Greene County; Jean
Armour, Franklin County; and Dana Whipple, Medina County.
OSU Team Seeks Standards in
Care of Newborn Babies
Dr. Alex F. Robertson, director of the newborn
nursery service at Ohio State University Medical Cen-
ter, heads a team of physicians and nurses who are
attempting to establish a system of model care for pre-
mature infants.
The team effort is funded with $6 0,000 from the
Ohio Department of Health and is directed at de-
velopment of comprehensive nursing and medical
standards to provide exemplary care of premature
babies.
According to Dr. Robertson, plans are underway
to make video tapes on procedures used in caring for
newborns. These will include the techniques of in-
trauterine transfusions and exchange blood transfu-
sions of infants endangered by RH incompatibility
at birth.
Maternity classes are being held for expectant
mothers as another facet of the program.
It has been demonstrated during the clinic’s year
of existence that home visits by nurses help mothers
of premature infants to better cope with their care.
"We are convinced that every hospital involved
in the care of low birth rate infants in families of
low income should have a clinic, with its own nurse
and pediatrician, to see such babies through the first
years of life,” Dr. Robertson said. "In this way
many problems that occur due to prematurity can be
avoided.
It is expected that the premature infant team will
serve as consultants to smaller hospitals in the state
for establishing or improving newborn care and
facilities.
Dr. Samuel D. Goldberg, Youngstown, was elected
president of the Jewish Federation of Youngstown,
an organization dedicated to establishing and financ-
ing a network of local and non-local humanitarian
services.
for October, 1966
1075
Obituaries
Ad Astra
Jacob Julian Alpers, M. D., Columbus; Tufts Uni-
versity School of Medicine, 1928; aged 64; died
August 12; former member of the Ohio State Medi-
cal Association; member of the American Psychiatric
Association. A specialist in the neuropsychiatric field
for many years in Columbus, Dr. Alpers was chief
neurological and psychiatric consultant in the Ohio
State University Health Service, and for many years
chief psychiatrist at the Ohio Penitentiary. Survivors
include his widow, two sons and four sisters.
Calvin Layie Baker, M. D., Columbus; University
of Cincinnati College of Medicine, 1932; aged 59;
died August' 25; member of the Ohio State Medi-
cal Association, the American Medical Association,
and American Psychiatric Association; diplomate of
the American Board of Psychiatry and Neurology.
A practicing physician for many years in Columbus
where he specialized in psychiatry, Dr. Baker was
formerly commissioner of mental hygiene for the
State of Ohio. He was honorary life vice-president
of the Ohio Association of Mental Retardation, and
a past president of the Ohio Mental Health Associa-
tion. Dr. Baker also served for many years on the
Committee on Mental Health for the Ohio State
Medical Association. During the early part of his
career, he was a general practitioner in Cridersville.
Among affiliations, he was a member of the Masonic
Lodge. A veteran of World War II, he is survived
by his widow, a son, his mother, and two sisters.
William B. Carmon, M. D., Norwood; University
of Cincinnati College of Medicine, 1927; aged 70;
died August 16; member of the Ohio State Medical
Association and the American Medical Association.
Dr. Carmon began his practice in the Norwood
area shortly after completing his medical education
in 1927 and continued in practice until this year.
Among professional activities he was surgeon for the
police and fire departments. Affiliations included
memberships in several Masonic bodies. Survivors
include his widow and a brother.
Harold Newton Cole, Sr., M. D., Cleveland;
Western Reserve University School of Medicine,
1909; aged 82; died August 20; member of the
Ohio State Medical Association, the American Medi-
cal Association, American Dermatological Associa-
tion and the American Academy of Dermatology and
Syphilology; diplomate of the American Board of
Dermatology and Syphilology. A practitioner of long
standing in the field of dermatology, Dr. Cole was
for many years associated with the faculty at Western
Reserve University School of Medicine. He was
one of the founders of the American Board of Der-
matology and Syphilology and was a past president
of the American Dermatological Association. A
member of the Baptist Church, he is survived by
two daughters, a son and a brother.
Joseph Alger Conner, M. D., Cincinnati; Univer-
sity of Cincinnati College of Medicine, 1919; aged
78; died August 12; member of the Ohio State
Medical Association and the American Medical As-
sociation. A general practitioner of long standing
in Cincinnati, Dr. Conner was associated with the
Price Hill Kiwanis Club and the Men’s Western
Hills Garden Club. He held the rank of lieutenant
colonel in the Ohio Defense Corps. His widow sur-
vives.
Claude Charles Crum, M. D., Torrance, Calif.;
Hospital College of Medicine, Louisville, Ky., 1901;
aged 88; died August 4; former member of the Ohio
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1076
The Ohio State Medical Journal
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for October, 1966
1077
State Medical Association. Dr. Crum practiced in
Columbus from 1930 to 1948. He is survived by his
widow and three daughters.
John T. Evans, Sr., M. D., Akron; Vanderbilt
University School of Medicine, 1926; aged 68; died
August 11; member of the Ohio State Medical Asso-
ciation, the American Medical Association, and the
American Academy of General Practice. A general
practitioner in Akron since 1928, Dr. Evans served
in the Army Reserve as a medical officer. Among
affiliations, he was a member of the Catholic Church.
Surviving are three daughters and four sons, among
them Dr. John T. Evans, Jr., of Jacksonville, Florida;
also three sisters and two brothers.
Richard Gilbert Hodges, M. D., Cleveland; Har-
vard Medical School, 1936; aged 57; died August 17;
member of the Ohio State Medical Association and
the American Academy of Pediatrics; diplomate of
the American Board of Pediatrics. Dr. Hodges was
chief of the pediatrics service at St. Luke’s Hospital
in Cleveland, and was formerly assistant professor of
pediatrics at Western Reserve University. He was
a veteran of World War II, having served in the Air
Force Medical Corps. Survivors include his widow,
two sons, a daughter, and two sisters.
William Maurice Hoyt, M. D., Grove City; Hahne-
mann Medical College and Hospital of Philadelphia,
1909; aged 84; died August 25; long a member of
the Ohio State Medical Association and the American
Medical Association. A native of Hillsboro, where
his father practiced before him, Dr. Hoyt served that
community as a practitioner for more than 50 years.
From 1963 to 1965 his practice was in Grove City.
Dr. Hoyt was first appointed to the State Medical
Board of Ohio in 1938 and served in that capacity
until his resignation in 1965. He was former coroner
of Highland County, was Highland County health
commissioner, and served as a member of the Hills-
boro Board of Education. He was a member of Phi
Kappa Psi Fraternity, and several Masonic bodies.
Survivors include his widow, and a son, Dr. Charles
W. Hoyt, of Cincinnati.
Stanley Hrynkiewich, M. D., Cleveland; Fried-
rich-Wilhelms University Faculty of Medicine, 1945;
aged 47; died April 18; member of the Ohio State
Medical Association, the American Medical Associa-
tion, and the American Society of Anesthesiologists.
Dr. Hrynkiewich was licensed to practice in Ohio
in 1956 and had been a practitioner in the Cleve-
land area since that time.
Floyd B. Jaquays, M. D., Cleveland; University of
Louisville School of Medicine, 1925; aged 67; died
August 8; member of the Ohio State Medical Asso-
ciation and the American Medical Association. A
practitioner in the Cleveland area for many years, Dr.
Jaquays began his specialty practice in ophthal-
mology in 1944. He retired in 1962 for reasons of
health. Among affiliations, he was a member of the
. . . introduce your patient to
(BENZTHIAZIDE)
AQUATAG (Benzthiazide) is a potent, orally
active, nonmercurial, diuretic agent. It is effective
orally in producing diuresis in edema states,
where it is therapeutically comparable to mercu-
rials given parenterally. AQUATAG (Benzthia-
zide) is mildly antihypertensive in its own right
and enhances the action of other antihyperten-
sive drugs when used in combination.
DIURETIC ACTION: Clinically, the oral administration of AQUATAG (benzthiazide) re-
sults in diuretic activity within two hours with maximal natriuretic, chloruretic, and diuretic
effects occurring during the fourth, fifth and sixth hours. Maintenance of response con-
tinues for approximately 12 to 18 hours. Acidosis is an unlikely complication since thera-
peutic doses of AQUATAG (benzthiazide) do not appreciably increase bicarbonate
excretion. Edematous patients receiving 50 mg. of AQUATAG (benzthiazide) daily for
five days developed a maximal increase in the rate of sodium excretion on the first day,
and maintained this high rate until depletion of excessive body stores of sodium.
In congestive heart-failure patients, AQUATAG (benzthiazide) produced the same
weight loss, during a 48-hour treatment period as did a maximally effective dose of
hydrochlorothiazide.
DOSAGE: Diuresis, initially 50 to 200 mg.; maintenance 25 to 150 mg., daily. Hyper-
tension 50 to 100 mg. initially, ad|usted to 50 mg. t.i.d. or downward to minimal effective
dosage level.
WARNINGS: Use with caution in the presence of renal disease as azotemia may be
precipitated or increased. In patients with advanced hepatic disease, electrolyte imbal-
ance may result in hepatic coma. Dosage of coadministered antihypertensive agents
should be reduced by at least 50%. In cases of suspected electrolyte imbalance, serum
electrolyte determinations.should be performed and imbalance, if any, corrected. Stenosis
or ulcer of small intestine have been reported with coated potassium formulas, and
surgery has been required and deaths have occurred. Based on surveys of both United
States and foreign physicians, incidence of these lesions is low and a causal relationship
in man has not been definitely established. Until further experience has been obtained,
the use of the drug in pregnant patients should be weighed against possible hazards
to the fetus.
CONTRAINDICATIONS: AQUATAG (benzthiazide) is contraindicated in progressive
renal disease or dysfunction including increasing oliguria and azotemia. Continued
administration of this drug is contraindicated in patients who show no response to its
diuretic or antihypertensive properties. Severe hepatic disease is a relative contra-
indication. (See "Warnings” above.)
PRECAUTIONS AND SIDE EFFECTS: Electrolyte imbalance with hypokalemia (digitalis
toxicity may be precipitated), hypochloremic alkalosis and hyponatremia may occur.
Patients with cirrhosis should be observed for impending hepatic coma and hypokalemia.
Other reactions may include blood dyscrasias, hyperuricemia and gout, nausea, jaundice,
anorexia, vomiting, diarrhea, dizziness, paresthesia, photosensitivity and headache.
Hepatic fetor, tremor, confusion and drowsiness are
signs of impending pre coma and coma in patients
with cirrhosis. Insulin requirements may be altered
in diabetes. AQUATAG (benzthiazide) should be
used with caution post-operatively as hypokalemia
is not uncommon. Potassium supplementation may be
advisable pre- and post-operatively. There have been
occasional reports of thrombocytopenia, leukopenia,
agranulocytosis, aplastic anemia and precipitation of
acute pancreatitis or jaundice.
Before prescribing or administering, read the pack-
age insert or file card available on request.
SJ.TUTAG
Available as 25 or 50 mg. scored tablets.
Request clinical samples and literature on your
letterhead.
& COMPANY
Detroit. Michigan 48234
1078
The Ohio State Medical Journal
New drugs take exams, too.
Today, virtually every medical school in the
United States cooperates with pharmaceutical
manufacturers in the clinical evaluation of new
and promising drugs. Just as you might find it
significantly more difficult to practice medicine
without the useful new compounds made avail-
able through original pharmaceutical research
in the past twenty years — prescription-drug
manufacturers would find it equally difficult to
obtain extensive, long-term, dependable evalu-
ations of new therapeutic agents without the
close cooperation of medical staffs and clinical
facilities of medical schools and teaching hos-
pitals. Such cooperation leads toward more
effective care of more patients — the common
goal of medical and pharmaceutical research —
toward reduction in the cost of disease, toward
increase in useful longevity.
This message is brought to you as a courtesy of this publica-
tion on behalf of the producers of prescription drugs.
Pharmaceutical
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Pharmaceutical
Advertising Council
1155 Fifteenth St.. N. W., Washington, D.C. 20005
Kiwanis Club and the Masonic Lodge. Survivors
include his widow and two sons.
Robert W. Kramer, Jr., M. D., Corning; Stritch
School of Medicine of Loyola University, 1954; aged
40; died August 20; member of the Ohio State Medi-
cal Association and the American Medical Associa-
tion. Dr. Kramer had been a practitioner in the
Corning area for six years, and previously practiced
for about three years in Dayton. He was a veteran
of World War II, during which he served with the
Navy Air Force. A member of the Catholic Church,
he is survived by his widow, three sons, a daughter,
his parents, and a brother.
Paul R. Lecklitner, M. D., Canton; Jefferson Medi-
cal College of Philadelphia, 1925; aged 65; died
July 28; member of the Ohio State Medical Associa-
tion and the American Medical Association. A Can-
ton practitioner for about 31 years, Dr. Lecklitner
specialized in orthopaedic surgery, and was physician
also for the Republic Steel Corporation. He was a
member of several Masonic bodies and the Evangeli-
cal United Brethren Church. Surviving are his
widow, two daughters, a son, a sister and a brother.
Robert Parker Little, M. D., Zurich, Switzerland;
Ohio State University College of Medicine, 1923;
aged 72; died July 7; former member of the Ohio
State Medical Association. Dr. Little practiced in
Columbus during the 1920’s before he moved to
California. He was making his home in Europe
in recent years.
Elmer H. McDonald, M. D., Dayton; Ohio State
University College of Medicine, 1911; aged 79; died
June 22; member of the Ohio State Medical Associa-
tion, the American Medical Association, and the Na-
tional Medical Association. Dr. McDonald practiced
medicine for some 52 years at Bloomingburg and
at Washington Court House. He was making his
home since retirement in Dayton with a son who
survives.
Charles E. McKinley, M. D., Camden; University
of Cincinnati College of Medicine, 1930; aged 64;
died August 11; member of the Ohio State Medical
Association. A native of Camden, Dr. McKinley
served virtually all of his professional career in the
Preble County community. He served during World
War II in the Medical Corps and attained the rank
of lieutenant colonel. For 20 years Dr. McKinley
served on the local school board, and among affilia-
tions was a member of the Presbyterian Church. He
is survived by his widow, a son, and a sister.
Ralph R. Wilkinson, M. D., Cincinnati; Miami
Medical College, Cincinnati, 1902; aged 90; died
August 23; former member of the Ohio State Medi-
cal Association. A practitioner of long standing in
Cincinnati where he specialized in obstetrics, Dr.
Wilkinson retired about 20 years ago. He is survived
by a daughter and two brothers.
William L. Wolffheim, M. D., Akron; Albertus
University Faculty of Medicine, Konigsberg, 1913;
aged 79; died August 28; member of the Ohio State
Medical Association and the American Medical As-
sociation. A native of Germany and practitioner
there for many years, Dr. Wolffheim came to this
country in 1941 and became a citizen four years later.
He practiced for 25 years in Akron, specializing in
the EENT field. His widow survives.
Lions Club Funds Help Research
Research on eye diseases at the University of Cin-
cinnati Medical Center will be supported this year by
$16,000 from the Ohio Lions Eye Research Founda-
tion. This brings to $86,500 the total given to the
University’s research program by the Foundation
since its establishment in 1952.
The Lions’ funds support the eye pathology lab-
oratory directed by Dr. Joseph Ginsberg, where re-
search is being conducted on birth defects and child-
hood tumors of the eye and effects of drug toxicity
on the eye.
GROUP LIFE INSURANCE
Initiated and Sponsored by
Your OHIO STATE MEDICAL ASSOCIATION
For Information, Call Or Write
TURNER & SHEPARD, inc.
insurance
20 SOUTH THIRD STREET COLUMBUS, OHIO 43215 PHONE 228-6115 CODE 614
1080
The Ohio State Medical Journal
SQUIBB NOTES ON THERAPY
MOLECULAR REMODELING-
laboratory exercise or clinical necessity?
j More than twenty-five years have passed
| since the discovery of the diuretic activ-
ity of sulfanilamide started pharmacol-
ogists on a succession of molecular re-
modelings to find the ideal diuretic.
i Diuresis— a sought-after clinical
effect from an unwanted side effect
It started in 1937 when a clinician re-
ported that the administration of a sul-
fonamide was sometimes accompanied
by an unexplainable side effect— meta-
bolic acidosis.1 Three years later the
side effect was explained. The sulfona-
mide radical of sulfanilamide inhibited
carbonic anhydrase,2 the enzyme re-
sponsible for converting carbon diox-
ide and water to hydrogen ions and bi-
carbonate ions.
Later, other investigators showed by
dog experiments that metabolic acidosis
probably resulted when the inhibition of
! carbonic anhydrase upset the exchange
of hydrogen and sodium ions, causing
increased excretion of sodium as the
bicarbonate.3
It was twelve long years after the
first report of the unexplainable side
effect (metabolic acidosis) that it was
finally shown that large doses of sulfa-
nilamide administered to edematous
patients were indeed capable of pro-
moting diuresis.4 However, the possibil-
ity of toxic effects from its prolonged
i use and its relatively weak diuretic ac-
tion made it impractical for clinical use
as a diuretic.5
Because the inhibition of carbonic
anhydrase seemed to be the key to ef-
fective diuresis, investigators began to
look for more potent enzyme inhibitors
; —in the hopes that they would be more
effective diuretics.
The most important of these early
compounds, acetazolamide, enjoyed sev-
eral years of fairly wide clinical use.
Its carbonic anhydrase inhibitory ac-
tivity was several hundred times greater
than that of sulfanilamide.6 The in-
crease in inhibitory activity, however,
increased not only the excretion of so-
; dium and bicarbonate ions, but also the
excretion of potassium.7 And, like its
predecessor, acetazolamide precipitated
! mild acidosis. Its prolonged use could
! result in hypokalemic acidosis.7
The ‘thiazides’— an answer to the
metabolic acidosis caused by
carbonic anhydrase inhibition
Despite the fact that the sulfonamide
■
group appeared to be responsible for
carbonic anhydrase inhibition which in
turn appeared to be responsible for di-
uresis, investigators began to synthesize
compounds with structural alterations
to the sulfonamide group.
The first major breakthrough came
with the synthesis of chlorothiazide.
Altering the sulfonamide group did in-
deed alter the ability of chlorothiazide
to inhibit carbonic anhydrase— it was
only 1/1 Oth as potent as acetazolamide
in inhibiting the enzyme.8 Despite the
drop in inhibitory potency, however,
chlorothiazide proved to be an effective
diuretic— an observation that led to the
conclusion that its diuaetic action was
due to some mechanism other than its
action on carbonic anhydrase.9’10
For effective diuresis, chlorothiazide
was administered in daily dosages rang-
ing from 250 to 2000 mg.11 It increased
the excretion of sodium and chloride;
and, to a lesser extent, potassium and
bicarbonate.11 The excretion of potas-
sium appeared to be maximal at higher
dose levels at which, theoretically, the
carbonic anhydrase inhibitory effect is
more active.11 Its prolonged use, there-
fore, could sometimes result in meta-
bolic hypokalemic, hypochloremic al-
kalosis.7
Naturetin— effective diuresis with
more favorable electrolyte balance
Other thiazides followed — with im-
provements being aimed at two particu-
lar areas: 1. attempts to increase di-
uretic action in relation to the milli-
gram potency of the drug, and 2. at-
tempts at a more favorable sodium/
potassium ratio in the urine, i.e., to de-
crease the excretion of potassium while
maintaining the excretion of sodium.12
One of these, Naturetin, Squibb Ben-
droflumethiazide, has made advances
on both these points. “By adding a 3-
benzyl radical to hydroflumethiazide a
rather dramatic reduction in dose range
is accomplished. With this drug, effec-
tive sodium excretion is obtained with
02
doses between 2.5 and 10 mg., which is
a 200 to 1 ratio as compared to chloro-
thiazide...” 13
Moreover, due probably to its virtual
lack of carbonic anhydrase inhibition,
Naturetin (bendroflumethiazide) has
been shown to cause less potassium and
bicarbonate loss and less alteration in
urinary pH than either chlorothiazide
or hydrochlorothiazide.
Naturetin is outstandingly effective
not only in establishing, but also in
maintaining, excretion of retained fluid
in edematous patients. And its duration
of action is sufficiently prolonged to
allow a single daily administration in
most patients. Naturetin is also an ef-
fective antihypertensive agent.
Contraindications: Severe renal impairment;
previous hypersensitivity.
Warning: Ulcerative small bowel lesions have
occurred with potassium-containing thiazide
preparations or with enteric-coated potassium
salts supplementally. Stop medication if ab-
dominal pain, distension, nausea, vomiting, or
G.I. bleeding occur.
Precautions: The dosage of ganglionic block-
ing agents, veratrum, or hydralazine when
used concomitantly must be reduced by at
least 50% to avoid orthostatic hypotension.
Electrolyte disturbances are possible in cir-
rhotic or digitalized patients.
Side Effects: Bendroflumethiazide may cause
increases in serum uric acid, unmask diabetes,
increase glycemia and glycosuria in diabetic
patients and may cause hypochloremic alka-
losis, hypokalemia; cramps, pruritus, paresthe-
sias, and rashes may occur.
Supplied: Naturetin (Squibb Bendroflumethia-
zide) 5 mg. and 2.5 mg. tablets. Also available
Naturetin c K [Squibb Bendroflumethiazide
(5 or 2.5 mg.) with Potassium Chloride (500
mg.)]. For full information, see Product Brief.
References: 1. Southworth, H.: Proc. Soc.
Exper. Biol. & Med. 36: 58, 1937. 2. Mann, T.
and Keilin, D.: Nature 746:164, 1940. 3. Pitts,
R. F., and Alexander, R. S.: Am. J. Physiol.
744:239, 1945. 4. Schwartz, W. B.: New Eng-
land J. Med. 240:173, 1949. 5. Friedberg,
C. K., in Moyer, J. H., and Fuchs, M.: Edema
Mechanisms and Management, Philadelphia,
W. B. Saunders Co., 1960, p. 259. 6. Cum-
ming, J. R.; Tabachnick, E., and Seelig, M., in
Moyer, J. H., and Fuchs, M.: op. cit., p. 254.
7. Werko, L., in Moyer, J. H., and Fuchs, M.:
op. cit., p. 188. 8. Beyer, K. H., Jr., in Moyer,
J. H., and Fuchs, M.: op. cit., p. 274. 9. Maren,
T. H., and Wiley, C. E.: J. Pharmacol. &
Exper. Therap. 742:230, 1964. 10. Earley,
L. E., and Orloff, J.: Ann. Rev. Med. 75:149,
1964. 11. Fuchs, M., and Mallin, S. R., in
Moyer, J. H., and Fuchs, M.: op. cit., p. 276.
12. Ford, R. V., in Moyer, J. H., and Fuchs,
M. : op. cit., p. 290. 13. cited in Fuchs, M., and
Mallin, S. R. (ref. 11): op. cit., p. 283.
Naturetin®
SQUIBB BENDROFLUMETHIAZIDE
to reduce excess fluid
or high blood pressure
Squibb
'The Priceless Ingredient’ of every product
is the honor and integrity of itSJnaRen
• • •
Activities of County Societies
LORAIN
A provocative title was chosen to commence the
Fall activities of Lorain County Medical Society, when
members and their wives met at the Aquamarine
Lodge, in Avon Lake, on the evening of September
13. The featured speaker of the evening, Homer
H. Stryker, M. D., of Kalamazoo, Michigan, chose
for the title of his address "Backing Into Business
Without Even Trying.”
A total of 138 were present, including 17 guests.
Continuing the policy of recent years, this September
meeting was a recognition dinner for the Board of
Supervisors of Lorain County Medical Foundation,
and those students within the county who received
scholarship grants from the Foundation to assist them
in furthering their careers in Medicine and Nursing.
Originally begun with surplus money from the Polio
Immunization Program in Lorain County, a total of
$1400 was awarded for the school year 1966-1967.
In introducing the Board of Supervisors, Society
President J. A. Cicerrella, M. D., acknowledged the
services and interest these community leaders have
displayed in their selection of deserving students.
Following presentation of the scholarship checks,
a short business meeting was conducted. Five mem-
bership applications received a first reading, and one
Associate Member was elected to Active Member-
ship in the Society. The status of one Active Mem-
ber was changed on his request to Intern/Resident
Membership with the approval of those present and
voting, for a two-year period while engaged in fur-
ther surgical training at University Flospitals in
Cleveland.
Secretary-Treasurer J. B. McCoy, M. D., intro-
duced Dr. Stryker, president of the Stryker Corpora-
tion. An orthopedic surgeon in Kalamazoo, Dr.
Stryker developed his hobby of designing and making
orthopedic and hospital equipment to use in his field
of surgery, from a small room in his basement into
what is now the Stryker Corporation, engaged in the
manufacture and world-wide distribution of the pro-
ducts of his invention. Recipient of several cita-
tions, he is one of 12 who have been elected by the
Michigan Health Council to the Michigan Health
Hall of Fame. An interesting connection with Lorain
County goes back to the years 1855 and 1856 when
Dr. Stryker’s grandfather attended Oberlin College.
Interspersed with humorous anecdotes, Dr. Stry-
ker’s theme was a timely portrayal of the "hurdles”
to be encountered by those pursuing the paths of pri-
vate enterprise.
LUCAS
The Academy of Medicine of Toledo and Lucas
County is again sponsoring a bowling team this year.
The season got under way on September 15 when
five-man teams met and officially joined the Academy
Bowling League.
The Academy has announced availability of a
Christmas card, sales from which will help boost the
Foundation Fund of the Academy.
SUMMIT
The Summit County Medical Society held its
monthly meeting on September 6 at the Children’s
Hospital Auditorium in Akron. Speaker for the oc-
casion was Dr. Lawrence C. Meredith, Elyria, Presi-
dent of the Ohio State Medical Association, who
discussed various aspects of issues of vital interest to
the medical profession, especially in regard to medi-
care, separate billing, interest in elections, organiza-
tion matters, etc.
TRUMBULL
The Trumbull County Medical Society held its
first meeting of the fall season on September 21 at
Squaw Creek Country Club. This was a joint meet-
ing with the ladies. A social hour and dinner pre-
ceded the program.
Speaker for the occasion was Fred Bordeaux, who
is associated with the Social Security Administration.
WINDSOR HOSPITAL
A NONPROFIT CORPORATION
— ESTABLISHED 1 8 9 8 —
Chagrin Falls, Ohio 44022
247-5300 (Area Code 216)
A hospital for the treatment
of Psychiatric Disorders
JOHN H. NICHOLS, M. D., Medical Director G. PAULINE WELLS, R. N., Admin. Director HERBERT A. SIHLER, Jr., Pres.
MEMBER: American Hospital Association — National Association of Private Psychiatric Hospitals — Ohio Hospital Association
Accredited by The Joint Commission on Accreditation of Hospitals.
Booklet available on request.
1082
The Ohio State Medical Journal
Establish and
maintain early,
more decisive
control of
blood pressure
DIUTENSEN:B
Cryptenamine 1.0 mg.* Methyclothiazide 2.5 mg. Reserpine 0.1 mg.
When blood pressure won’t stay down despite initial therapy—
when complaints of headache, fatigue or dizziness are often voiced —
it may be time for a change to Diutensen-R.
Diutensen-R is thiazide and reserpine plus cryptenamine— a rational,
comprehensive therapy to help establish and maintain early,
more decisive control of blood pressure.
The cryptenamine in Diutensen-R helps improve normal vasodilating
reflexes while the thiazide and reserpine components maintain
vasorelaxant, sedative, and saluretic benefits. Cryptenamine lowers
pressoreceptor reflex thresholds (which may be abnormally high in
hypertension) —“resets” pressoreceptors to function at more nearly
normotensive levels.
Early, more decisive control with Diutensen-R helps secure
continuing benefits — may reduce or even obviate the need for poorly
tolerated drugs later in therapy.
". . .quite apart from the problem of vascular damage, there
arises a possibility of virtual 'cure' or remission of hypertension
when treatment is early, i.e., before too many other secondary
pressor systems have entered into the disequilibrium of pressor con-
trol, and when it is adequately suppressive.”
Corcoran, A. C.: The choice of drugs in the treatment of hypertension. In: Drugs
of Choice 1966-67, W. Modell, Ed., St. Louis, C. V. Mosby Company, 1966, p. 417.
Indications: Diutensen-R may be employed in all grades of essential hypertension.
Dosages: Usual dose is 1 tablet twice daily, at morning and evening meals.
However, adjustment of dosage to suit individual circumstances may be
required. Please refer to package insert for full particulars. Side effects and
precautions: The side effects observed with patients on Diutensen-R have
been of a mild and nonlimiting nature. These include occasional urinary frequency,
nocturia, nasal congestion, muscle cramps, skin rash, joint pains due to gout
symptoms and nausea and dizziness which have been reported for the individual
components. Most of these symptoms disappear while the drug is continued at
the same or lower dosage level. The concomitant use of digitalis and Diutensen-R
may increase the possibility of digitalis-like intoxication. If there is
evidence of myocardial irritability (extrasystoles, bigeminy or AV block), dosage
of Diutensen-R should be reduced or discontinued. Nocturia in patients
with marginal cardiac status and salt and fluid retention can be effectively
controlled by limiting the time of administration to early afternoon.
Diutensen-R should not be used in patients with a known intolerance to reserpine.
Package inserts furnish a complete summary of recommended cautions related to
each of the ingredients of Diutensen-R.
*As tannate salts equivalent to 130 Carotid Sinus Reflex Units.
NEISLER gg)|
NEISLER LABORATORIES, INC. • DECATUR, ILLINOIS
SUBSIDIARY OF UNION CARBIDE CORPORATION
W Oman’s Auxiliary Highlights . . .
By MRS. S. L. MELTZER, Publicity Committee
Chairman, 2442 Dorman Dr., Portsmouth 45662
T
^HE COFFEE PARTY — the Postcard Party —
the Dial-a-Dozen Program — are they among
the coming season’s social calendar of important
events? Well — yes and no. Certainly they’re social
to a point — but the social activity they generate is
secondary to their vital role in pre-election activity.
Coffee Party? Postcard Party? Sounds provocative,
don’t you think? Let’s spotlight the real significance
of them in the social whirl — a whirl that has only
about a month now in which to produce results. And
while you’re "whirling,” never forget for one mo-
ment that this is a vital election year!
It might be well to remind you that before the
Coffee Party program is undertaken, the candidate’s
campaign manager must be contacted and the project
must be coordinated with the physician who is serving
as the candidate’s district chairman. Your objective
is to make certain the party is a success and that
the candidate meets all guests in a minimum of time.
Schedule the party to permit mothers to get chil-
dren off to school. A typical day would schedule
coffee parties at 9:30, 11:00 a. m. and 2:30 P. M. for
housewives; 4:00, 7:30 and 9:00 p. m. for business
girls or men, and/or couples, with an informal din-
ner with the community committee at 6:00 P. M.
Sunday afternoon patio gatherings are good. Satur-
days are generally poor choices for gatherings, but
don’t overlook the possibility of a group which
doesn’t fit the pattern.
The Coffee Party
Here are some suggestions for the hostess of the
Coffee Party: Invite your guests well in advance
whenever possible. In telephoning, tell them why
you want them to hear your candidate. Stress the
fact, where necessary, that attendance doesn’t imply
endorsement. A little flattery won’t hurt ! Tell them
you know their opinion carries weight and you would
like to have their estimate of the candidate.
Don’t try for more than 20 to 30 people at one
gathering at the very most (smaller groups, depend-
ing on your facilities, of course). If possible, make
up the guest list, showing full name, address and oc-
cupation of husband. Send the list to the candidate
so he has a chance to go over it. Keep the session
down to an hour and a half at the very most. Set
your invitation time for 15 minutes before the candi-
date is scheduled to arrive. Greet and seat guests
and have coffee served immediately. Have an assist-
ant write out a name tag for each guest.
See that you have an adequate supply of campaign
literature. Explain to the candidate that he will speak
for a few minutes and then be open to questions.
Inform the group on some interesting and favorable
points regarding the candidate and his family. Never
permit a guest to "buttonhole” the candidate or to
enter into arguments. Elaborate furnishings, food or
tea services are unnecessary. The Coffee Party is an
excuse for getting together, and the stress should be
on easy informality and comfort. Above all, do not
let the party drag — if necessary, adjourn the get-
together early. Remember that at all times the
hostess is captain of the ship.
The Dial-A-Dozen Program has this objective:
To obtain as many people as possible to telephone
on behalf of the candidate. The technique is applied
by using various mailing lists from which a letter is sent
asking individuals to telephone 12 of their friends.
Close friends, acquaintances and neighbors are the
best prospects to call. It is suggested that the caller
identify herself and state she is interested in electing
the candidate and that she has volunteered to call on
his behalf. If the person called expresses interest and
wants to help, this should be clearly indicated on the
tally sheet. To make this telephone campaign most
effective, the results of the calls noted on the tally
sheet should be returned to the candidate’s headquar-
ters promptly.
Again it is important to remember that before tak-
ing any of the above action, the candidate’s campaign
manager must be contacted as well as the physician
serving as the candidate’s district chairman.
The Postcard Party
What is the Postcard Party and its objective? To
get a personal endorsement of a candidate in the
hands of every voter. This works best in small or
suburban communities where people know each other.
Have the party well in advance of the mailing date.
Mail the cards just a few days before the election.
There should be two committees: One the "prepara-
tion” group — to address cards; the second, the
"signing” group consisting of prominent individuals
in the community to sign the cards. The cost involved
is in purchasing and printing of the postcards (if
possible the cards should have a picture of the can-
didate) and, of course, the postage. Have coffee
available and plenty of ball point pens. It’s a good
idea, if practical, to have the candidate stop in and
1088
The Ohio State Medical Journal
You can have a system “tailored” to your needs
— using standard HP Sanborn monitoring mod-
ules — whether it involves a few conditions for
a few patients ... or many patient conditions,
eight or more beds, and complete central station
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heart rate, for example (shown above), and as
needs and budget enlarge, add “780” modules
to monitor more functions, more patients or
both. (Illustration below shows the addition of
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astolic pressure monitoring functions, plus pace-
maker, to the original two functions.) System
suitability, economy, future functional and loca-
tion adaptability, and rapid staff training are the
continuing benefits of modular “780” systems.
able to free space around beds, or two styles of
“780” carts give complete instrumentation mo-
bility. For Central Station use, a wide choice of
units is available for visual display, audible
alarm, signal switching, graphic and tape re-
cording.
When complete cardiac function monitoring is
needed, with automatic ECG recording at se-
lected intervals or on distress, the 780B Viso-
Monitor provides it in a single bedside unit.
Indicators display heart rate, QRS event, brady-
cardia, tachycardia, pulse loss and arrest; in-
ternal/external pacemaker is built in. Com-
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alarm of all conditions monitored by the Viso-
Monitor.
Specific capabilities of these units, in addition to
those mentioned, include venous pressure mon-
itoring . . . internal /external DC defibrillation
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HP/Sanborn field offices can give you valuable
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Cincinnati Sanborn Division, 4110 North Avenue, Silverton, (513) 891-7396
Cincinnati, Ohio 45236
for October , 1966
1089
thank everyone who has had a part in the addressing
and signing.
At the risk of repeating myself, I want to say
again that this is far more than just an ordinary
election year. It is an election of considerable signifi-
cance and importance. If you want the right man
to be elected, you’ve got to do a lot more than
vote for him, vital as that is. You’ve got to convince
others that he is the right man. The time has long
since past when doctors and doctors’ families can sit
back complacently and say politics is not their meat.
Whether it likes it or not, the medical profession
has been catapulted onto the political scene.
A Personal Plea
To local publicity chairmen ! Do you want your
county written up in this column so that the doctors
know what you are doing? Don’t you think your
county auxiliary merits all the publicity it can get?
Will you cooperate with me, please, by sending your
newspaper clippings and any other data relating to
your group to me? — each and every month!
This column designated for the October issue is
shorter than usual. Auxiliaries do not meet during
the summer months and this is, of necessity, being
written in early September. Moreover, your reporter
is vacationing in New England and she’s short on
material but long on colorful, incredible scenery !
But if this month’s column does what it is primarily
intended to do — to get each and every one of you
on the bandwagon of election activity and fervor —
then the abbreviated length is of no moment. One
last thought: Fall Conference is just upon us (Oct-
ober 11 and 12 in Columbus). There is so much
good to be had from attending it — and even some
fun ! Give Ruth Wychgel and Ludel Sauvageot your
support by being there . . . And give the rest of us
on the State Board the chance to meet you to help
you and to answer any questions you may have.
We’d consider it a privilege, truly ... Be seeing
you . . .
COMING MEETINGS
Ohio State Medical Association:
1967 Annual Meeting, Columbus, May 15-19.
1968 Annual Meeting, Cincinnati, Week of May 12.
1969 Annual Meeting, Columbus, Week of May 1 1 .
American Medical Association:
1966 Clinical Convention, Las Vegas, Nevada,
November 27-30.
1967 Annual Convention, Jersey City, N. J., June
18-22.
American College of Physicians, (Regional, in-
cluding Ohio), Morgantown, W. Va., January 20-21.
American Rheumatism Association, Netherland
Hilton Hotel, Cincinnati, December 2-3.
Association of Physicians of the Department of
Mental Hygiene and Correction, Columbus, Octo-
ber 14.
Disaster Institute Program, Columbus, October 30.
Sixth Councilor District Postgraduate Day,
Akron, October 19.
Symposium on Diabetes Mellitus, Sponsored by
Ohio State University College of Medicine and Cen-
tral Ohio Diabetes Association, October 26, at the
Fort Hayes Hotel, Columbus.
American College of Physicians
Gastroenterology Program
The American College of Physicians, with head-
quarters at 4200 Pine Street, Philadelphia, Pa. 19104,
has announced a program entitled "Progress in Gas-
troenterology— 1966,’’ to be given in cooperation
with the University of Pennsylvania School of Medi-
cine, November 28 - December 2. Place is the audi-
torium of the Annenberg School of Communications,
3620 Walnut Street, Philadelphia.
1090
The Ohio Slate Medical Journal
iff
Diagnosis:
cystitis?
pyelonephritis?
pyelitis?
urethritis?
prostatitis?
any case,
usually gram-negative3
Bfl
89
Therapy!
two 500 mg. Caplets® q.i.d,
(initial adult dose)
NegGrarrr
Brand of
nalidixic acid
a specific anti-gram-negative
eradicates most urinary
tract infections...
lions: Urinary tract infections caused by gram-negative and some gram-
'e organisms.
fleet*: Mainly mild, transient gastrointestinal disturbances; in
onal instances, drowsiness, fatigue, pruritus, rash, urticaria, mild
•philia, reversible subjective visual disturbances (overbrightness of
change in visual color perception, difficulty in focusing, decrease in
acuity and double vision), and reversible photosensitivity reactions.
i overdosage, coupled with certain predisposing factors, has produced
onvulsions in a few patients.
itlons: As with all new drugs, blood and liver function tests are advis-
jring prolonged treatment. Pending further experience, like most
therapeutic agents, this drug should not be given in the first trimester
inancy. It must be used cautiously in patients with liver disease or
Impairment of kidney function. Because photosensitivity reactions have
ad in a small number of cases, patients should be cautioned to avoid
issary exposure to direct sunlight while receiving NegGram, and if a
n occurs, therapy should be discontinued. The dosage recommended
Its and children should not arbitrarily be doubled unless under the
supervision of a physician. Bacterial resistance may develop.
esting the urine for glucose in patients receiving NegGram, Clinistix®
it Strips or Tes-Tape® should be used since other reagents give a
ositive reaction.
»: Adults: Four Gm. daily by mouth (2 Caplets® of 500 mg. four times
or one to two weeks. Thereafter, if prolonged treatment Is indicated,
iage may be reduced to two Gm. dally. Children may be given
Imately 25 mg. per pound of body weight per day, administered in
I doses. The dosage recommended above for adults and children
not arbitrarily be doubled unless under the careful supervision of a
ian. Until further experience is gained, Infants under 1 month
not be treated with the drug.
ipplied: Buff-colored, scored Caplets® of 500 mg. for adults, conve-
available in bottles of 56 (sufficient for one full week of therapy) and in
of 1000. 250 mg. for children, available in bottles of 56 and 1000.
nces: (1) Based on 23 clinical papers, 1512 cases. Bibliography on
t- (2) Bush, I. M., Orkin, L. A., and Winter, J. W., in Sylvester, J. C.:
crobial Agents and Chemotherapy -1964, Ann Arbor, American
1 for Microbiology, 1965, p. 722.
• Low incidence of untoward effects; no fungal
overgrowth, crystalluria, ototoxic or nephrotoxic
effects have been observed.
• “Excellent” or “good” response reported in
more than 2 out of 3 patients with either chronic
or acute gram-negative infections.1
^throp
1r°P Laboratories, New York, N. Y. 10016
*As many as 9 out of 10 urinary tract infections are now caused
by gram-negative organisms: E. coli, Klebsiella, Aerobacter,
Proteus, Paracolon or Pseudomonas2. . . However, infections of the
urethra and prostate caused by non-gonococcal gram-negative
organisms are believed to be less prevalent.
State Association Officers and Committeemen
Headquarters Office: 17 S. High St. — Suite 500, Columbus 43215. Telephone: (614) 228-6971
OFFICERS and COUNCILORS
Lawrence C. Meredith, M. D., President
205 Elyria Block, Elyria 44035
Robert E. Howard, M. D., President-Elect
2500 Central Trust Tower, Cincinnati 45202
Henry A. Crawford, M. D., Past President
1058 Hanna Bldg., Cleveland 44115
Philip B. Hardymon, M. D., Treasurer
350 East Broad St., Columbus 43215
Paul N. Ivins, M. D., First District
306 High Street, Hamilton 45011
Theodore L. Light, M. D., Second District
2670 Salem, Avenue, Dayton 45406
Frederick T. Merchant, M. D., Third District
1051 Harding Memorial Parkway,
Marion 43305
Robert N. Smith, M. D., Fourth District
3939 Monroe Street, Toledo 43606
P. John Robechek, M. D., Fifth District
10525 Carnegie Avenue, Cleveland 44106
Edwin R. Westbrook, M. D., Sixth District
438 North Park Avenue, Warren 44481
Sanford Press, M. D., Seventh District
525 N. Fourth Street, Steubenville 43952
Robert C. Beardsley, M. D., Eighth District
2236 Maple Avenue, Zanesville 43705
Oscar W. Clarke, M. D., Ninth District
4th & Sycamore St., Gallipolis 45631
Richard L. Fulton, M. D., Tenth District
1211 Dublin Road, Columbus 43212
William R. Schultz, M. D., Eleventh District
1749 Cleveland Road, Wooster 44691
THE EXECUTIVE STAFF
Hart F. Page, Executive Secretary
Herbert E. Gillen, Administrative Assistant
W. Michael Traphagan, Administrative Assistant
Charles W. Edgar, Director of Public Relations
and Assistant Executive Secretary
Jerry J. Campbell, Administrative Assistant
R. Gordon Moore, Executive Editor
THE EDITOR: Perry R. Ayres, M. D.
COMMITTEES
Committee on Education — Thomas E. Rardin, Columbus, Chair-
man (1971) ; Clyde W. Muter, Warren (1970) ; Thomas S.
Brownell, Akron (1969) ; John G. Sholl, Cleveland (1968) ;
Elmer R. Maurer, Cincinnati (1967).
Judicial and Professional Relations Committee — Frank F. A.
Rawling, Toledo, Chairman (1968) ; Henry A. Crawford, Cleve-
land (1971) ; Homer A. Anderson, Columbus (1970) ; Chester H.
Allen, Portsmouth (1969) ; David Fishman, Cleveland (1967).
Committee on Public Relations and Economics — Frederick P.
Osgood, Toledo, Chairman (1969) ; Horace B. Davidson, Colum-
bus (1971) ; Luther W. High, Millersburg (1970) ; John H.
Budd, Cleveland (1968) ; John J. Cranley, Jr., Cincinnati
(1967).
Committee on Scientific Work — Samuel Saslaw, Columbus,
Chairman (1968) ; Jerry Hammon, West Milton (1971) ; Robert
E. Zipf, Dayton (1971) ; Jack Schreiber, Canfield (1970) ;
Walter J. Zeiter, Cleveland (1970) ; John D. Battle, Jr., Cleve-
land (1969) ; Harold J. Schneider, Cincinnati (1969) ; Isador
Miller, Urbana (1968) ; William Hamelberg, Columbus (1967) ;
F. A. Simeone, Cleveland (1967).
Committee on AMA-ERF — Robert S. Martin, Zanesville,
Chairman.
Committee on Auditing and Appropriations — William R.
Schultz, Wooster, Chairman ; Edwin R. Westbrook, Warren ;
George Newton Spears, Ironton.
Committee on Cancer — Arthur G. James, Columbus, Chair-
man ; Thomas D. Allison, Lima ; Andrew M. Barone, Lima ;
William F. Boukalik, Cleveland; William J. Flynn, Youngs-
town ; Douglas P. Graf, Cincinnati ; Stanley O. Hoerr, Cleve-
land ; William A. Newton, Jr., Columbus ; W. D. Nusbaum,
Lancaster ; Arthur E. Rappoport, Youngstown ; Carl A. Wilz-
bach, Cincinnati.
Committee on Disaster Medical Care — Thomas D. Allison,
Lima, Chairman ; Thomas P. Bowlus, Toledo ; Nino M. Camardese,
Norwalk ; Drew L. Davies, Columbus ; John H. Davis, Cleveland ;
Gregory G. Floridis, Dayton ; Robert D. Gillette, Huron ; Robert
S. Heidt, Cincinnati ; Robert E. Holmberg, Cleveland ; N. J. M.
Klotz, Wadsworth ; Thomas W. Morgan, Gallipolis ; Sterling
W. Obenour, Jr., Zanesville; Vol K. Philips, Columbus; Liaison
with the American Medical Association : Wendell A. Butcher,
Columbus.
Committee on Environmental Health — Rex H. Wilson, Akron,
Chairman ; William W. Davis, Columbus ; Larry L. Hipp, Gran-
ville ; Robert C. Markey, Bowling Green ; B. C. Myers, Lorain ;
Tuathal P. O’Maille, Marietta ; Thomas N. Quilter, Marion ; I. C.
Riggin, Lorain ; Robert E. Schulz, Wooster ; Victor A. Simiele,
Lancaster ; John P. Storaasli, Cleveland ; Robert Vogel, Dayton ;
Robert C. Waltz, Cleveland ; Tennyson Williams, Delaware ;
John L. Zimmerman, Fremont.
Committee on Eye Care — Arthur D. Collins, Cleveland, Chair-
man ; Martin J. Cook, Springfield ; Thomas L. Edwards, Lima ;
Robert H. Magnuson, Columbus ; Russell J. Nicholl, Cleveland ;
Claude S. Perry, Columbus ; Norman W. Pinschmidt, Gallipolis ;
Barnet R. Sakler, Cincinnati ; Robert L. Willard, Toledo.
Committee on Government Medical Care Programs — H. Wil-
liam Porterfield, Columbus, Chairman ; James O. Barr, Chagrin
Falls ; Dwight L. Becker, Lima ; Robert A. Borden, Fremont ;
Edwin W. Burnes, Van Wert ; Philip T. Doughten, New Phila-
delphia ; Robert B. Elliott, Ada ; George T. Harding, Sr.,
Worthington ; Roger E. Heering, Columbus ; M. Robert Huston,
Millersburg ; Francis M. Lenhart, Defiance ; Harold E. Mc-
Donald, Elyria ; Elliott W. Schilke, Springfield ; Bernard A.
Schwartz, Cincinnati; Clarence V. Smith, Canton; Joseph B.
Stocklen, Cleveland; Don P. Van Dyke, Kent; William M.
Wells, Newark.
Committee on Hospital Relations — Robert M. Craig, Dayton,
Chairman ; L. Fred Bissell, Aurora ; L. A. Black, Kenton ;
Wendell T. Bucher, Akron ; Oscar W. Clarke, Gallipolis ; Henry
A. Crawford, Cleveland; John V. Emery, Willard; Harvey C.
Gunderson, Toledo ; Henry L. Hartman, Toledo ; E. R. Haynes,
Zanesville ; Middleton H. Lambright, Cleveland ; Lloyd E. Lar-
rick, Cincinnati; James C. McLarnan, Mt. Vernon; Ben V.
Myers, Elyria ; E. W. Schilke, Springfield ; Robert A. Tennant,
Middletown ; V. William Wagner, Port Clinton ; William A.
White, Canton.
Committee on Insurance — David A. Chambers, Cleveland,
Chairman ; William F. Bradley, Columbus ; Walter A. Daniel,
Tiffin ; Chester R. Jablonoski, Cleveland ; William A. Knapp,
Zanesville ; Marvin R. McClellan, Cincinnati ; William Neal,
Archbold ; Oliver E. Todd, Toledo ; Robert E. Tschantz, Canton ;
Allan L. Wasserman, Dayton; John W. Wherry, Elyria; Wil-
liam A., White, Canton.
Committee on Laboratory Medicine — Horace B. Davidson,
Columbus, Chairman; William H. Benham, Columbus; John B.
Hazard, Cleveland ; Melvin Oosting, Dayton ; Arthur E. Rappo-
port, Youngstown; William Sinclair, Cleveland; Gilbert B.
Stansell, Toledo; Philip B. Wasserman, Cincinnati.
1092
The Ohio State Medical Journal
State Association Officers and Committeemen (Continued)
Committee on Legislation — James T. Stephens, Oberlin, Chair-
man ; Chester H. Allen, Portsmouth; Donald R. Brumley, Find-
lay; Jonathan G. Busby, Columbus; George D. J. Griffin, Cin-
cinnati ; Jack L. Kraker, Lancaster ; William J. Lewis, Dayton ;
Maurice F. Lieber, Canton ; James C. McLarnan, Mt. Vernon ;
Wesley J. Pignolet, Willoughby ; Marvin J. Rassell, Hamilton ;
Theodore E. Richards, Urbana ; Robert E. Rinderknecht, Dover ;
John H. Sanders, Cleveland; William W. Trostel, Piqua.
Committee on Maternal Health — Anthony Ruppersberg, Colum-
bus, Chairman ; Otis G. Austin, Medina ; Raymond E. Barker,
Columbus ; William D. Beasley, Springfield ; Keith R. Brande-
berry, Gallipolis ; Thomas E. Byrne, Mentor ; Mel A. Davis,
Columbus ; Marion F. Detrick, Jr., Findlay ; John P. Garvin,
Columbus ; Richard P. Glove, Cleveland ; Robert A. Heilman,
Columbus; John F. Hillabrand, Toledo; Robert E. Johnstone,
Cincinnati; Albert A. Kunnen, Dayton; James F. Morton,
Zanesville ; Ralph K. Ramsayer, Canton ; Robert E. Swank,
Chillicothe ; Densmore Thomas, Warren; Robert S. VanDervort,
Elyria.
Committee on Medicine and Religion — Charles A. Sebastian,
Cincinnati, Chairman ; John D. Albertson, Lima ; Eugene F.
Damstra, Dayton ; Francis M. Lenhart, Defiance ; Ralph W.
Lewis, Portsmouth ; George W. Petznick, Cleveland ; J. Kenneth
Potter, Cleveland; John R. Seesholtz, Canton; William B.
Smith, Zanesville; James T. Stephens, Oberlin; Donald J.
Vincent, Columbus; Don G. Warren, West Lafayette.
Committee on Mental Health — Wendell A. Butcher, Columbus,
Chairman ; Homer A. Anderson, Columbus ; Robert D. Eppley,
Elyria ; Max D. Graves, Springfield ; Richard G. Griffin, Worth-
ington ; Warren G. Harding, Columbus ; Edward O. Harper,
Cleveland ; Henry L. Hartman, Toledo ; William H. Holloway,
Akron ; C. Eric Johnston, Columbus ; Robert E. Reiheld, Orr-
ville ; Philip C. Rond, Columbus ; W. Donald Ross, Cincinnati ;
Viola V. Startzman, Wooster; Victor M. Victoroff, Cleveland.
Military Advisory Committee — Drew L. Davies, Columbus,
Chairman ; Ralph G. Carothers, Cincinnati ; Homer D. Cassel,
Dayton ; Henry A. Crawford, Cleveland ; Walter L. Cruise,
Zanesville ; Charles R. Keller, Mansfield ; Ralph W. Lewis,
Portsmouth ; Edward L. Montgomery, Cireleville ; Frank T.
Moore, Akron ; Frederick P. Osgood, Toledo ; Earl Rosenblum,
Steubenville; Richard G. Weber, Marion.
Committee on Rural Health — Robert E. Reiheld, Orrville,
Chairman; Chester J. Brian, Eaton; Robert R. C. Buchan,
Troy; J. Martin Byers, Greenfield; Walter A. Campbell, Co-
shocton ; E. Joel Davis, East Canton ; Victor R. Frederick,
Urbana ; Benjamin W. Gilliotte, Zanesville ; Jerry L. Hammon,
West Milton; Jasper M. Hedges, Cireleville; Luther W. High,
Millersburg ; E. D. Mattmiller, Athens ; John R. Polsley, North
Lewisburg ; Leonard S. Pritchard, Columbiana ; Harold C.
Smith, Van Wert ; Kenneth W. Taylor, Pickerington.
OSMA Advisory Committee to the Ohio State Society of
Medical Assistants — Richard L. Fulton, Columbus, Chairman ;
George Newton Spears, Ironton.
Committee on School Health — Charles H. McMullen, Loudon-
ville. Chairman; Walter Felson, Greenfield; Howard H. Hop-
wood, Cleveland ; Dale A. Hudson, Piqua ; Howard J. Ickes,
Canton ; Charles L. Kagay, Dayton ; Thomas E. Wilson, Warren ;
Robert C. Markey, Bowling Green ; Robert J. Murphy, Colum-
bus ; Carey B. Paul, Jr., Columbus ; Carl L. Petersilge, Newark ;
William H. Rower, Ashland ; Thomas E. Shaffer, Columbus ;
Aubrey L. Sparks, Warren; Homer B. Thomas, Gallipolis.
OSMA Members of the Joint Committee on School Bus Driver
Examinations — Carey B. Paul, Jr., Columbus; Thomas N.
Quilter, Marion ; Drew L. Davies, Columbus.
OSMA Members of the Joint Advisory Committee on Athletic
Injuries — Walter A. Hoyt, Jr., Akron ; John R. Jones, Toledo ;
Don A. Kelly, Cleveland; Sol Maggied, West Jefferson; Marvin
R. McClellan, Cincinnati ; Robert P. McFarland, Oberlin ;
Charles H. McMullen, Loudonville ; Robert J. Murphy, Colum-
bus ; Carey B. Paul, Jr., Columbus ; Thomas E. Shaffer,
Columbus.
Committee on Workmen’s Compensation — H. P. Worstell,
Columbus, Chairman ; A. L. Berndt, Portsmouth ; Thomas H.
Brown, Jr., Toledo ; Charles A. Browning, Jr., Bellefontaine ;
Oscar W. Clarke, Gallipolis ; Frederick A. Flory, Columbus ;
Lawrence T. Hadbavny, Cleveland ; Clyde O. Hurst, Ports-
mouth ; Edmund F. Ley, Tiffin ; Joseph Lindner, Sr., Cincinnati ;
John D. Osmond, Jr., Cleveland ; James G. Roberts, Akron ;
George L. Sackett, Sr., Painesville ; William V. Trowbridge,
Cleveland ; Rex H. Wilson, Akron ; James N. Wychgel, Cleve-
land; Joseph H. Shepard, Columbus; Frederick A. Wolf,
Cincinnati.
Woman’s Auxiliary Advisory Committee — Robert C. Beard-
sley, Zanesville, Chairman ; Theodore L. Light, Dayton ; Fred-
erick T. Merchant, Marion.
Ohio Medical Indemnity Liaison Committee — Robert E.
Tschantz, Canton, Chairman ; Henry A. Crawford, Cleveland ;
Lawrence C. Meredith, Elyria ; Mr. Hart F. Page, Executive
Secretary, OSMA, Columbus.
DELEGATES AND ALTERNATES
Delegates and Alternates to the American Medical Association
— George W. Petznick, Cleveland ; H. T. Pease, Wadsworth, alter-
nate ; Carl A. Lincke, Carrollton ; Robert S. Martin, Zanesville,
alternate ; Theodore L. Light, Dayton ; Kenneth D. Arn, Dayton,
alternate ; Edmond K. Yantes, Wilmington ; Harry K. Hines,
Cincinnati, alternate; John H. Budd, Cleveland; P. John Robe-
chek, Cleveland, alternate ; Richard L. Meiling, Columbus ;
Frank F. A. Rawling, Toledo, alternate ; Frederick P. Osgood,
Toledo ; Robert N. Smith, Toledo, alternate ; Charles A. Sebas-
tian, Cincinnati ; J. Robert Hudson, Cincinnati, alternate ; Ed-
win H. Artman, Chillicothe ; Philip B. Hardymon, Columbus,
alternate ; Robert E. Tschantz, Canton ; Henry A. Crawford,
Cleveland, alternate.
County Societies’ Officers and Meeting Dates
First District
Councilor: Paul N. Ivins, Hamilton 45011
306 High Street
ADAMS — Gary J. Greenlee, President, Manchester 45144 ; Stan-
ley H. Title, Secretary, Manchester 45144.
BROWN — Charles H. Maly, President, Sardinia 45171 ; Charles
W. Hannah, Secretary, Sardinia 45171. 1st Monday monthly.
BUTLER — Robert Johnson, President, 500 S. Breiel Boulevard.
Middletown 45042 ; Mr. Charles G. Greig, Executive Secretary,
110 North Third Street, Hamilton 45011. 4th Wednesday
monthly.
CLERMONT — Cecil F. Barber, President, State Route 133, Feli-
city 45120; Phillips F. Greene, Secretary, Route 1, Box 509.
New Richmond 45157. 3rd Wednesday monthly, except July
and August.
CLINTON — Richard R. Buchanan, President, 115 West Main,
Wilmington 45177 ; Mary Ranz Boyd, Secretary, Box 629,
Wilmington 45177. 4th Tuesday monthly.
HAMILTON — Elmer R. Maurer, President, 320 Broadway, Cin-
cinnati 45202 ; Mr. Edward F. Willenborg, Executive Secretary,
320 Broadway, Cincinnati 45202. Monthly meeting dates, 1st
Tuesday; Academy, 3rd Tuesday, except June, July and August.
HIGHLAND — Thomas L. Jones, President, 528 South St., Green-
field 45123 ; Walter Felson, Secretary, 357 South St., Greenfield
45123. 3rd Tuesday bimonthly.
WARREN — O. Williard Hoffman, President, 20 East Fourth
Street, Franklin 45005 ; Ray E. Simendinger, Secretary, 901
North Broadway Street, Lebanon 45036. 2nd Tuesday monthly.
Second District
Councilor: Theodore L. Light, Dayton 45406
2670 Salem Ave.
CHAMPAIGN — Myron J. Towle, President, 848 Scioto Street,
Urbana 43078 ; Fred R. Denkewalter, Secretary, 848 Scioto
Street, Urbana 43078. 2nd Wednesday monthly.
CLARK — Henry M. Tardif, President, 2608 E. High Street.
Springfield 45505 : Mrs. Marion L. Wilcoxson, Executive
Secretary, 616 Building, Room 131, 616 N. Limestone St.,
Springfield 44503. 3rd Monday monthly, except June, July
and August.
DARKE — William A. Browne, President, 722 Sweitzer St.,
Greenville 45331 ; Delbert D. Blickenstaff, Secretary, 552 S.
West St., Versailles 45380. 3rd Tuesday monthly.
GREENE — Clement G. Austria, President, 1142 North Monroe
Drive. Xenia 45385 ; Mrs. C. K. Elliott, Executive Secretary,
225 Pleasant Street, Xenia 45385. 2nd Thursday monthly
except July and August.
MIAMI — David Brown, President, 1060 North Market Street,
Troy 45373; Jack P. Steinhilber, Secretary, 145 Sunset Drive,
Piqua 45356. 1st Tuesday monthly.
MONTGOMERY — Charles E. O’Brien, President, 600 Fidelity
Ruilding, Dayton 45402 ; Mr. Robert F. Freeman, Executive
Secretary, 280 Fidelity Medical Building, Dayton 45402. 1st
Friday monthly October through May — 1st Wednesday June.
PREBLE — John D. Darrow, President, 228 N. Barron St., Eaton
45320 ; Willard C. Clark, Jr., Secretary, 228 N. Barron, Eaton
45320. Irregular meetings.
SHELBY — George J. Schroer, President, 322 Second Ave., Sidney
45365 : Alfonsas Kisielius, Secretary, Ohio Bldg., Sidney 45365.
for October, 1966
1093
County Societies’ Officers and Meeting Dates (Continued)
Third District
Councilor: Frederick E. Merchant, Marion 43305
1051 Harding Memorial Pky.
ALLEN — Carl H. Zinsmeister, President, 729 W. Market Street.
Lima 45801 ; Thomas D. Allison, Secretary, 401 Metropolitan
Bank Building, Lima 45801. 3rd Tuesday monthly.
AUGLAIZE — Robert Sobocinski, President, 75 Blackhoof Street,
Wapakoneta 45895 ; J. F. Bowling, Secretary, 319 West Spring
Street, St. Marys 45885. 1st Thursday monthly except July.
CRAWFORD — Don E. Ingham, President, 201 N. Market Street,
Galion 44833 : Johnson H. Chow, Secretary, 1040 Devonwood
Drive, Galion 44833. Called meetings.
HANCOCK — Raymond J. Tille, President, 801 S. Main St., Find-
lay 45840 ; Herbert L. Queen, Secretary, 828 Woodworth Dr.,
Findlay 45840.
HARDIN— William D. Dewar, President, 405 North Main Street,
Kenton 43326 ; John J. Roget, Secretary, Belle Center 43310.
2nd Tuesday monthly.
LOGAN — Thomas Seitz, President, 223 E. Columbus Street,
Bellefontaine 43311 ; Glen Miller, Secretary, R. D. 2, West
Liberty 43357. 1st Friday monthly.
MARION — Ransome Williams, President, 1035 Harding Me-
morial Parkway, Marion 43302 ; Alice Fisher, Secretary, 1040
Delaware Avenue, Marion 43302. 1st Tuesday monthly.
MERCER — R. Duane Bradrick, President, Rockford 45882 ; R. L.
Dobbins, Secretary, 5402 State Route 29 East, Celina. 3rd
Thursday, monthly.
SENECA — Olgierd C. Garlo, President, 53 Clay Street, Tiffin
44883 ; Leonard M. Gaydos, Secretary, 233 South Monroe
Street, Tiffin 44883. 3rd Tuesday monthly.
VAN WERT — Norman L. Marxen, President, Medical Arts Bldg.,
Fox Road, Van Wert 45891 ; W. L. Iler, Secretary, Medical
Arts Bldg., Fox Road, Van Wert 45891. 4th Friday monthly.
WYANDOT — Herschel A. Rhodes, President, 777 N. Sandusky
Ave., Upper Sandusky 43351 ; J. J. Browne, Secretary, 777 N.
Sandusky Ave., Upper Sandusky 43351. 2nd Tuesday monthly.
Fourth District
Councilor: Robert N. Smith, Toledo 43606
3939 Monroe St.
DEFIANCE — L. F. Berry, Jr., President, 1400 East Second
Street, Defiance 43512 ; W. S. Busteed, Secretary, Box 218,
Defiance 43512.
FULTON — B. H. Reed. Jr., President, Delta 43515 ; R. L. Davis,
Secretary, Wauseon 43567. 2nd Tuesday quarterly March,
June, September, December.
HENRY — J. J. Harrison, President, 113 East Clinton Street,
Napoleon 43545 ; Gamble S. Hall, Secretary, 834 Strong
Street, Napoleon 43545. 1st Tuesday monthly.
LUCAS — E. L. Doermann, President, 2001 Collingwood Blvd.,
Toledo 43620 : Mr. Robert W. Elwell, Executive Secretary, 3101
Collingwood Blvd., Toledo 43610. 3rd Tuesday monthly except
July and August.
OTTAWA — V. Wm. Wagner, President, 122 East Perry, Port
Clinton 43452 ; William Coon, Secretary, 120 East Perry, Port
Clinton 43452. 2nd Thursday monthly.
PAULDING — Roy R. Miller, President, 220 W. Perry, Paulding
45879 ; D. Paul Ward, Secretary, Box 416, Oakwood 45873.
Meetings called.
PUTNAM — Arthur P. Daniel, President, 144 N. Walnut, Ottawa
45875 ; Oliver N. Lugibihl, Secretary, Pandora 45877. 1st
Tuesday monthly.
SANDUSKY — J. L. Zimmerman, President, Memorial Hospital
of Sandusky County, Fremont 43420 ; Mrs. Patsy J. Askins.
Executive Secretary, Memorial Hospital of Sandusky County,
Fremont 43420. 3rd Wednesday monthly.
WILLIAMS — John E. Moats, President, Central Drive, Bryan
43506 ; Neil T. Levenson, Secretary, 907 Noble Drive, Bryan
43506. 2nd Tuesday monthly.
WOOD — Roger A. Peatee, President, 140 S. Prospect Street.
Bowling Green 43402 ; Douglas Hess, Secretary, 920 North
Main St., Bowling Green, Ohio 43402. 3rd Thursday monthly.
Fifth District
Councilor: P. John Robechek, Cleveland 44106
10525 Carnegie Ave.
ASHTABULA — J. R. Nolan, President, 2736 Lake Avenue, Ash-
tabula 44004 ; Richard Millberg, Secretary, 430 West 25th
Street, Ashtabula 44004. 2nd Tuesday monthly.
CUYAHOGA — David Fishman, President, Room 404, 10515 Car-
negie Avenue, Cleveland 44106 ; Mr. Robert A. Lang, Executive
Secretary, 10525 Carnegie Avenue, Cleveland 44106.
GEAUGA — Bruce F. Andreas, President, 400 Downing Drive,
Chardon 44024 ; Mrs. Martha Withrow, Executive Secretary,
P. O. Box 249, Chardon 44024. 2nd Friday monthly.
LAKE — Robert W. Colopy, President, 89 E. High Street, Paines-
ville 44077 ; Mrs. Owen A. McLaren, Executive Secretary,
7408 Cadle Avenue, Mentor 44060. 4th Wednesday evening
monthly, January, May, March, September and November
unless otherwise ordered by Council.
Sixth District
Councilor: Edwin R. Westbrook, Warren 44481
438 North Park Ave.
COLUMBIANA — Edith S. Gilmore, President, 432 W. 5th St.,
E. Liverpool 43920 ; Fraser Jackson, Secretary, 205 W. 6th
St. 3rd Tuesday monthly.
MAHONING — F. A. Resch, President, Doctors Park, Canfield
44406 ; Mr. Howard C. Rempes, Jr., Executive Secretary, 245
Bel-Park Building, 1005 Belmont Avenue, Youngstown 44504.
3rd Tuesday monthly except July and August.
PORTAGE — David Palmstrom, President, 124 North Prospect
Street, Ravenna 44266 ; William R. Brinker, Secretary, 141
East Main Street, Kent 44240. 3rd Tuesday monthly.
STARK — A. R. Furnas, Jr., President, 420 Lake Avenue, N. E.,
Massillon 44646 ; Mr. John H. Austin, Executive Secretary,
405 4th Street, N. W., Canton 44702. 2nd Thursday monthly.
SUMMIT — James G. Roberts, President, 655 West Market Street,
Akron 44303 ; Mr. Sidney H. Mountcastle, Executive Secretary,
437 Second National Building, 159 South Main Street, Akron
44308. 1st Tuesday monthly.
TRUMBULL — John F. McGreevey, President, 297 Hawthorne
Lane N. E., Warren 44484 ; Mrs. Kay Ticknor, Executive
Secretary, 280 North Park Avenue, Warren 44481. 3rd
Wednesday monthly September through May.
Seventh District
Councilor : Sanford Press, Steubenville 43952
525 North Fourth Street
BELMONT — James Sutherland, President, 9 North 4th Street,
Martins Ferry 43935 ; Bertha M. Joseph, Secretary, 100 South
4th Street, Martins Ferry 43935. 3rd Thursday of February,
March, April, June, September, October, November and
December.
CARROLL — Glen C. Dowell, President, 207 West Main, Car-
rollton 44615 ; Thomas J. Atchison, Secretary, 292 East
Main, Carrollton 44615. 1st Thursday monthly.
COSHOCTON — Don Warren, President, 600 East Main Street,
West Lafayette 43845 ; Harold Lear, Secretary, 133 South
Fourth Street, Coshocton 43812. 2nd Tuesday monthly.
HARRISON — Charles D. Evans, President, 159 South Main
Street, Cadiz 43907 ; G. E. Vorhies, Secretary, Scio 43988,
Quarterly.
JEFFERSON — Jacob R. Cohen, President, 341 Market Street,
Steubenville 43952 ; Irving Dreyer, Secretary, Ohio Valley
Hospital, Steubenville 43952. 4th Tuesday monthly except
December, January, February.
MONROE — Byron Gillespie, Secretary, Woodsfield 43793.
TUSCARAWAS — Robert J. Kuba, President, 319 Grant St., Den-
nison 44621 ; Thomas E. Ogden, Secretary, 138 E. Main St.,
Gnadenhutten. 2nd Thursday monthly.
Eighth District
Councilor: Robert C. Beardsley, Zanesville 43706
2236 Maple Ave.
ATHENS — D. R. Johnson, President, 52 West Washington
Street, Nelsonville 45764 ; L. A. Hamilton, Secretary, 400 East
State Street, Athens 45701. 2nd Tuesday monthly except July
and August.
FAIRFIELD — George W. LeSar, President, 216 Harmon Avenue,
Lancaster 43130 ; Stephen R. Hodsden, Secretary, 1423 West
Market Street, Baltimore 43105. 2nd Tuesday monthly.
GUERNSEY — A. C. Smith, President, 1115 Clark Street, Cam-
bridge 43725 ; Dayle O. Snyder, Secretary, 840 Wheeling
Avenue, Cambridge 43725. 1st Tuesday monthly.
LICKING — Carl L. Petersilge, President, 104 Hudson Avenue.
Newark 43065 ; Robert P. Raker, Secretary, 317 N. Granger
Street, Granville 43023. 4th Tuesday monthly.
MORGAN — A. H. Whitacre, President, Chesterhill 43728 ; Henry
Bachman, Secretary, Box 199, Malta 43758.
MUSKINGUM — Paul A. Jones, President, 838 Market Street,
Zanesville 43701 ; Myron Powelson, Secretary, 2825 Maple
Avenue, Zanesville 43705. 2nd Tuesday monthly.
NOBLE — Frederick M. Cox, President, Caldwell 43724 ; Edward
G. Ditch, Secretary, 415 Main Street, Caldwell 43724. 1st
Tuesday monthly.
PERRY — Charles B. McDougal, President, 319 High St., New
Lexington 43764 ; Michael P. Clouse, Secretary, West Main St.,
Somerset 43783.
WASHINGTON — Mary L. Whitacre, President, Rt. 6, Marietta
45750; G. E. Huston, Secretary, 328 Fourth St., Marietta
45750. 2nd Wednesday monthly.
1094
The Ohio State Medical Journal
County Societies’ Officers and Meeting Dates (Continued)
Ninth District
Councilor: Oscar W. Clarke, Gallipolis 45631
4th & Sycamore St.
GALLIA— Quentin Korfhage, President, Gallipolis Clinic, Gal-
lipolis 45631 ; John Groth, Secretary, Holzer Clinic, Gallipolis
45631. Monthly meetings at called times.
HOCKING — Jan S. Matthews. President, 9 East Second Street,
Logan 43138: H. M. Boocks, Secretary, Route 3, Logan 43138.
2nd Tuesday monthly.
JACKSON— John M. Cook, President, Box 316, Oak Hill 45656 ;
Earl J. Levine, Secretary, 120 N. Ohio Ave., Wellston 45692.
LAWRENCE — Frank W. Crowe, President, 2110 South 9th
Street, Ironton 45638 ; George Newton Spears, Secretary, 2213
South Ninth Street, Ironton 45638. Quarterly at called times.
MEIGS — Charles J. Mullen, President, 210% E. Main St., Pome-
roy 45769 ; Edmund Butrimas, Secretary, 204 E. Main St.,
Pomeroy 45769.
PIKE — Robert T. Leever, President, 100 East Third St., Waverly
45690 ; Albert M. Shrader, Secretary, East Water St., Waverly
45690. 1st Tuesday monthly.
SCIOTO — Chester H. Allen, President, 1405 Offnere Street,
Portsmouth 45662 ; Erich Spiro, Secretary, 1735 Waller Street,
Portsmouth 45662. 2nd Monday in February, April and Octo-
ber ; December meeting and summer meeting decided by the
Council and members notified one month in advance.
VINTON — Richard E. Bullock, President, 203 South Market St.,
McArthur 45651.
Tenth District
Councilor: Richard L. Fulton, Columbus 43212
1211 Dublin Rd.
DELAWARE — Don K. Michel, President, 98 W. William, Dela-
ware 43015 ; Tennyson Williams, Secretary, Box 265, Delaware
43015. 3rd Tuesday monthly.
FAYETTE — R. D. Woodmansee, President, 403 East Market
Street, Washington C. H. 43160 ; M. H. Roszmann, Secretary,
1005 East Temple Street, Washington C. H. 43160. 2nd
Friday monthly
FRANKLIN — Joseph A. Bonta, President, 3100 Olentangy River
Road, Columbus 43202 : Mr. W. “Bill” Webb, Jr., Executive
Secretary, 17 South High St., Suite 528, Columbus 43215.
3rd Tuesday monthly.
KNOX — Richard L. Smythe, President, 812 Coshocton Road,
Mt. Vernon 43050 ; Robert E. Sooy, Secretary, Box 470, Mt.
Vernon 43050. 1st Wednesday evening monthly.
MADISON — Sol Maggied, President, 15 East Pearl Street, West
Jefferson 43162 ; Michael Meftah, Secretary, 11 East 2nd
Street, London 43140. 1st Wednesday monthly.
MORROW — Francis W. Kubb, President, 140 North Main, Mt.
Gilead 43338 ; William S. Deffinger, Secretary, Box 8, Marengo
43334. 1st Tuesday monthly.
PICKAWAY — V. D. Kerns, President, 143 E. Main Street,
Circleville 43113 ; Carlos Alvarez, Secretary, 147 Pinckney
Street, Circleville 43113. 1st Friday evening monthly, except
months of July and August.
ROSS — Joseph McKell, President, 174 W. Main Street, Chilli-
cothe 45601 ; Lowell O. Smith, Secretary, 217 Delano Avenue,
Chillicothe 45602. 1st Thursday evening monthly.
UNION — Malcolm Maclvor, President, 110 N. Court St., Marys-
ville 43040 ; May B. Zaugg, Secretary, 225 Stockdale Drive,
Marysville 43040. 1st Tuesday, February, April, October,
December.
Eleventh District
Councilor: William R. Schultz, Wooster 44691
1749 Cleveland Road
ASHLAND — Henry C. Chalfant, President, 309 Arthur Street,
Ashland 44805 ; H. W. Smith, Secretary, 414 Samaritan Ave-
nue, Ashland 44805. 1st Thursday monthly.
ERIE — Clinton F. Lavender, President, 1218 Cleveland Road.
Sandusky 44870 ; Mrs. David Wolfert, Executive Secretary,
1205 Tyler Street, Sandusky 44870.
HOLMES — Charles H. Hart, President, 109 South Clay Street,
Millers burg 44654; William A. Powell, Secretary, 8 West
Adams Street, Millersburg 44654. 3rd Thursday monthly.
HURON — W. R. Graham, President, 15 Main Street, Wakeman
44889 ; E. R. McLoney, Secretary, 257 Benedict Avenue, Nor-
walk 44857. 2nd Wednesday of February, April, June, Au-
gust, October, and December.
LORAIN — Joseph A. Cicerrella, President, 209 6th Street, Lorain
44052 ; Mrs. Gladys Davidson, Executive Secretary, 428 West
Avenue, Elyria 44035. 2nd Tuesday monthly except June,
July and August.
MEDINA — Myrl A. Nafziger, President, Albrecht Building.
Wadsworth 44281 ; Mr. A. Dana Whipple, Executive Secretary.
320 East Liberty Street, Medina, Ohio 44256. 3rd Thursday
monthly.
RICHLAND — C. J. Shamess, President, 74 Wood Street, Mans-
field 44903 ; Harold F. Mills, Secretary, 70 Madison Road.
Mansfield 44905. 3rd Thursday monthly except June, July and
August.
WAYNE — Howard MacMillan, President, 1740 Cleveland Road
Wooster 44691 ; R. J. Watkins, Secretary, 1736 Beall Avenue!
Wooster 44691. 2nd Wednesday monthly, January. February,
April. September, November and December.
Socio-Economics of Health Care
Topic of National Congress
The effective organization and delivery of health
services will be explored at the 1st National Con-
gress on the Socio-Economics of Health Care, Jan-
uary 22-23, 1967, in Chicago.
The Congress, sponsored by the Council on Medi-
cal Service and the Division of Socio-Economic Ac-
tivities of the American Medical Association, will
be held at the Palmer House, and will bring together
authorities from medicine, health care administration,
social science, education, community planning, and
other disciplines to report on new issues, develop-
ments and techniques in the organization, delivery
and financing of health care services.
George W. Slagle, M. D., Battle Creek, Mich.,
chairman of the Council, said the meeting will serve
as a national forum for interchange of information
and opinion among the many areas of society con-
cerned with this subject.
Through a series of presentations and discussion
session, conference participants will explore current
health status of the population, impact of medical
and social changes on patterns of health care, the
changing role of the hospital and its medical staff in
the community, new methods in training and utiliza-
tion of health manpower, and financing of health
services.
THE WOMAN S AUXILIARY TO THE OHIO STATE MEDICAL ASSOCIATION
President : Mrs. James N. Wyehgel
3320 Dorchester Rd., Cleveland 44120
Vice-Presidents : 1. Mrs. Malachi W. Sloan, II
415 Towerview Rd., Dayton 45429
2. Mrs. Carl F. Goll
1001 Granard Pkwy., Steubenville 43952
3. Mrs. Edward L. Doerman
3605 Laskey Rd., Toledo 43623
Past President and Nominating Chairman:
Mrs. Herbert F. Van Epps
425 E. 15th St., Dover 44622
President-Elect : Mrs. Paul Sauvageot
2443 Ridgewood Rd., Akron 44313
Recording Secretary : Mrs. James W. Loney
15450 Hemlock Point Rd., Chagrin Falls
Corresponding Secretary : Mrs. Vincent T. Kaval
19201 VanAken Blvd., Cleveland 441*2
Treasurer: Mrs. Russell L. Wiessinger
2280 West Wayne St., Lima 45805
for October, 1966
1095
JOURNAL ADVERTISERS
Advertisers in The Journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The Journal,
and help make it a quality publication. In return we
place their messages on the desks of Ohio’s physicians.
Please familiarize yourself with their services and pro-
ducts, and let them know that you see their advertising
in The Journal.
In This Issue:
Abbott Laboratories 1007-1008-1009-1010
Allergy Laboratories of Ohio, Inc.
1077
Ames Company, Inc
996
Appalachian Hall
984
Associated Credit Bureaus of Ohio
1052
Ayerst Laboratories
.1004-1005
The Brown Pharmaceutical Co.
990-1006
Burroughs Wellcome & Co. (USA) Inc 1065
Ciba Pharmaceutical Company
.1066-1067
The Coca-Cola Company
1006
Daniels-Head & Associates, Inc
1076
Dorsey Laboratories, a Division of the
Wander Company 985-986-987-988-989
Geigy Pharmaceuticals, Division of
Geigy Chemical Corporation
995
Glenbrook Laboratories (Bayer Aspirin) 991
Hewlett-Packard Company,
Sanborn Division
1089
Hynson, Westcott & Dunning, Inc
977
The Kendall Company
1021
Lederle Laboratories, A Division of
American Cyanamid Company
. 992,
1015, 1019-1020,
.1056-1057
Lilly, Eli, and Company
1022
Loma Linda Foods, Medical
Products Division
993
The Medical Protective Company
990
Merck Sharp & Dohme, Division of
Merck & Co., Inc
.1000-1001
Merrell, The William S., Company, Division
of Richardson-Merrell Inc
1016-1017
Neisler Laboratories, Inc., Subsidiary of Union
Carbide Corporation 1002-1003,
1086-1087
Parke, Davis & Company Inside Front Cover
Pharmaceutical Manufacturers Association ....1079
Philips Roxane Laboratories 980-981, 1097
Pitman-Moore, Division of
Dow Chemical Company
1053
Robins, A. H., Company, Inc
... 997-998
Roche Laboratories, Division of
Hoffman-La Roche Inc
Back Cover
Sanborn Division, Hewlett-
Packard Company
1089
Searle, G. D., & Company
.1054-1055
Smith Kline & French
Laboratories Inside Back Cover
Squibb, E. R., & Sons 1011,
1081, 1098
Syntex Laboratories Inc 982-983,
1084-1085
Touro Infirmary, New Orleans
1073
Turner & Shepard, Inc
1080
Tutag, S. J., & Co
1078
The Wendt-Bristol Company
1090
West-ward Inc
1013
Windsor Hospital
1082
Winthrop Laboratories 978,
1018, 1091
Table of Contents
(Continued From 979)
Page
984 AMA Issues Comprehensive Report on
Distribution of Physicians
984 Cincinnati Heart Studies Are Backed by Grant
994 In Our Opinion:
Brand vs. Generic Names
Government Policies Are Inconsistent
999 Vital Statistics in Ohio
1049 Disaster Institute Program
1050 Sixth District Postgraduate Day, Akron,
October 19
1051 St. Rita’s Hospital, Lima, Schedules
Inhalation Therapy Seminar
1051 Ohio State’s Third Symposium on Diabetes
1052 Physicians in State Mental Hygiene
Schedule Program
1052 Cleveland Clinic Foundation Announces
Postgraduate Programs
1068 American Academy of Pediatrics Features
Ohioans on Program
1069 American Medical Association, 20th Clinical
Convention, Las Vegas, November 27-30
1072 Cleveland Pathologist Shares First of Stouffer
Awards
1072 12 Hospitals Designated in Ohio as Needed
for Tuberculosis Patients
1073 Statement of Ownership, Management, and
Circulation of The Journal
1073 New Executive Secretary Named for State
Board of Pharmacy
1074 Executives of Ohio’s Medical Societies
Attend Chicago Conference
1076 Obituaries
1082 Activities of County Medical Societies
1083 Application for Space in Scientific Exhibit,
1967 OSMA Annual Meeting
1088 Woman’s Auxiliary Highlights
1090 Coming Meetings
1090 American College of Physicians Program
1092 Rosters (Pages 1092-1095)
1095 Socio-Economics of Health Care Topic of
National Congress
1096 The Journal’s Advertisers in This Issue
1097 Classified Advertisements (also on page 1096)
Classified Advertisements
URGENT NEED for general surgeon and pediatrician. Stimulat-
ing and rewarding practice available at once. Oak Hill Medical As-
sociates, Box 316, Oak Hill, Ohio.
FOR RENT or SALE: Large, air-conditioned office, well equipped:
X-ray, EKG, other medical equipment and supplies. Good location
in Fostoria, Ohio. Near hospital. Owner leaving for salaried posi-
tion. Call Dayton 513-263-2611 and ask for L. C. Gerlinger, M. D.
EMERGENCY ROOM PHYSICIANS, Ohio license, guarantee
$20,000 for average of 56 hours/wk. Busy ER, 269-bed JCAH
hospital. For add'l info, contact ass’t. adm. St. Joseph Hospital,
Lorain, Ohio. 216-245-6851.
EMERGENCY ROOM PHYSICIANS: Ohio licensed, for full
or part-time coverage, 380-bed JCAH-approved hospital. High sal-
ary, pleasant community. Write Springfield Professional Associates,
Inc., 1343 North Fountain, Springfield, Ohio 45501.
1096
The Ohio State Medical Journal
OHIO STATE MEDICAL
journal
OSMA OFFICERS B
President §§
Lawrence C. Meredith, M. D. B
205 Elyria Block, Elyria 44035 g
President-Elect B
Robert E. Howard, M. D. gjj
2500 Central Trust Tower, g
Cincinnati 45202 §§
Past President B
Henry A. Crawford, M. D. B
1058 Hanna Bldg., Cleveland 44115 g
T reasurer =
Philip B. Hardymon, M. D. B
350 E. Broad St., Columbus 43215 g
EDITORIAL STAFF j|
Editor §§
Perry R. Ayres, M. D. jj
Managing Editor and j|
Business Manager g
Hart F. Page jj
Executive Editor and M
Executive Business Manager B
R. Gordon Moore H
Table of Contents
P“ge Scientific Section
1157 Immunologic Deficiency States. A Review. James I.
Tennenbaum, M. D., Columbus.
1162 Hypersensitivity Diseases of the Lung. A Review (To
be concluded). Jon P. Tipton, M. D., Durham, North
Carolina.
1166 Endoscopy Revisited. F. L. Mendez, Jr., M. D., C. W.
Hoyt, M. D., and E. R. Maurer, M. D., Cincinnati.
1168 Intracranial Aneurysm — A Nine-Year Study. William
E. Hunt, M. D., John N. Meagher, M. D., and Rob-
ert M. Hess, M. D., Columbus.
1172 Subdural Hematoma in Posterior Fossa. Report of a Case
Complicated by Meningitis in a Newborn Infant.
C. Norman Shealy, M. D., La Crosse, Wisconsin.
1174 Aneurysmal Bone Cyst of the Calvarium. Report of a
Case with Isotopic Visualization. Oscar A. Turner,
M. D., Thomas Laird, M. D., and Leon L. Bernstein,
M. D., Youngstown.
1177 A Clinicopathological Conference from The Ohio State
University Hospital, Columbus, Ohio.
1138 The Historian’s Notebook: Health Officers of Cincin-
nati, Ohio, and the Problems of Their Day — 1900
to I960. (Part V.) Kenneth I. E. Macleod, M. D.,
Cincinnati.
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
OSMA EXECUTIVE STAFF
Executive Secretary
Hart F. Pace
Director of Public Relations and
Assistant Executive Secretary
Charles W. Edgar
Administrative Assistants
W. Michael Traphagan
Herbert E. Gillen
Jerry J. Campbell
News and Organization Section
1182 Proceedings of The Council
1185 Councilor for Ninth District Named
Address All Correspondence: g
The Ohio State Medical Journal B
17 South High Street, Suite 500 B
Columbus, Ohio 43215 gf
1191 Heart-Cancer-Stroke Plan in Ohio
1192 American Academy of Orthopaedic Surgeons To Convene
in Cleveland
Published monthly under the direction of the =|
Council for and by members of The Ohio State g=
Medical Association, 17 South High Street, Suite sis
500, Columbus, Ohio 43215, a scientific society,
nonprofit organization, with a definite member-
ship for scientific and educational purposes.
Subscription, $6.00 per year to non-members; gg
single copy, 50 cents (outside Continental U.S., gg
$7.50 and 75 cents). g
Entered as second class matter July 5, 1905, at |§g
the Postoffice at Columbus, Ohio, under the Act fg§
of Congress of March 3, 1879; Acceptance for gg
mailing at special rate of postage provided for in HI
Section 1103, Act of Oct. 3, 1917. Authority §j||
July 10, 1918. Second-Class Postage Paid at ^
Columbus, Ohio. ^g
The Journal does not assume responsibility for gg
opinions expressed by the essayists. Advertisers gg
must conform to policies and regulations estab- gg
lished by The Council of the Ohio State Medical gg
Association.
1194 AMA to Convene in Las Vegas
1195 Campaign for Support of Medical Education Opens
1198 Outstanding Scientific Exhibit at the OSMA Annual
Meeting
(Continued on Page 1226)
STONEMAN PRESS, COLUMBUS, OHIO
[PRINTED f
IN U-S A-J]
Does she really care?
Is she alert, encouraged,
positive and optimistic
about getting completely
well soon?
Or has she given in to
the demoralizing impact
of confinement, disability
and dependency?
When functional fatigue
complicates convalescence,
Alertonic can help . . .
Pleasant-tasting Alertonic is pipradrol hydrochloride
—an effective cerebral stimulant whose gentle ana-
leptic action helps counteract the apathy and inertia
that can often delay convalescence— together with an
excellent vitamin and mineral formula, in a satisfy-
ing 15% alcohol vehicle.
Nothing fosters confidence and a sense of well-
being better than your own personal warmth, under-
standing and encouragement together with Alertonic
to help insure prompt response.
Adequate dosage is important: Prescribe Alertonic—
one tablespoonful t.i.d., 30 minutes before
meals.. . tastes best chilled.
And for your patient’s sake, prescribe Alertonic
in the convenient, economical one-pint bottle.
Alertonic
Available Only On Prescription
Each 45 cc. (3 tablespoonfuls) contains: alcohol, 15% ; pipradrol hydro-
chloride, 2 mg.; thiamine hydrochloride (vitamin Bi) (10 MDR*), 10
mg.; riboflavin (vitamin Bo) (4 MDR); 5 mg.; pyridoxine hydrochloride
(vitamin B6), 1 mg.; niacinamide (5 MDR), 50 mg.; choline,! 100 mg.;
inositol,! 100 mg.; calcium glycerophosphate, 100 mg. (supplies 2%
MDR for calcium and for phosphorus) and 1 mg. each of the following:
cobalt (as chloride), manganese (as sulfate), magnesium (as acetate),
zinc (as acetate)^ and molybdenum (as ammonium molybdate).
♦Multiple of adult Minimum Daily Requirement supplied.
fThe need for these substances in human nutrition has not been established.
Indications: 1. Functional fatigue such as that often associated with: a
depressing life experience or stressful time of life; advancing years;
convalescence; limited activity or confinement 2. Poor appetite and
vitamin-mineral deficiency as they occur in: patients having faulty eat-
ing habits; geriatric patients who are losing interest in food; patients
convalescing from debilitating illness or surgery.
Dosage: Adults, 1 tablespoonful; children (over 15 years old), 1 to 2
teaspoonfuls; children (4 to 15 years old), 1 teaspoonful. To be taken
three times daily 30 minutes before meals.
Contraindications: As with other drugs with CNS stimulating action,
Alertonic is contraindicated in hyperactive, agitated or severely anxious
patients and in chorea or obsessive compulsive states.
Side effects: Reports of overstimulation have been rare. Patients who
are known to be unduly sensitive to the effects of stimulant drugs should
be observed carefully in the initial stages of treatment.
N THE WM. S. MERRELL COMPANY
Merrell ) Division of Richardson-Merrell Inc.
y Cincinnati, Ohio 45215
Booklet on Distribution of
Physicians and Hospitals
The American Medical Association recently issued
a booklet entitled "Distribution of Physicians, Hos-
pitals, and Hospital Beds in the United States,” a
statistical study by region, state, county, and metro-
politan area.
The following figures are given for Ohio: Total
number of physicians (M. D.’s) 13,293; total in pri-
vate practice, 8,894; general practice, 3,343; general
surgery, 869; internal medicine, 1,146; obstetrics-
gynecology, 624; pediatrics, 440; psychiatry, 243.
Number of hospitals in Ohio, 192; number of hos-
pital beds, 35,948; resident population of the state,
10,471,200; income per capita, $2,235; income per
household, $7,628.
The tables contained in the booklet are intended
to serve as guides for comparing regions, and other
subdivisions with respect to total number of phy-
sicians, physicians in private practice by specialty, etc.
Comparative figures are likewise given for hospitals,
number of beds, etc. The AMA indicates that such
information is of interest especially to individuals
and organizations concerned with the provision of
health care services.
The booklet may be ordered from the AMA for
$1.00 per copy for persons in the United States,
Canada and Mexico.
Ohioan Is Installed as President of
National Anesthesiology Group
Dr. Nicholas G. DePiero, of Cleveland, was in-
stalled on October 5 as president of the American
Society of Anesthesiologists during the society’s an-
nual meeting in Philadelphia. He succeeded Dr. John
J. Bonica, of Seattle, Washington.
New president-elect is Dr. E. M. Papper, of New
York City. Among other officers elected is Dr. Carl
E. Wasmuth, also of Cleveland, speaker of the House
of Delegates.
Colorado Springs Will Be Site
Of Surgeons Meeting
All doctors of medicine are invited to attend the
second of three Sectional Meetings of the American
College of Surgeons in Colorado Springs, February
15-17. Sessions will be held in the Broadmoor Hotel.
Dr. Woodrow L. Pickhardt, Chicago, is in charge
of Sectional Meeting programs for the College. In-
quiries may be addressed to him at College head-
quarters: 55 East Erie Street, Chicago, Illinois 60611.
The third and final Sectional Meeting for the
1967 season will be held in New York, February 27 -
March 2.
The 1967 annual Clinical Congress of the Col-
lege will be held in Chicago, October 2-6.
in the treatment of
IMPOTENCE
Ml*
■fir
mm
Android
(thyroid-androgen)
TABLETS
Effectiveness confirmed by another double blind studyi
ANDROID
GOOD TO EXCELLENT 75%
PLACEBO
20%
percent ^ 0
10
20
30
40
50
60
70
80
90
SUMMARY
1. Forty cases reported.
2. Excellent to good results, 75% with Android, 20% with Placebo.
3. Cites synergism between androgen and thyroid.
4. No side effects in patients treated.
5. Alleviation of fatigue noted.
6. Case histories on 4 patients.
7. Although psychotherapy still needed, role of
chemotherapy cannot be disputed.
*“ Sexual impotence treatment with methyl testosterone • thyroid (ANDROID) a
double blind study” - Montesano, Evangelista: Clinical Medicine, April 1966.
CONTRAINDICATIONS - Methyl testosterone is
not to be used in malignancy of reproductive
organs in male, coronary heart disease, hyper-
thyroidism. Thyroid is not to be used in heart
disease, hypertension unless the metabolic
rate is low.
CAUTION: Federal law prohibits dispensing
without prescription.
REFER TO
PDR
ANDROID
Each yellow tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. (1/6 gr.) 10 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
ANDROID-HP
Each red tablet contains:
Methyl Testosterone
Thyroid Ext. (1/2 gr.)
Glutamic Acid
Thiamine HCL
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
. 5.0 mg.
...30 mg.
...50 mg.
...10 mg.
ANDROID-X1
Each orange tablet contains:
Methyl Testosterone...- 12.5 mg.
Thyroid Ext. (1 gr.) 64 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 or 2 tablets daily.
Available:
Bottles of 60, 500.
Write for literature and samples:
( BRolWfc THE BROWN PHARMACEUTICAL CO. 2500 W. 6th St., Los Angeles, Calif. 90057
ANDROID-PLUS
Each white tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. (Vi gr.) 15 mg.
Thiamine HCL 25 mg.
Ascorbic Acid (Vit. 0 250 mg.
Glutamic Acid 100 mg.
Pyridoxine HCL 5 mg.
Niacinamide 75 mg.
Calcium Pantothenate 10 mg.
Vitamin B-12 2.5 meg.
Riboflavin 5 mg.
Dose: 1 tablet twice daily.
Available:
Bottles of 60, 500.
1104
The Ohio State Medical Journal
Ohio through endorsement of their licenses to prac-
tice in states having reciprocity with Ohio, or through
certification by the National Board of Medical Ex-
aminers.
National Library of Medicine
Expands Computer System
Dr. Martin M. Cummings, director of the Na-
tional Library of Medicine, in Bethesda, Maryland,
recently reported on progress toward expansion of
MEDLARS (Medical Literature Analysis and Re-
trieval System), and discussed the awarding of a
contract aimed at determining specifications for en-
hancing and extending effectiveness of the system.
The continuing information explosion in the bio-
medical sciences and the increasing need for improved
communications among members of the medical com-
munity is a major concern, Dr. Cummings said. The
study will include investigation of new areas for ap-
plying the computer capabilities; mechanization of
the library’s card catalog and serial records; develop-
ment of drug information module; storage and re-
trieval of graphic images, etc. Millions of pages are
being microfilmed each year.
At least one medical school in Ohio is sending
librarians to the Washington area to study the
MEDLAR System, another indication of expanding
interest in this field.
Harding Hospital
(Formerly Harding Sanitarium)
WORTHINGTON, OHIO
For the Diagnosis and Treatment of Psychiatric Disorders
and with
Limited Facilities for the Aging
GEORGE T. HARDING, M. D. JAMES L. HAGLE, M. B. A.
Medical Director Administrator
Phone: Columbus 885 - 5381
(Area Code: 614)
Licenses for Practice in Ohio
Issued by State Board
Results of the examinations conducted by the State
Medical Board of Ohio on June 16 to 18 were con-
sidered by the board at its meeting on August 22.
Dr. William T. Washam, executive secretary of
the board, reported that certificates to practice medi-
cine and surgery were awarded to 306 graduates of
schools of medicine. Lifty-six graduates of osteo-
pathic schools were authorized certificates to practice
osteopathic medicine and surgery. Also 4l chirop-
odists were authorized to receive certificates in their
field.
In the limited practice branches, three were award-
ed certificates to practice physical therapy, 25 to
practice chiropractic, four to practice massage, and
two to practice cosmetic therapy.
Highest grade in the examinations for doctors of
medicine was made by Donald G. Rau, Cincinnati,
a graduate of the University of Cincinnati College of
Medicine, with an average of 91 per cent.
The second highest grade of 89-8 per cent was
made by Albert M. Iosue, Cleveland, a graduate of
Western Reserve University School of Medicine; and
third highest was made by John R. Burg, Painesville,
a graduate of Ohio State University College of Medi-
cine, whose percentage was 89.5.
In August the board also announced that 106 doc-
tors of medicine had been licensed to practice in
for November, 1966
1109
postoperative atelectasis of remaining right lung after pneumonectomy*
To clear the airwayin bronchopulmonary disease-DORNAVAC® ( pancreatic dornase)
Only Dorn av ac— the pancreatic enzyme for inhala-
tion therapy— offers:
• selective action against DNA-protein complex— a
major contributor to the viscosity of purulent secre-
tions
• pancreatic enzyme lyses extracellular accumula-
tions and disintegrating cells only, not living tissue
• no reports of foaming within lungs— often a prob-
lem with detergents
• wide margin of safety— attested by years of exten-
sive clinical use
• compatibility with IPPB and other equipment
Successful in removing thick mucus and pus even in
far-advanced bronchopulmonary diseases'
“A broad spectrum of chronic bronchopulmonary dis-
ease has been treated with this enzyme [Dornavac]
and it has been found useful in patients with pulmo-
nary disease complicated by thick secretions or thick
pus, such as bronchiectasis or lung abscess. It has
proved to be of real value in patients with chronic de-
bilitating diseases who develop pulmonary complica-
tions and have difficulty in raising sputum. In these
cases, as with postoperative patients, it has been life-
saving.”2
In addition to bronchiectasis and lung abscess,
Dornavac has been useful in reducing the tenacity of
purulent secretions in such conditions as atelectasis;
emphysema; unresolved pneumonia; chronic puru-
lent bronchitis; and chronic bronchial asthma.
Physician's Bookshelf
Handbook of Clinical Laboratory Data, edited by
Henry C. Damm, Ph. D., and John W. King, M. D.,
Ph. D., ($12.50, The Chemical Rubber Co., Cleve-
land, Ohio). Desiring to aid in the conduct of medi-
cal practice and research, the editors have brought
together in one volume a distillation of the enormous
literature on this subject. It was conceived as a com-
panion publication of the Handbook of Chemistry
and Physics. Within the limits they assigned them-
selves, the editors have done an excellent job. Al-
though the organization of the text seems a little dif-
ficult at first, one suspects it would be easier to find
his way around after using the book for a while.
It is well indexed, and the matter is clearly and
concisely written.
A unique feature is the inclusion of systematic flow
sheets for the evaluation of glandular, organ, and
system functions. Starting with the beginning signs
and symptoms of organ dysfunction, an attempt is
made to demonstrate the laboratory findings in vari-
ous clinical conditions leading to a differential diag-
nosis. Unfortunately, these flow sheets are a little
difficult to follow and contain some errors (e.g., high
T-3 red cell uptake and high thyroidal uptake of
radioactive iodine are listed as screening tests for
thyroid hypofunction) . In this reviewer’s opinion,
these flow sheets detract from an otherwise excellent
text. The book should not be considered a sub-
stitute for a textbook of medicine, but it should prove
to be a valuable addition to the library of the prac-
ticing physician.
The Practical Manual for Clinical Laboratory
Procedures, edited by Henry C. Damm, Ph. D., and
John W. King, M. D., Ph. D., ($12.50, The Chemi-
cal Rubber Co., Cleveland, Ohio ) This is a loose-
leaf book, which the editors intend to update con-
tinuously by inserts to be published quarterly. It is
a companion publication of the Handbook of Clinical
Laboratory Data consisting of a compendium of clini-
cal laboratory procedures. Nicely printed and clearly
written, it is divided into six easily recognized sec-
tions, viz.: Blood Bank, Chemistry, Hematology,
Histology, Microbiology, and Urinalysis. Its chief
value will be for the use of laboratory technicians and
those physicians personally involved in laboratory
work.
A seminar on mental health was held in Van Wert
in mid-September under joint sponsorship of the Van
Wert County Health Foundation and the local chap-
ter of the Academy of General Practice representing
Paulding, Van Wert and Mercer Counties. The
theme was "Recognizing Mental Illness in the Child.’’
. . . introduce your patient to
(BENZTHIAZIDE)
AQUATAG (Benzthiazide) is a potent, orally
active, nonmercurial, diuretic agent. It is effective
orally in producing diuresis in edema states,
where it is therapeutically comparable to mercu-
rials given parenterally. AQUATAG (Benzthia-
zide) is mildly antihypertensive in its own right
and enhances the action of other antihyperten-
sive drugs when used in combination.
DIURETIC ACTION: Clinically, the oral administration of AQUATAG (benzthiazide) re-
sults in diuretic activity within two hours with maximal natriuretic, chloruretic, and diuretic
effects occurring during the fourth, fifth and sixth hours. Maintenance of response con-
tinues for approximately 12 to 18 hours. Acidosis is an unlikely complication since thera-
peutic doses of AQUATAG (benzthiazide) do not appreciably increase bicarbonate
excretion. Edematous patients receiving 50 mg. of AQUATAG (benzthiazide) daily for
five days developed a maximal increase in the rate of sodium excretion on the first day,
and maintained this high rate until depletion of excessive body stores of sodium.
In congestive heart-failure patients, AQUATAG (benzthiazide) produced the same
weight loss, during a 48-hour treatment period as did a maximally effective dose of
hydrochlorothiazide.
DOSAGE: Diuresis, initially 50 to 200 mg.; maintenance 25 to 150 mg., daily. Hyper-
tension 50 to 100 mg. initially, adjusted to 50 mg. t.i.d. or downward to minimal effective
dosage level.
WARNINGS: Use with caution in the presence of renal disease as azotemia may be
precipitated or increased. In patients with advanced hepatic disease, electrolyte imbal-
ance may result in hepatic coma. Dosage of coadministered antihypertensive agents
should be reduced by at least 50%. In cases of suspected electrolyte imbalance, serum
electrolyte determinations.should be performed and imbalance, if any, corrected. Stenosis
or ulcer of small intestine have been reported with coated potassium formulas, and
surgery has been required and deaths have occurred. Based on surveys of both United
States and foreign physicians, incidence of these lesions is low and a causal relationship
in man has not been definitely established. Until further experience has been obtained,
the use of the drug in pregnant patients should be weighed against possible hazards
to the fetus.
CONTRAINDICATIONS: AQUATAG (benzthiazide) is contraindicated in progressive
renal disease or dysfunction including increasing oliguria and azotemia. Continued
administration of this drug is contraindicated in patients who show no response to its
diuretic or antihypertensive properties. Severe hepatic disease is a relative contra-
indication. (See "Warnings" above.)
PRECAUTIONS AND SIDE EFFECTS: Electrolyte imbalance with hypokalemia (digitalis
toxicity may be precipitated), hypochloremic alkalosis and hyponatremia may occur.
Patients with cirrhosis should be observed for impending hepatic coma and hypokalemia.
Other reactions may include blood dyscrasias, hyperuricemia and gout, nausea, jaundice,
anorexia, vomiting, diarrhea, dizziness, paresthesia, photosensitivity and headache
Hepatic fetor, tremor, confusion and drowsiness are
signs of impending pre coma and coma in patients
with cirrhosis. Insulin requirements may be altered
in diabetes. AQUATAG (benzthiazide) should be
used with caution post-operatively as hypokalemia
is not uncommon. Potassium supplementation may be
advisable pre- and post-operatively. There have been
occasional reports of thrombocytopenia, leukopenia,
agranulocytosis, aplastic anemia and precipitation of
acute pancreatitis or jaundice.
Before prescribing or administering, read the pack-
age insert or file card available on request.
Available as 25 or 50 mg. scored tablets.
Request clinical samples and literature on your
letterhead.
S.J.TUTAG
& COMPANY
Detroit. Michigan 48234
for November, 1966
1113
C-14 AS MICROGRAMS NICOTINIC ACID PER LITER OF PLASMA
Sustained circulatory, respirator
and cerebral stimulation for th
TIME AFTER ADMINISTRATION (Hours)
(fewer absent doses by
absent-minded patients)
mindedness or senile confusion. Therapy can be con-
tinuous on a daily dose of only one Geroniazol TT tab-
let every 12 hours.
The gradual release of nicotinic acid in Geroniazol
TT will provide the well-known peripheral vasodilata-
tion needed in patients with deficient circulation ano !
with a minimum amount (if any) of “flushing.” Also,
cerebrovascular circulation is complemented by pen-
tylenetetrazol, long-established as a cerebral and res-
piratory stimulant.
Geroniazol TT improves the typical, unfortunate,
signs of senile confusion. Patients become more alert,
Human volunteer subjects were administered Geroni-
azol TT tablets with the nicotinic acid component
made radioactive with C-14. Plasma and urine sam-
ples were analyzed. (See Figures I and II) The radio-
active tracer study substantiated the previous clinical
evidence that the release of nicotinic acid from the
Geroniazol TT tablet produced a gradual rise in
plasma levels to a plateau for a total of 12 hours and
more.
Such proven sustained activity makes the manage-
ment of geriatric patients much easier by minimizing
the possibility of neglected doses through absent-
l
iged and debilitated
less confused and moody. Personal care, memory,
emotional stability, social attention improve. Fatigue,
apathy and irritability are reduced.
A prescription for 100 tablets of Geroniazol TT will
permit your patients to enjoy the benefits of time-
pi olonged nicotinic acid/pentylenetetrazol therapy,
at an economical price. Dosage is only one tablet every
12 hours.
Contraindications : There are no known contraindica-
tions.
Precautions : Exercise caution when treating patients
( with a low convulsive threshold.
Side Effects: Side effects are rarely encountered, how-
ever due to the vasodilatation effect of nicotinic acid,
transitory mild nausea, flushing, tingling and pru-
ritus are possible.
Dosage: One tablet every 12 hours.
Supplied: Prescribe bottles of 100 tablets, to take ad-
vantage of recent price reduction.
References: 1. Report by Nuclear Science & Engi-
neering Corp., Pittsburgh, Pa., in files of Philips
Roxane Laboratories. 2. Connolly, R. : W. Virginia Med.
J. 56: 263 (Aug.) 1960. 3. Curran, T. R., and Phelps,
D. K. : Am. Pract. & Digest Treat. 11 :617 (July) 1960.
I
“First with the Retro-Steroids ”
PHILIPS ROXANE LABORATORIES
Division of Philips Roxane, Inc., Columbus, Ohio
A Subsidiary of Philips Electronics and
Pharmaceutical Industries Corp.
Geroniazol'TT
nicotinic acid 150 mg., pentylenetetrazol 300 mg.
Tempotrol® Time Controlled Tablet
In Our Opinion
Comments on Current Economic, Social
And Professional Problems
THE BUREAUCRAT AND
THE DOCTOR
A spokesman for medicare, commenting on a re-
port that doctors have raised their fees for elderly pa-
tients by "as much as 300 per cent” since the pro-
gram began, jumped to a hasty and predictable con-
clusion. "This is a situation,” he told the New York
Times, "in which the professional takes advantage
of the plan.”
President Johnson has lent credence to this charge
by ordering a study of rising medical costs.
Ever since George Bernard Shaw, the Fabian social-
ist, wrote "The Doctor’s Dilemma,” advocates of
government controlled medicine have tended to blame
the doctors for everything that has gone wrong in
their profession.
What the Times report boiled down to was simply
that many doctors who have been treating the elderly
and indigent at cut-rate fees, out of consideration for
these patients, are raising the fees to conform to their
standard fees. 'Tm not raising fees,” one doctor
protested, "but eliminating a discount.”
This doesn’t strike us as unreasonable. There is no
reason why a doctor who has been helping elderly
patients by charging less than the going rate should
now be expected to grant the same subsidy to the
government — especially when he is paying social
security taxes himself for benefits which, in all likeli-
hood, he will never receive. Doctors rarely retire at
65, and with today’s shortage there is more need than
ever for them to stay on the job.
If the government, for its part, wants the elderly
to receive the quality of care that they have been
promised under the voluntary, supplemental program
to which nearly all of them have subscribed, it hardly
makes sense for it to refuse to pay what other patients
pay.
This isn’t to say that all doctors are perfect or that
there won’t be any abuses on their part. But when a
government spokesman suggests that the medical pro-
fession is profiteering simply because doctors object to
subsidizing the government more than they already
are, the doctors can’t be blamed for looking at the
whole program with a jaundiced eye.
This is the way schisms have developed between
doctors and bureaucrats wherever a government has
stepped into the practice of medicine. If it is an
indication of the way things are to be here, too, the
prognosis for medicare is a gloomy one. — The Chi-
cago Tribune.
SOME INTERESTING BACKGROUND
ON CHIROPRACTIC FACULTIES
An article in the September 19 issue of The Journal
of the AMA presents some revealing information
on the qualifications of faculty members of chiroprac-
tic schools in this country and in Canada.
Information presented is from a survey made by
the AMA’s Department of Investigation based on
data printed in catalogs of 13 "approved” chiroprac-
tic schools. JAMA comments as follows on findings
of the investigators:
"It is submitted that this study proves the inade-
quacy of the quality of chiropractic school faculties
as gained from information in their own school cata-
logs. It confirms a statement by the former director
of education of the American Chiropractic Associa-
tion, who said:
" 'Too many instructors [in chiropractic schools are]
teaching the basic sciences without having had any
advanced or graduate training in these sciences. Too
many instructors [are] not trained or qualified as
teachers nor masters in their fields, resulting in slavish
devotion to textbook teaching and instruction con-
siderably below the level of postcollege professional
education.’
"As seen from the table, more than 50 per cent of
the faculty members do not have recognized four-
year academic degrees, and 23 of 126 recognized aca-
demic degrees listed by faculty members were not
confirmed by the granting institutions. Also, 228 of
the total of 267 faculty members listed the 'spurious’
D. C. degree.
"It is not surprising, therefore, that no chiropractic
school is accredited by any recognized educational
accrediting agency in the United States.”
The report speaks for itself, and the AMA is to be
commended for this excellent study and a forthright
presentation of the facts.
1116
The Ohio State Medical Journal
INDOCIN
INDOMETHACIN
Indications: Chronic and acute rheumatoid arthritis,
rheumatoid (ankylosing) spondylitis, degenerative
joint disease (osteoarthritis) of the hip, and gout.
Contraindications: Active peptic ulcer, gastritis,
regional enteritis, or ulcerative colitis. Safety in
pregnancy has not been established. Not recom-
mended for pediatric age groups.
Warning: Patients who experience dizziness, light-
headedness, or feelings of detachment on
INDOCIN should be cautioned against operating
motor vehicles, machinery, climbing ladders, etc.
Use cautiously in patients with psychiatric dis-
turbances, epilepsy, or parkinsonism.
Precautions and Adverse Reactions: Most com-
monly, headache, dizziness, lightheadedness, G.l.
disturbances. The C.N.S. effects are often tran-
sient and frequently disappear with continued
treatment or reduced dosage. The severity of these
effects may occasionally require cessation of
therapy. G.l. effects may be minimized by giving
the drug with food or with antacids or immedi-
ately after meals. Ulceration of the stomach, duo-
denum, or small intestine has been reported and,
in a few instances, severe bleeding with perfora-
tion and death. Gastrointestinal bleeding with no
obvious ulcer formation has also been noted;
INDOCIN should be discontinued if G.l. bleeding
occurs. As a result of G.l. bleeding, some patients
may manifest anemia, and for this reason periodic
hemoglobin determinations are recommended.
Rare reports of effects not definitely known to
be attributable to INDOCIN include bleeding from
the sigmoid colon (either from a diverticulum or
without a known previous pathologic condition),
perforation of preexisting sigmoid lesions (di-
verticulum, carcinoma), and hematuria. In other
rare cases, a diagnosis of gastritis has been made
while the drug was being given. One patient de-
veloped ulcerative colitis, and another, regional
ileitis, while receiving INDOCIN; when the drug
was given to patients with preexisting ulcerative
colitis, there was an increase in abdominal pain.
Infrequently observed side effects may include
drowsiness, tinnitus, mental confusion, depression
and other psychic disturbances, blurred vision,
stomatitis, pruritus, edema, and hypersensitivity
reactions. Slight BUN elevation, usually transient,
has been seen in some patients, although the pre-
ponderance of evidence indicates that INDOCIN
does not adversely affect renal function, even in
patients with preexisting renal disease. Neverthe-
less, renal function should be checked periodically
in patients on long-term therapy. Leukopenia has
been seen in a few patients. Transient elevations in
alkaline phosphatase, cephalin-cholesterol floccu-
lation, and thymol turbidity tests have been ob-
served in some patients and, rarely, elevations of
SGOT values; the relationship of these changes to
the drug, if any, has not been established. As with
any new drug, patients should be followed carefully
to detect unusual manifestations of drug sensitivity.
Before prescribing or administering, read prod-
uct circular with package or available on request.
Two Columbus Physicians Launch
Preschooler Nutrition Study
A national nutrition survey of preschool children
has been launched from Children’s Hospital, of Co-
lumbus, under the direction of George Owen, M. D.,
and Carl Nelsen, M. D.
Dr. Owen, principal investigator, is head of Chil-
dren’s new Nutrition Division and associate profes-
sor of pediatrics in the Ohio State University Col-
lege of Medicine. Dr. Nelsen, head of the Hospi-
tal’s new Renal Division, is an assistant professor in
the College.
Financed under a five-year grant from the Federal
Children’s Bureau, the survey has a first-year budget
of $160,000. It is the first of its kind conducted
in this country among preschool children. Studies in
other countries have shown this age group to be
particularly vulnerable to nutritional deficiency dis-
eases.
The survey is beginning with a pilot study of chil-
dren from lower-income families, where major prob-
lems are expected, and will expand to include pre-
school children from all income groups.
The first children seen include some receiving care
in Children’s Outpatient Department. The research-
ers will gradually work out from the Hospital as
procedures and techniques are refined.
Drs. Owen and Nelsen expressed the hope that the
survey may be launched on a national scale by the third
year. — Adapted from "Pediascript,” Bulletin of Chil-
dren’s Hospital, Columbus.
American Motorists Among Safest
Drivers the World Over
Though more Americans are being killed in motor
vehicle accidents than ever before, United States
motorists are probably the world’s safest — in at least
one important category.
Based on figures for 1963, the United States’ total
of 52.6 deaths per 100,000 registered vehicles was low
for the 20 nations whose figures were compared.
New Zealand, with a 53.8 average, was the only
nation that approached this country’s record.
"Unsafest” country, according to the figures, was
Japan, whose toll was nearly eight times as high as
that of the United States. Finland, Italy, and Austria
had death rates about five times as high.
The registered vehicle mortality rate in Japan was
402.2; in Finland, 261.2; Italy, 257; and Austria,
242.9.
In many countries where statistics are most grim,
blame generally is placed on a too sudden influx of
automobiles driven by relatively inexperienced drivers
on poor roads regulated by inadequate laws.
Meanwhile, lest American drivers become com-
placent, WHO figures showed that the motor vehicle
accident death rate in this country per 100,000 popu-
lation has been rising steadily since 1961. — Health
Insurance Institute.
for November, 1966
1121
NomyLb.e*
(norethindrone 2 mg. c mestranol 0.1 mg.)
for multiple contraceptive action that has
produced a record of unexcelled effectiveness
no unplanned pregnancies
Norinyl provides multiple action for
maximum assurance of success. It does
not depend on ovulation inhibition
alone for contraceptive effectiveness.
The mechanism of action of combined
hormonal therapy results in ovulation
inhibition reinforced by other protec-
tive mechanisms, including a hostile
cervical mucus1'13 and an acceleration
of endometrial changes. 1-3>7‘16 With
Norinyl, no unplanned pregnancies
have been reported to date when used
as directed.
inhibition of ovulation by means of
2 time-proved hormonal agents
production of a cervical mucus hostile to
sperm motility and vitality
creation of an endometrium unreceptive
to egg implantation
1122
The Ohio State Medical Journal
This extended formula, completely
compatible with the infant, has
demonstrated its advantages over
older modified-milk formulas in
intensive clinical tests.1*4
It provides:
OPTIMUM CONTENTMENT.
New Optimil's marked superiority in
achieving satiety-reflected by infants'
infrequent crying — is most reassuring
to mothers.
OPTIMUM DIGESTIBILITY.
New Optimil provides protein, fat and
carbohydrate in kinds and amounts
more consistent with the infant's
needs. Spitting-up is minimized and
skin integrity maximized.
OPTIMUM GROWTH.
New Optimil's superior nutritional
balance of major nutrients and their
components provides highest caloric
efficiency. Optimum protein and min-
eral content assures lowest renal
solute load.
Optimil is recommended as regular feeding for
optimum growth and development of normal new-
borns; as an ideal supplement to or replacement
for breast milk; as sound nutrition for prematures;
and as prophylaxis against both essential fatty acid
and nutritional iron deficiency.
Optimil, diluted 1 to 1 with water, provides a stand-
ard feeding formula-20 calories per oz. Supplied
in new, convenient 16-oz. cans, Optimil is avail-
able for your specification at leading drug stores.
The complete Optimil system available to hospitals
includes: 5% Glucose Water in presterilized 4-oz.
disposable bottles • Optimil 13 calories/oz. Pre-
pared Formula in 4-oz. disposable bottles* • Opti-
mii 20 calories/oz. Prepared Formula in 4-oz.
disposable bottles* • Optimil Concentrated Infant
Formula in 16-oz. cans • Sterilized disposable nip-
ples • Optimil Gift Pack: six 4-oz. disposable bot-
tles of Optimil 20 calories/oz. Prepared Formula*
and one 16-oz. can of Optimil Concentrated Infant
Formula.
* prediluted and sterilized
1. Carson, M., and Hart, L.: "New Perspectives on
Nutritional Aspects of Modified Milk-Fat For-
mulas,” Colloquim held under the auspices of The
Pediatric Department, Western Reserve University
School of Medicine at Cleveland, Ohio, Sept. 8, 1966.
Data available on request.
2. Hepner, R.: ibid. 3. Nichols, M.: ibid. 4. McCann,
M.L.; Teree, T., and Wallace, W.; ibid.
Watch for further details on Optimil, the first optimum- nutrition infant formula
from a world leader in nutrition — (aniation®
CARNATION COMPANY/5045 WILSHIRE BOULEVARD / LOS ANGELES, CALIFORNIA 90036
for November, 1966
1125
New Members . . .
Following are names of new members of the Ohio
State Medical Association certified to the Headquar-
ters Office during August and September. List shows
name of physician, county, and city in which he is
practicing, or temporary addresses for those taking
graduate work:
Allen
Homer H. Cheng, Lima
Belmont
Felipe V. Lavapies, Tiltonsville
Calvin B. Monte DeRamos,
Barnesville
Clark
William I. Goettman,
Springfield
Cuyahoga
Abdoollah Bidar, Cleveland
Gene W. Boychuk, Cleveland
Roland D. Carlson, Cleveland
Angelo B. Cordova, Cleveland
Alexander S. Dowling, Jr.
Cleveland
Richard L. Dunn, Cleveland
Lungee G. Dy, Cleveland
Edgar J. Filson, Cleveland
Emmett W. Hilton, Cleveland
George D. Kiperman,
Cleveland
Vladamir D. Korba, Cleveland
Reuben S. Lorenzo, Cleveland
Stewart N. Nickel, Cleveland
Eugenia B. Perez, Cleveland
Cahit Plaantekin, Berea
Barry S. Yulish, Cleveland
Franklin
James Q. Dorgan, Jr.,
Columbus
Imanta V. Freimanis,
Columbus
Edward E. Huston, Columbus
Paul F. Keith, Columbus
Eugene R. Perrin, Columbus
Samuel L. Portman, Columbus
Hamilton
Flavio Amongero, Cincinnati
Seymour B. Bronstein,
Cincinnati
Mark G. Carroll, Jr.,
Cincinnati
Georges Daoud, Cincinnati
Patrick H. Lagan, Cincinnati
Leo H. Munick, Cincinnati
Robert H. Poe, Cincinnati
Harry C. Roach, Cincinnati
Anthony J. Salem, Cincinnati
Abbot G. Spaulding,
Cincinnati
Holmes
Daniel J. Miller,
Walnut Creek
Jefferson
James V. Current, Steubenville
Lorain
Richard F. Runser, Elyria
Mahoning
Ilarion N. Dombczewsky,
Youngstown
Montgomery
Merle E. Gibson, Dayton
Theodore Hirsch, Dayton
Paul Kezdi, Dayton
Francesco M. Salerno, Dayton
Layton R. Sutton, Dayton
Summit
Josephine C. Aronica, Akron
Vasant A. Chand, Akron
John M. Dunn, Akron
James S. Reef, Akron
Socio-Economics of Health Care,
Topic for January Program
The Council on Medical Service and the Division
of Socio-Economic Activities of the American Medi-
cal Association will sponsor the First National Con-
gress on Socio-Economics of Health Care on January
22-23, 1967, at the Palmer House in Chicago. The
Congress will bring together authorities from medi-
cine, health care administration, social science, edu-
cation, community planning and other disciplines to
report on new issues, developments, and techniques
in the organization, delivery and financing of health
care services.
"Silent World, Muffled World’’ is the name of a
color, sound film for showing to civic, educational,
voluntary and professional health groups, including
medical and paramedical professions. This is one of
a number of films available from the Public Health
Service Audiovisual Facility, Atlanta, Georgia 30333;
Attn: Distribution Unit.
YOUR DEBTOR
DESERVES . . .
When your customer, patient,
or borrower demonstrates
good credit habits, he
deserves that you let other
creditors know. It will help
him obtain credit and financ-
ing from them — for better
living, economic progress.
YOU DESERVE...
When your prospective cus-
tomer, patient or borrower
has a poor credit record or
maximum obligations among
other creditors, you deserve
to know — for your protec-
tion — for his good.
Your local Credit Bureau has
for you the credit histories of
almost every adult and
family in your community.
And, your local Credit Bureau
needs to know your credit
experiences — for the good
of your fellow creditors —
— for the good of the credit
seeker.
ASSOCIATED
CREDIT BUREAUS
OF OHIO
P. 0. Box 1114, Lima, Ohio 45802
1126
The Ohio State Medical Journal
REGIONAL WEATHER FORECAST
Severe Snow Storms, Strong Winds and Bitter Cold Followed by
Cough, Stuffed and Runny Noses and Aches and Pains.
Escanaba
Wausau
Traverse City.
Milwaukee
Detroit
Chicago'
Cleveland'''.
) Springfield
Columbus
OUTLOOK FOR
THIS AFTERNOON
COLD WARM STATIONARY
FRONT FRONT FRONT
OCCLUOtO
FRONT
Evansville
DIRECTION OF WIND
wESr
WIND
O CLEAR 3cPfS;lDVY • CLOUDY
(T) RAIN 0) SNOW (T)'R''^NG
© Jtorms"© foc © M,SSINC
* HURRICANE
Tussagesic breaks up coughs, quickly clears stuffed
and runny noses and relieves aches and pains. Pro-
vide coverage of the tough cold for up to 24 hours
with just a single timed-release tablet dosed morning,
midafternoon and at bedtime.
each
Tussagesic
timed-release tablet contains:
Triaminic® 50 mg.
(phenylpropanolamine hydrochloride 25 mg.,
pheniramine maleate 12.5 mg., pyrilamine
maleate 12.5 mg.)
Dextromethorphan hydrobromide 30 mg.
Terpin hydrate 180 mg.
Acetaminophen 325 mg.
Dosage: Adults— 1 tablet, swallowed whole to preserve timed-
release feature, in morning, midafternoon and at bedtime. Side
effects: Occasional drowsiness, blurred vision, cardiac palpita-
tions, flushing, dizziness, nervousness or gastrointestinal up-
sets. Precautions: The patient should be advised not to drive a
car or operate dangerous machinery if drowsiness occurs. Use
with caution in patients with hypertension, heart disease, dia-
betes or thyrotoxicosis.
DORSEY LABORATORIES • a division of The Wander Company • LINCOLN, NEBRASKA
for November, 1966
1131
Ohio State to Conduct Studies
On Accident Prevention
What is reported to be the first U. S. Public Health
Service-sponsored graduate training program in the
United States to prepare researchers for work in air
and highway transportation accident prevention is
getting under way this fall at Ohio State University.
Four university departments — industrial and civil
engineering, preventive medicine and aviation — are
joining in the program which is supported by a
$330,000 five-year grant from the Accident Preven-
tion Grants Division of the U. S. Department of
Health, Education, and Welfare.
Director of the program is Thomas H. Rockwell,
Ph. D., professor of industrial engineering and prin-
cipal investigator on a number of highway transporta-
tion research projects during the past several years.
Also involved in the project is Charles E. Billings,
Jr., M. D., assistant professor of preventive medicine,
and others.
The Ohio State program is the first of its type an-
nounced by the HEW and one of three in the nation
scheduled to be funded by that agency.
Dr. Rockwell said Ohio State was chosen to conduct
the project because it is one of the top two or three
universities in the nation in terms of on-going re-
search in transportation safety.
As evidence of the state of Ohio’s commitment to
a long-term program of transportation research at
Ohio State, it has recently provided $2,000,000 for
the aquisition of land for the development of a
Transportation Research Center including specialized
test highways for research purposes.
The center will be located on a 5000-acre site in
central Ohio on Route 33, midway between Marys-
ville and Belief on taine. Purchase of the land is only
the first step in the project. Establishment of a $25
million Transportation Research Center is scheduled
on the tract, to be operated by Ohio State University
College of Engineering.
Employment of Handicapped Award
Goes to Dayton Physician
Dr. Herman J. Bearzy, of Dayton, was named
Physician of the Year by the President’s Committee
on Employment of the Handicapped for his work in
behalf of the hire-the-handicapped program in the
Dayton area.
The award was presented at the meeting of the
American Medical Association Council on Occupa-
tional Health in Portland, Oregon. Since Dr. Bearzy
was attending another meeting in Boston, the award
was accepted in his behalf by a colleague, Dr. John
N. Aides, of Los Angeles, who received the same
award himself in 1959.
Dr. Bearzy is director of the Department of Physi-
cal Medicine and Rehabilitation at Miami Valley
Hospital in Dayton. Among his numerous affilia-
tions, he is a member of the Dayton Mayor’s Com-
mittee and the Ohio Governor’s Committee on Em-
ployment of the Handicapped.
en/ice
mah
Professional Protection Exclusive
since 1899
NORTHERN OHIO OFFICE: J. R. Ticknor, A. C. Spath, Jr., R. A. Zimmermann, Representatives
11955 Shaker Boulevard Cleveland 44120 Telephone: 216-795-3200
CENTRAL OHIO OFFICE: J. E. Hansel and R. E. Stallter, Representatives
Room 201, 1818 West Lane Ave., P. O. Box 5684, Columbus 43221 Telephone: 614-486-3939
SOUTHERN OHIO OFFICE: Louis A. Flaherty, Representative
Medical Specialties Building, Room 704
3333 Vine Street, P. O. Box 20084 Cincinnati 45220 Telephone: 513-751-0657
1132
The Ohio State Medical Journal
foMig
infection
B and C vitamins are therapy: STRESSCAPS B and C vitamins in thera-
peutic amounts . . . help the body mobilize defenses during convalescence . . . aid
response to primary therapy. The patient with a severe infection, and many
others undergoing physiologic stress, may benefit from STRESSCAPS capsules.
Each capsule contains:
Vitamin B, (as Thiamine Mononitrate) 10 mg
Vitamin B2 (Riboflavin) 10 mg
Vitamin B* (Pyridoxine HCI) 2 mg
Vitamin Bi2 Crystalline 4 mcgm
Vitamin C (Ascorbic Acid) 300 mg
Niacinamide 100 mg
Calcium Pantothenate 20 mg
Recommended intake: Adults, 1 capsule
daily, for the treatment of vitamin deficien-
cies. Supplied in decorative “reminder'1
jars of 30 and 100: bottles of 500.
LEDERLE LABORATORIES, A Division of American Cyanamid Company, Pearl River, New York
626-6— 3612
The Historian's Notebook
Health Officers of Cincinnati, Ohio
And the Problems of Their Day
1900 to 1960
KENNETH I. E. MACLEOD, M. D., M. P. H.*
PART V
(Continued from October Issue)
SO SERIOUS was the diphtheria in those days
there were no less than 23 antitoxin stations,
many of them in pharmacies throughout the
city. There were nearly 400 cases in 1919, a low
year.
On the not-so-glorious "Rhine of Cincinnati” Dr.
Peters notes with pleasure in this same year (1919)
that it is "soon to be drained. The conditions of
the canal described by Dr. Landis years ago are prac-
tically the same today. The water polluted and
turbid ...”
An interesting SOS is noted in November, 1919:
The mortality from diarrheal diseases in children under two
years is at a standstill. Up to the present time a steady de-
cline has been noted. It is not unlikely that there is some
relationship between this increase in the death rate in New
York City and the high cost of milk. Pure cow’s milk is
the ideal food for babies after they have been weaned. Let
us do all that we can to increase production and consump-
tion of clean, pasteurized cow’s milk . . .
Health Condition Among Draftees
An extract from a paper by Colonel M. P. Ravenel,
Professor of Preventive Medicine in the University
of Missouri, captured national attention. It was read
before the annual meeting of the American Public
Health Association in 1919. Dr. Peters published
an extract of the paper in the Cincinnati Sanitary
Bulletin for December, 1919. Colonel Ravenel
points out that,
The draft made it possible for the first time to ascertain
the physical condition of young men throughout the country.
Of 5,719,152 men 21 to 31 years of age examined, 1,680,175
or 29-35 per cent were found unfit for military duty on ac-
count of physical defects. A certain number of these defects
were considered remediable or had been remediable in their
incipiency. Other countries in the war have had like ex-
periences. The Premier of Great Britain has recently said
that but for the loss of the physically unfit, one million
more men could have been put in the field. We cannot
maintain an A-l country unless our population rates
A-l . . .
*Dr. Macleod, Cincinnati, is Commissioner of Health, City of
Cincinnati.
Submitted March 16, 1966.
Fakes and Fakers and Other Matters
On "Fakes and Fakers” Dr. Peters wrote with some
feeling regarding a certain "Dr. Emma Adams who,
posing as a physician, worked up quite a practice
...” Among medicine man medications of a bizarre
nature, Mrs. Adams did a thriving business (that
was before the law caught up with her) dispensing
essence of "Chicken Livers” said to be good for
whatever ails you.
And on saccharine, he was not less pointed, as
he wrote :
Let us not be misled by unscrupulous advertisers suggesting
the use of saccharine to relieve the inconvenience and suffer-
ing during the sugar shortage. Saccharine is a coal tar de-
rivative, not a food, and has no food value whatever. We
shall continue to prosecute if saccharine is substituted for
sugar . . .
On anti-venereal medication he proclaims that,
One of the greatest hindrances to the forces which we hav-e
marshalled to combat venereal disease is the most obnox-
ious advertisement of "sure cures.” Certain steps have been
taken to neutralize the pernicious effect of it by the sub-
stitution of plain, sound, sensible information and advice
issued by Federal, State, and Municipal Boards of Health.
The contraction of a venereal disease usually implies a
moral blunder. To neglect prompt and proper treatment
is always a disastrous mistake . . .
The classifications system for restaurants was
adopted that year. Under "A,” "B,” "C,” and
"D,” the latter referred to "cheap restaurants serv-
ing 15^ and 20 <f meals.” [no less]
1920 — Narcotics
In his opening cannonade for 1920, Dr. Peters
noted that,
The enforcement of the Harrison Narcotic Law undoubtedly
has done much to lessen drug addiction but unfortunately
no provision is made, even in the amendments of 1918, for
the drug addict, the principal affected, as a result of which
he and his family are the victims of the "trafficker,”
"vendor,” "morphine doctor,” and "dope apothecary” to
such an extent that he is forced to petty thievery and his
dependents reduced to want.
[The question is current if the approach to the
problem under the Harrison Act is "best,” or ought
(Continued on Page 1143)
1138
The Ohio State Medical Journal
the United States substitute the "British Approach"
which is "more permissive and less punitive," and
tends to cut out completely the nefarious traffic in
drugs at exorbitant cost to the addict?] K. I. E. M.
The 12th Street Health Center
On the role of the 12th Street Health Center, Dr.
Peters notes:
It is not too much of an extravagance to assert that the
combination of health activities at the health center is a
measure of pioneering in public health work which will be
of great and permanent benefit to the people of Cincinnati.
Until January 1, the building had been occupied by the
Anti-Tuberculosis League. The dispensary and nursing
sendee have been taken over by the Cincinnati Health De-
partment. The premises offering ample facilities for the
centralization of other departmental agencies, we have
worked out a plan for that purpose. It is our wish and
desire that the health center be a clearing house of health
information, the focus as it were, which should bring to-
gether all community agencies dealing with the health of the
people . . .
Alcohol
And on the evils of alcohol, especially "wood”
alcohol, he warns:
Special warning of the tragic consequences which may fol-
low the use of wood alcohol, denatured alcohol, and medi-
cated alcohol for beverage purposes, has been sent broadcast
and sounded in the daily press. The harmful action of this
poison and the cumulative effect is noticeable shortly after
exposure. One teaspoonful taken internally may cause
blindness . . .
Trachoma Survey
In March, 1920, a Trachoma Survey was con-
ducted by the Department in cooperation with the
United States Public Health Sendee and the Ohio
Department of Health. The prevalence of the dis-
ease was estimated, for example, as 33,000 in the
State of Kentucky alone. (There were 134 cases
found among 52,000 school children.)
And on the problem of whether "movies hurt the
eyes” Dr. Peters notes,
It is safe to say a person may witness a picture lasting
about an hour and a half each day without straining the
eyes, but eye discomfort in the movies should be regarded
as a danger signal and should lead the sufferer to the doc-
tor’s office for an examination . . .
[What would he say now about the hours upon
hours of TV we 'enjoy’?]
The Public Health Nurse
And more and more on milk and the growing
child, on botulism, and on the role of the public
health nurse, about whom he says among many other
things :
The public health nurse bears a conspicuous integral
relation to the rapid evolution of community health ideals.
She is learning to administer all the community needs, with
a happy blending in her duties, in service to the expectant
mother, the w^ell baby and the sick baby, and the tender
child of preschool age. She assists the school physician
in his medical inspection . . . She is a valuable assistant
in the TB dispensary, and visits the homes of the tubercu-
lous patients radiating sunshine and good cheer. It is here
that she is able to render valuable social sendee by suggest-
ing remedies for the social and economic conditions which
underlie the causes of disease.
Industrial Health and Other Subjects
On industrial health and particularly on the dan-
gers of breathing "rock dust,” he urges: "If in your
place of employment such health hazards as have been
described have not been eliminated or minimized by
the installation of blower systems, condensers and the
like, notify the Health Commissioner at once . . .”
The Joy of Giving and the Dollar
On the "Joy of Giving,” he notes that
The Community Chest Campaign, April 5-14 for a mini-
mum budget of $1,875,000 presents a splendid opportunity
to all citizens of Cincinnati and Hamilton County. The
Community Chest drive is to care for 70 local charitable
and Social Service organizations, and to provide our quota
for Foreign Relief . . .
And on what the dollar could purchase in those
days,
In 1919 the Division of Laboratories with a personnel in-
cluding a chemist, bacteriologist, and twn assistants, ex-
amined over 30,000 samples submitted — all for an annual
appropriation of a mere $6,460.
Housing
And on public housing he notes that,
Under the Housing and Town Planning Act of July 9,
1919, 500,000 houses are to be built. In his speech on
housing, the King of England (no less) says: "It is not
merely houses that are needed. The new houses must be
homes. Can we not aim at securing to the working classes
in their homes the comfort, leisure, brightness and peace
which we can usually associate with the world 'home’?”
The Board of Health has been invited to send representa-
tives to this most important congress in London, but we
have been forced to reply in the terms of the colored man
who was asked to loan his friend $10: "Thanks for the
compliment.”
Malnutrition and TB
And again on tuberculosis, noting that the Anti-
Tuberculosis League continues to render good service,
Dr. Peters adds: "Malnutrition among school chil-
dren is one of the principal predisposing causes con-
spiring to maintain the army of susceptibles ...”
And on "Peace Gardens,” he writes: "The devotee
of open-air bears the stamp of religion on his face.
The garden hobby is a priceless aid to health ...”
And on ophthalmia neonatorum, he reminds his
readers that, "The Health Department maintains a
supply of silver nitrate solution for free distribution
to physicians and midwives ...”
Health Commissioners Meet
On May 12, 13, and 14, 1920, the First Annual
Conference of District Health Commissioners was
held in Columbus at the "New Southern Hotel.” The
program included discussion of the milk problem,
public health administration in cities, and other phases
of public health work. A special feature was an
address by the Honorable James M. Cox, Governor
of Ohio. "Boards of Health are required to pay the
expenses ...”
( Continued in December Issue )
for November, 1966
1143
Butazolidin alka
phenylbutazone, 100 mg.
dried aluminum hydroxide gel, 100 mg.
magnesium trisilicate, 150 mg.
homatropine methylbromide, 1.25 mg.
Usually works within 3 to 4 days
in osteoarthritis
The trial period need not exceed 1 week. In
contrast, the recommended trial period for
indomethacin is at least 1 month.
That’s why it’s logical to start therapy with
Butazolidin alka— you’ll know quickly whether
or not it works. And usually, it will.
A large number of investigators have re-
ported major improvement in about 75% of
cases. Some patients have gone into remis-
sion. Relief of stiffness and pain may be
followed quickly by improved function and
resolution of other signs of inflammation. And
Butazolidin alka is well tolerated, especially
since it contains antacids and an antispas-
modic to minimize gastric upset.
Contraindications
Edema; danger of cardiac decompensation;
history or symptoms of peptic ulcer; renal,
hepatic or cardiac damage; history of drug
allergy; history of blood dyscrasia. Because
of the increased possibility of toxic reactions,
the drug should be used with greater care in
the elderly and should not be given when the
patient is senile or when other potent chemo-
therapeutic agents are given concurrently.
Large doses of Butazolidin alka are contra-
indicated in patients with glaucoma.
Warning
If coumarin-type anticoagulants are given
simultaneously, the physician should watch
for excessive increase in prothrombin time.
Pyrazole compounds may potentiate the phar-
macologic action of sulfonylurea, sulfonamide-
type agents and insulin. Patients receiving
such concomitant therapy should be carefully
observed for this effect.
Use with caution in the first trimester of preg*
nancy.
Precautions
Before prescribing, the physician should ob-
tain a detailed history and perform a com-
plete physical and laboratory examination,
including a blood count. The patient should
be kept under close supervision and should
be warned to report immediately fever, sore
throat, or mouth lesions (symptoms of blood
dyscrasia); sudden weight gain (water re-
tention); skin reactions; black or tarry stools.
Regular blood counts should be made to
guard against blood dyscrasias.
Adverse Reactions
The most common adverse reactions are nau-
sea, edema and drug rash. Moderately lowered
red cell count may sometimes occur due to he-
modilution. The drug has been associated with
peptic ulcer and may reactivate a latent peptic
ulcer. Infrequently, agranulocytosis, exfoliative
dermatitis, Stevens-Johnson syndrome or a
generalized allergic reaction may occur and
require withdrawal of medication. Stomatitis,
salivary gland enlargement, vertigo or languor
may occur. Leukemia and leukemoid reactions
have been reported but cannot definitely be
attributed to the drug. Thrombocytopenic
purpura and aplastic anemia are also possible
side effects.
Confusional states, hyperglycemia, agitation,
headache, blurred vision, optic neuritis and
transient hearing loss have been reported, as
have hepatitis, jaundice and several cases of
anuria and hematuria. With long-term use,
reversible thyroid hyperplasia may occur
infrequently.
Dosage
The initial daily dosage in adults is 300-600
mg. daily in divided doses. In most instances,
400 mg. daily is sufficient. When improvemenl
occurs, dosage should be decreased to the
minimum effective level: this should not
exceed 400 mg. daily, and is often achieved
with only 100-200 mg. daily.
For complete details, please refer to full
prescribing information.
6509-V(B)
Also available: Butazolidin®, phenylbutazone J
Tablets of 100 mg.
Geigy Pharmaceuticals
Division of Geigy Chemical Corporation
Ardsley, New York BU-3804R
Geigy
in gram-negative urinary tract infections often the single well-chosen agent
ColyMyciir Infectab
(colistimethate sodium)
indications: Especially indicated for the treatment of severe acute and resistant
chronic urinary tract infections due to sensitive strains of gram-negative organisms.
Also indicated in respiratory tract, surgical, wound and burn infections and in septi-
cemia due to sensitive organisms. Particularly indicated when any of these infections
are caused by sensitive strains of Pseudomonas aeruginosa.
Adverse Reactions: Occasional reactions such as circumoral paresthesias, tingling
of the extremities, pruritus, vertigo or dizziness may occur. Reduction of dosage may
alleviate symptoms. Therapy need not be discontinued, but such patients should be
observed with extra care.
Warning: Patients should be cautioned not to drive vehicles or use hazardous ma-
chinery while on therapy.
Precautions: In cases of impaired or suspected renal impairment, use with greater
caution and reduce dosage in proportion to extent of impairment. Transient eleva-
tions of BUN have been reported. As a routine precaution, appropriate blood studies
should, therefore, be made during prolonged therapy.
As with all polypeptides, the possibility of muscular weakness, including apnea, due
to inadvertent overdosage or normal dosage in the presence of impaired renal func-
tion, should not be overlooked. In cases of apnea, medication should be promptly dis-
continued and assisted respiration given until serum levels fall and normal breathing
is restored.
Other antibiotics, such as kanamycin, streptomycin, dihydrostreptomycin, polymyxin,
and neomycin, may also have varying neurotoxic or nephrotoxic potential. They
should be used with great caution concomitantly with Coly-Mycin Injectable (colis-
timethate sodium).
For deep intramuscular injection only.
Dosage: By the I.M. route only, in 2 to 4 divided doses ranging from 1 .5 to 5 mg./Kg./
day (0.7 mg. to 2.3 mg./lb./day). Average adult dose is 2.5 mg./Kg./day (1.1 mg./
Ib./day). In the presence of bacteremia, septicemia, or other serious infection, greater
than average doses may be required; however, maximum daily doses should not
exceed 5 mg./Kg. (2.3 mg./lb.) where renal function is normal.
Not recommended against Proteus.
Colistin is also available (as colistin sulfate) in: Coly-Mycin® Pediatric for Oral Sus-
pension (not for systemic use), and Coly-Mycin® Otic with Neomycin and Hydro-
cortisone.
Full information is available on request. p—
i'wc)
warner-chilcott Morris Plains. New Jersey L2=kl
CI-GP-69-R2
Extensive Cancer Survey Study
Underway at Ohio State
Examination of indigent women of Franklin County
for detection and treatment of cancer of the cervix
is underway in the Ohio State University Medical
Center, Columbus. The project is funded by a
$474,000 grant from the U. S. Public Health Service,
payable over a five-year period.
According to Drs. John C. Ullery and Emmerich
von Haam, codirectors of the project, 30,000 women
are expected to participate each year. Dr. Ullery
is chairman of the Department of Obstetrics and
Gynecology, while Dr. von Haam is chairman of the
Department of Pathology.
Indigent women over age 20 are eligible. Candi-
dates may be referred from all the clinics at Ohio
State, Planned Parenthood Center, Columbus State
Hospital and county and state penal institutions.
Dr. Samuel L. Portman will be assistant director of
the project, aided by Dr. G. W. Lewis, chief resident
physician in the Department of Obstetrics and
Gynecology.
Each woman, except those who are pregnant, is
asked to collect secretion specimens at home using
a cytopipette. Laboratory findings using the cytopi-
pette will be compared with those found using stand-
ard examination techniques.
All women in the project will be followed for up
to five years with periodic re-examination. The
medical team is assisted by social workers in the
follow-up appointment making.
American Heart Association Honors
Cleveland Research Physician
For the third time this year Dr. Harry' Goldblatt,
of Cleveland, was honored for his outstanding con-
tributions in the research field. The American Heart
Association’s $1000 Research Achievement Award
was presented to him for his pioneer studies in the
field of high blood pressure. Setting for the award
was the AHA annual meeting in New York on
October 21-25.
Only recently Dr. Goldblatt was named co-winner
of the newly founded Stouffer Prize for research in
arteriosclerosis and hypertension. Last March he
received the Gold Headed Cane Award of the Ameri-
can Association of Pathologists and Bacteriologists.
Dr. G. Douglas Talbott, Dayton, was guest speaker
at the Oakwood Kiwanis Club dinner meeting where
he spoke on the topic, "The Role of Computers and
Automation in Heart Attacks."
Dr. Robert A. Vogel, Montgomery County health
commissioner, addressed the Riverdale Kiwanis Club
at a dinner meeting on the topic, ”A Unified Health
District Is Overdue."
An institution for the diagnosis and treatment of psychiatric and neurological illnesses,
rest, convalescence, drug and alcohol habituation. There are ample facilities for classification
of patients
Insulin coma, electroshock, psychotherapy, occupational and recreational therapy are employed. The
hospital is equipped with complete laboratory facilities, including electroencephalography and x-ray.
Appalachian Hall is located in Asheville, North Carolina, a resort town in the beautiful Smoky
Mountain Range, an ideal location for rehabilitation.
WM. RAY GRIFFIN, Jr., M. D. MARK A. GRIFFIN, Sr., M. D.
ROBERT A. GRIFFIN, M. D. MARK A. GRIFFIN. Jr„ M. D.
For rates and further information write APPALACHIAN HALL, Asheville, N. C.
31 i * ♦ | k Established 1916
^Upalcldltan Jljml • Asheville, North Carolina
1148
The Ohio Stale Medical Journal
SQUIBB NOTES ON THERAPY
“‘Tranquilizer’ is not a good word”1
THIS classification is psychologi-
cally too seductive, pharmaco-
logically too unspecific, and in
terms of results not infrequently
untrue."2
What is a tranquilizer? According
to the 24th Edition of Dorland's
Medical Dictionary3 a tranquilizer
is "an agent which acts on the
emotional state, quieting or calm-
ing the patient without affecting
clarity of consciousness."
Defining a drug by its effects, how-
ever, can be misleading. The same
effects by which the dictionary
defines a tranquilizer have some-
times been seen after administra-
tion of a sedative — or, for that
matter, a placebo.
Ambiguous though the term may
be, it appears to be here to stay.
The 1966 edition of the Physicians'
Desk Reference4 lists 42 tranquil-
izers indicated for treatment of
anxiety and apprehensive states.
'Tranquilizers' have differences in
action, differences in effect
Although all tranquilizers are in-
tended to calm anxious patients
there are differences in their
actions — and in their effects. They
have been divided into three cate-
gories — the rauwolfia group, the
'minor' tranquilizers, and the phe-
nothiazines.5
Although the tranquilizing effect
of rauwolfia has been known for
centuries, its use as an antipsy-
chotic agent in current practice
has diminished.5
A 'minor' tranquilizer is often pre-
scribed to achieve more than one
effect. Thus, besides being tran-
quilizers some of these com-
pounds may be muscle relaxants,
antihistaminics with some calming
action, anticholinergic sedatives,
or antispasmodics.5
The phenothiazines are considered
'major' tranquilizers because they
alter psychotic behavior.1 This clas-
sification may have done them
more harm than good because it
implies that the phenothiazines
should be reserved for the more
severely disturbed. This is not nec-
essarily true.
The phenothiazines — and the
problem of sedation
One of the problems of prescrib-
ing phenothiazines for ambulatory
patients has been the fear that ex-
cessive sedation will impair the
patient's ability to function. This,
however, is less of a problem with
some of the phenothiazines.
"Clinically they may be differenti-
ated primarily in terms of their
potency and the extent of their
sedative effect, which appear to be
inversely proportional. That is, the
least potent, the one which is used
in highest dosage, chlorpromazine,
is the most sedative, while the re-
verse holds true for fluphenazine."6
In a recent report on various stud-
ies conducted over several years
evaluating 360 patients treated for
anxiety and stress with seven phe-
nothiazines, this inverse relation-
ship of potency to sedation was
confirmed.7 Also under considera-
tion was the degree to which the
particular phenothiazines neutral-
ized anxiety (the angolytic index).
Interestingly enough there was,
again, an inverse relationship. The
most sedative of the phenothia-
zines appeared to be the least
active in neutralizing anxiety. Flu-
Contraindications: Do not use with high doses of
hypnotics or in patients with subcortical brain
damage. Use with caution in patients with a his-
tory of convulsive disorders. Severe reactions may
occur in patients with idiosyncrasy to other cen-
trally-acting drugs, and severe hypotension may
occur in patients with special medical disorders,
e.g. mitral insufficiency and pheochromocytoma.
Precautions: Effects of atropine, anesthetics and
C.N.S. depressants may be potentiated. Hypoten-
sion may occur in patients undergoing surgery. Do
not use epinephrine for treatment of the hypo-
tensive reactions which may appear in patients on
phenothiazine therapy.
Side Effects: Extrapyramidal reactions, allergic skin
reactions, the possibility of anaphylaxis, drowsi-
ness, visual blurring, dizziness, insomnia, nausea,
anorexia, salivation, edema, perspiration, dry
phenazine, one of the least seda-
tive, on the other hand, was found
to be most effective in relieving
anxiety.7
RELATIVE SEDATIVE AND
ANGOLYTIC INDICES OF
PRINCIPAL PHENOTHIAZINES*
BASED ON
SEDATIVE ANGOLYTIC STANDARD
DRUG
INDEX
INDEX
DOSE OF
Chlorpromazine
100
15
25 mgs.
Triflupromazine
100
15
25 mgs.
Thioridazine
90
17
25 mgs.
Perphenazine
15
25
4 mgs.
Carphenazine
25
25
25 mgs.
Trifluoperazine
3.3
95
2.0 mgs.
Fluphenazine
3.5
100
2.5 mgs.
*adapted from Sainz7
Prolixin is therapeutically effective
without excessive sedation
When used as a 'tranquilizer' in
general medical practice, in many
patients Prolixin (Squibb Fluphe-
nazine Hydrochloride) suppresses
anxiety, but not normal activity.
These two features are of particu-
lar importance to patients who
must be able to live and work with-
out their normal daily activities
being restricted.
Because of its longer duration of
action, Prolixin, in doses of as little
as one to three milligrams in adults,
generally taken once a day, is ef-
fective in maintaining many pa-
tients free of their symptoms of
anxiety and tension.
mouth, abnormal lactation, polyuria, hypotension,
and jaundice and biliary stasis may occur. Routine
blood counts are recommended to determine pos-
sible blood dyscrasias; if symptoms of upper res-
piratory infection occur, discontinue drug and
institute appropriate therapy.
Available: 1 mg. tablets. Bottles of 50 and 500.
For full prescribing information, see package insert
References: 1. Simpson, G.M.: Postgrad. Med.
39:557, 1966. 2. Freyhan, F.A.: Am. J. Psychiat.
775:577, 1959. 3. Dorland's Illustrated Medical Dic-
tionary, ed. 24, Philadelphia, W. B. Saunders Co.,
1965, p. 1603. 4. Physicians' Desk Reference, 1966,
Oradell, N.J., 1965, p. 310. 5. Cohen, S.: Northwest
Med.: 65:197, 1966. 6. Detre, T., and Jarecki, H.:
Connecticut Med. 25:553, 1961. 7. Sainz, A.: Psy-
chosomatics 5:167, 1964.
PROLIXIN
SQUIBB FLUPHENAZINE HYDROCHLORIDE
‘The Priceless Ingredient’ of every product
|IW is the honor and integrity of its maker
Article in Ohio Newspaper Emphasizes
Troubles in British Health Service
UNDER THE HEADING, "Health Service
Mess Adds to Wilson’s Troubles,” The Plain
Dealer, leading Cleveland newspaper, pub-
lished the following article in its September 25 issue.
The article, reproduced here by permission, was dis-
patched from London and carried the by-line of
W. Holden White.
* * *
LONDON — In the truckload of trouble worrying
Prime Minister Wilson, one mess currently costing
him points in opinion polls is the rotten condition
of the socialized health service.
Never a healthy child, this product of the Attlee
administration is now, at the end of its teen-age span,
a sick, steadily declining, badly nursed juvenile.
Even the very leftist New Statesman titled a Page
1 editorial on the topic "The Ailing Health Service.”
The British Medical Association, officially doing an
ethical and so far as possible conscientious job urging
doctor-members to try to keep the program going, is
at its wit’s end.
AS ONE BMA member privately commented: "If
we have to handle anything like an epidemic of any-
thing, heaven help all of us.”
To a dozen other major problems is now added the
worst one any government has met since the health
service was blasted off in 1948: a large-scale revolt
among young doctors comprising hospital medical
staffs. They are resigning, operating go-slows, emi-
grating, persuading pals to keep out of British medi-
cine. The worst of these disasters is emigration of
recently qualified young medics.
According to the New Statesman, emigration rate
of doctors now exceeds the rate of output of newly
qualified interns from three large medical schools. As
this happens, the number of new medics joining hos-
pital staffs takes a stiff dive on account of other emi-
grants getting out of Wilsonian Britain without even
giving the British hospitals a trial. A recent exam
for interns who had applied to take their skill to the
United States drew nearly twice as many as expected.
A SAD-FACED Harley Street consulting special-
ist, said: "Who should blame them? They have a
120-hour work week compared with 42 for a dock-
worker or construction worker. Their take-home pay
isn’t much more than the dockworker or builder. In
the United States, Canada, Australia, South Africa,
they are offered jobs for decent remuneration.”
The result of these defections is an alarming increase
in the size of hospital waiting lists. The total at
3,000 state- run hospitals is now over 500,000. All
the services you get free on the socialized system; for
example x-ray, physiotherapy, pathological examina-
tion, are reduced and are to be cut back further.
MORE SERIOUS, many hospitals actually have to
close accident wards at times because there are no
medics to treat patients. When this happens to a guy
run over by a bus, or hurt in a fire, he is shunted off
to another hospital.
Most serious, patients are now sometimes unable to
get into hospitals for a major operation till it is too
late. A Midlands woman was diagnosed as having
incipient cancer. The high probability was that im-
mediate treatment would have saved her life. She
did not get it, and died. Medical authorities who
must be nameless assure us that this is far from an
isolated case.
THE LAST STRAW was the failure of the Wilson
regime to implement a promise to pay doctors more.
Long ago they raised hob about pay and conditions.
The prime minister promised a big salary boost. This
mollified the medics. Temporarily, the quitter quota
eased off. But the promise was broken like a match-
stick under the excuse of the national wage freeze.
From that point the queue of medical emigrants at
travel bureaus thickened like a fox’s brush.
In the place of emigrating British doctors hospitals
are hiring colored medics, mainly Pakistanis, Niger-
ians and Indians, who come to the United Kingdom
to study medicine at recognized medical schools and
colleges with the object of taking their knowledge
back to their native lands.
UNBELIEVABLE as it may seem, leprosy is ac-
tually on the list of diseases showing incidence in-
crease in Britain since 1964. Others are hookworm,
typhoid, dysentery and tuberculosis. These, especially
TB, are now flourishing — typhoid and dysentery in
spasmodic epidemics, TB and hookworm in steady
growth. Another frequently appearing is smallpox,
albeit in a mild form. However, in the summer of
1966 it was severe enough to cause European govern-
ments to insist that British tourists should produce
certificates of vaccination and/or immunity. A col-
league of ours, with connections in the Harley Street
and just plain Doc Smith zones, says: "I am 58 and
I never heard of this happening to a holder of a
British passport before.”
The Conservatives built new hospitals, expanded
existing ones. The Socialists have stopped the con-
struction program, except in a few cases where it has
been cut back. Because of the staff scarcity they ac-
tually are closing sections of hospitals all over the
place.
This is a picture of the health service after two
years of what Wilson in the party platform called
"purposive planning.”
1150
The Ohio State Medical Journal
Immunologic Deficiency States
A Review
JAMES I. TENNENBAUM, M. D.
The Author
• Dr. Tennenbaum, Columbus, is a member of
the Attending Staff, The Ohio State University
Hospitals; Instructor, Department of Medicine,
Division of Allergy, The Ohio State University
College of Medicine.
IN THE past few years, great progress has been
made in the understanding of the nature and
development of the lymphoid cell system and its
function in the production of serum antibodies and
development of delayed (cellular) hypersensitivity.
The thymus has been shown to play a significant, if
not the major, role in the origin and integrity of
the lymphoid system and adaptive immunity. Several
excellent review7 articles on thymic function are
available1'3 and, therefore, a detailed discussion
concerning this important structure will not be pre-
sented here. It is the purpose of this review7 to
present the clinical and laboratory features of the
primary syndromes involving the immune system
which result in pronounced susceptibility to repeated
infections.
The Immunoglobulins
It is now recognized that there are four classes
of distinct, but structurally related serum proteins
w7hose main function is to act as antibodies. The
Chart 1. Immunoglobulin Terminology
W.H.O.
ALTERNATIVE SYNONYMS
7G
IgG
7 S y-globulin, y2-globulin
yss -globulin
yA
IgA
ylA, B2 A globulin
yM
IgM
yi M globulin, B2 M globulin,
19S- y-globulin
yD
IgD
largest proportion of these proteins migrate electro-
phoretically in the region commonly designated as
y-globulin. In addition, semm proteins wdth ^-globu-
lin mobility have been demonstrated to contain anti-
Submitted March 4. 1966.
body activity. For this reason the term immunoglob-
ulins has been applied to these proteins. Chart 1
presents the World Health Organization4 suggested
nomenclature for these proteins, and some of the
commonly used synonyms.
y-G constitutes approximately 71 per cent of the
total semm immunoglobulins.5 It is the only im-
munoglobulin that crosses the human placenta. It
has a molecular weight of about 160,000 and a sedi-
mentation constant of 7 Svedberg units. Most anti-
bacterial and antiviral antibodies are present in this
fraction.
y-A constitutes about 21 per cent of the immuno-
globulins and does not cross the placenta. However,
large amounts appear in the external secretions of the
body.6 It is of interest that the majority of reaginic
(allergic) antibodies have been localized in the y-A
fraction.7 Some bacterial and viral antibodies and
isohemagglutinins have also been found in this frac-
tion.8-9 y-A has a molecular weight of approxi-
mately 160,000 to 500,000 and sedimentation con-
stant between 7 and 15.
y-M constitutes about 7 per cent of the immuno-
globulins and does not cross the placenta. These
antibodies are generally the first antibodies produced
1157
following primary immunization, and they diminish
once a strong antibody response occurs. It should
be noted, however, that typhoid "O,” Wassermann,
and heterophile antibodies, the majority of isohemag-
glutinins, rheumatoid factor, and cold agglutinins are
y-M antibodies.1 2 3 4 5 * * * * 10 y-M has a molecular weight of 1
million and sedimentation constant of 19.
y-D was discovered only recently and constitutes
about 0.2 per cent of the total serum immuno-
globulins.11 It has a Svedberg constant of 7. No
information is available at the present time regarding
the antibodies present in this fraction.
Stmctural analysis and genetic studies have estab-
lished that the immunoglobulins are made up of at
least two types of polypeptide chains, each of which
is under separate genetic control.12’ 13 Figure 1 is a
schematic diagram of a y-G molecule. One chain
known as the light or L chain is common to all the
immunoglobulins and accounts for their similarity.
There are two types of L chains (designated Kappa
and Lambda), identified on the basis of distinctive
immunochemical properties and peptide composition.
The presence of the Kappa chains determines that
an immunoglobulin molecule is type K or I. Lambda
chains confer type L or II properties. An L chain
has a molecular weight of approximately 20,000.
Bence-Jones proteins are identical to L chains except
that they are dimers of the chain. The other distinct
chain is a heavier chain or H chain and appears to
be unique for each class of immunoglobulin. This
chain has a molecular weight of 55,000 and is respon-
sible for the skin fixation, complement fixation, and
placental transfer of a given immunoglobulin.14
Syndromes involving deficiencies of the various
immunoglobulins may be either primary or secondary
(chart 2). The primary immunoglobulin deficiency
syndromes may be divided into two major groups —
the agamma or hypogammaglobulinemias and the
Chart 2. Immunologic Insufficiency States
1. IMMUNOGLOBULIN DEFICIENCY
A. Agamma or Hypogammaglobulinemias
Usually all immunoglobulins involved.
1. Congenital sex-linked type (Bruton)
2. Agammaglobulinemia with Lymphopenia
(Swiss type)
3. Congenital sporadic type
4. Late onset hypogammaglobulinemia (adult)
a. Idiopathic
b. Secondary
5. Transient or Physiologic type
B. Dysgammaglobulinemia —
Deficiency of Specific immunoglobulins
with normal or increased concentrations
of the other immunoglobulins
2. CELLULAR IMMUNITY DEFICIENCY
A. Primary
1. Wiskott-Aldrich syndrome
B. Secondary
1. Hodgkin’s Disease
2. Sarcoidosis
L CHAIN
S
S
I H CHAIN
1
S
1
s
1
r
s
1
s
1
n
s
1
s
1
1
s
H CHAIN
1
s
1
1
L CHAIN
Fig. 1. Schematic Diagram of y-G Molecule.
dysgammaglobulinemias. The hypogammaglobulin-
emias may be divided into three main groups —
congenital, acquired, and the transient or physiologic
types.
Congenital Hypogammaglobulinemia
The classic Bruton type was first described in
195 2. 15 The disease is inherited through a congeni-
tal sex-linked recessive gene and, therefore, affects
males only. Bacterial infections become a problem
about the age of 5-6 months. Major infections are
pneumonia, septicemia, pyoderma, conjunctivitis, sup-
purative otitis media, and meningitis. Viral infec-
tions are usually tolerated quite well except for in-
fectious hepatitis, which is generally fatal for these
patients. There is a complete absence of pharyngeal
lymphoid tissue as well as very poor development of
lymph nodes.
The serum gamma globulin levels are from 0 to
50 mg. per 100 ml. but usually are below 25 mg./lOO
ml. Janeway and Gitlin believe that individuals with
a level above 150 mg./lOO ml. do not belong to this
particular group.16 All of the immunoglobulins are
lacking. In addition, these patients may have neutro-
penia. There are no measurable isohemagglutinins
and, therefore, this laboratory test may be used as a
screening procedure. Circulating antibodies are al-
most totally lacking. However, delayed hypersen-
sitivity is normal. Gamma globulin catabolism is
normal or delayed. The half-life of y-G is around
23 days in normal subjects but in these children it
may be lengthened to 4 to 6 weeks.17
The main pathologic finding is the absence of
pharyngeal lymphoid tissue, Peyer’s patches, and
appendiceal lymphoid tissue. There are no plasma
cells although a few lymphocytes may be present.
The thymus appears normal.18 An interesting com-
plication has been the development of acute lymphatic
leukemia in three of these children.
Agammaglobulinemia With Lymphopenia
The lymphopenic or Swiss type of agammaglobu-
linemia, the most severe type, was first described in
1158
The Ohio State Medical Journal
1950. 19 There is suggestive evidence that this dis-
ease is inherited as autosomal recessive type as both
boys and girls may be affected. There has been a
high incidence of consanguinity in the families of
these children. In some families, the syndrome may
be inherited as a sex-linked recessive trait.20 An
important clue to the correct diagnosis of this entity
is the fact that these infants have growth failure
from birth and actually have serious infections in
the very first weeks of life. Bacterial infections are
common; however, fungal and viral infections are
particularly troublesome. It is in these children
where smallpox vaccination may be followed by fatal
generalized vaccinia. If these children live long
enough, ulcerative colitis and a malabsorption syn-
drome may occur.21
Pertinent physical findings are the complete ab-
sence of tonsillar tissue and palpable lymph nodes.
The serum gamma globulin level is usually below
25 mg. per 100 ml. but may range up to 50 mg.
There are less than 1000 lymphocytes per cc. of
blood. In addition to not being able to produce cir-
culating antibody, there is good evidence that these
patients have a failure of delayed hypersensitivity
and homograft rejection.22 Pathologic examination
has shown a very marked deficiency of lymphocytes
not only in the blood stream, but also in the bone
marrow, lymphoid organs, and lamina propria. The
thymic tissue resembles the embryonic epithelial anlage
suggesting that the primary cause of this syndrome
may be a failure of development of this anlage of the
thymus. Despite therapy with gamma globulin and
attempts at thymic transplants, all of these children
have died before the age of 18 months.
Congenital Sporadic Form
Another type of agammaglobulinemia occurs in
both male and female children in sporadic fashion.
Familial studies suggest that this form is inherited
as an autosomal recessive trait.23 The onset of re-
current infections is in early childhood, usually be-
tween 2 months and 4 years of age. Without a
family history of agammaglobulinemia, one cannot
absolutely differentiate this syndrome from the con-
genital sex-linked type in a male. However, signifi-
cant positive physical findings are that in one third of
the cases splenomegaly is present and in one sixth there
is lymphadenopathy and the gamma globulin levels
may be slightly higher in this type, up to 400 mg. per
100 ml. As a group, this syndrome may be differenti-
ated from the sex-linked form by a more frequent oc-
currence of small amounts of y-M and y-A and low
titers of isohemagglutinins. Generally, reticuloen-
dothelial hyperplasia is seen on biopsy material.
Late Onset Hypogammaglobulinemia
Primary late onset hypogammaglobulinemia may
be defined as hypogammaglobulinemia occurring af-
ter the age of 4 years and not associated with an
underlying disorder. The usual age of onset, how-
ever, is 30 to 50 years. The disease occurs in both
males and females. There is strong evidence to sug-
gest that this disease may not be "acquired” but
rather inherited on a genetic basis.24 Occasionally
there are adult patients with this syndrome in which
there is a high incidence of collagen diseases, ab-
normal antibodies suggestive of a collagen disease
(ie, positive LE preparations, positive rheumatoid
factor, etc.) without clinical evidence of disease, hy-
pogammaglobulinemia, and hypergammaglobulinemia
in their families. It has been suggested that the in-
herited trait may express itself in many ways with
hypogammaglobulinemia being one of them. Physi-
cal examination usually offers no particular clues to
the diagnosis.
Prior to the onset of symptoms, the immune systems
apparently are normal. However, after onset of the
disease there is poor antibody response to antigenic
challenge. Up to 20 per cent of these patients may
develop a sprue-like syndrome. The serum gamma
globulin level is in the range of 10 to 20 mg. per 100
ml. with all three immunoglobulins usually dimin-
ished. Plasma cells are absent from the bone mar-
row and lymph nodes, which often lack germinal
centers.
It is apparent that there is a great deal of over-
lapping between the congenital sporadic form and
the late onset type and in some cases no clear-cut
definition is possible.
Secondary Acquired Hypogammaglobulinemia
This type will be mentioned only briefly. By
definition, the secondary forms are due to diseases
that do not involve the immune system primarily.
The majority of the patients have blood dyscrasias
or diseases characterized by abnormal losses of the
serum proteins. One third to two thirds of pa-
tients with chronic lymphatic leukemia have hypogam-
maglobulinemia and account for a large number of
the patients in this category. Other diseases asso-
ciated with secondary hypogammaglobulinemia are
multiple myeloma, Waldenstrom’s macroglobulin-
emia, nephrosis, and protein losing enteropathies.
Transient or Physiologic Type
During the first few months of life, the majority of
circulating antibodies in a baby are those that are
transmitted from the mother’s circulation via the
placenta. During this time, the baby’s immune system
matures and is able to perform its vital role. If,
however, the maturing process is not quite adequate,
the total immunoglobulins may drop to very low
levels between the fourth and twelfth week after
birth. The absolute amount of gamma globulin is
not quite as important as the type and amount of
specific antibodies transmitted to the infant from the
mother. The infants may have recurrent diarrhea,
septicemia, and meningitis. Occasionally, it may be
very difficult to differentiate a male with the congen-
ital type from the physiologic type if the gamma
for November, 1966
1159
globulin levels are markedly low. Only observation
will afford the absolute diagnosis. The newborn-
infant is unable to manufacture y-A until the third,
to sixth weeks of life and may not have normal adult
levels for several years. y-M is present in minute
amounts in most newborns. Serum levels rise quite
quickly, reaching adult levels by 9 months of age.
y-G levels reach adult levels by 2 to 3 years.25
The Dysgammaglobulinemias
The dysgammaglobulinemias are syndromes in
which there is a deficiency of a specific immuno-
globulin in the presence of normal or increased
amounts of the other immunoglobulins. Several
types of specific immunoglobulin deficiencies have
been described. y-A deficiency occurs physiologically
in the newborn. Several cases of isolated deficiency
of this immunoglobulin have been reported in other-
wise healthy adults.26 Such a deficiency has also
been described in ataxia-telangiectasia. An isolated
deficiency of y-G has also been noted and was ac-
companied by repeated infections. No isolated de-
ficiency of y-M has been reported to date. Several
cases of patients having deficiencies of two immuno-
globulins have also been reported. These have been
markedly diminished y-A and y-G with normal y-M27,
and minute amounts of y-A and y-M with normal
y-G.28 These cases have also been accompanied by
repeated infections.
Plasma cells may be absent, present in small num-
bers, or present in relatively large amounts. The
exact mechanism for the occurrence of these isolated
syndromes is unclear. The most attractive theory
has been proposed by Fudenberg and Franklin.13
These workers suggested that there is a genetically
determined inability to synthesize the various com-
ponents of the immunoglobulin molecule similar to
the mechansim involved in the hemoglobulinopathies.
It has also been postulated that these syndromes
represent varying degrees and types of cellular mat-
uration arrest.29 However, this seems doubtful in
cases with normal appearing plasma cells.
A very interesting disease associated with a dys-
gammaglobulinemia is ataxia-telangiectasia which is
characterized by a progressive cerebellar ataxia, oculo-
cutaneous telangiectasia, and frequent infections, espe-
cially sinopulmonary infections.30 It is a familial
disease probably transmitted by an autosomal recessive
gene and, therefore, affects both sexes equally. The
symptoms begin in early childhood. The neurologic
manifestations are often first. Death usually occurs
before adolescence. Physical examination reveals
bulbar conjunctival telangiectases and telangiectases
about the neck, face, anticubital and popliteal fossae.
Frequently, there is stunted growth. The striking ab-
normality of the serum immunoglobulins is the almost
total absence of y-A, with a low or normal y-G and
normal y-M, although a few cases have been reported
in which the y-A was normal or elevated.
Some of the patients have a decreased ability to
produce antibodies. In a large percentage of the
patients, there is an absence or inability of response
to delayed hypersensitivity phenomena. At present,
there is no known direct correlation of the immuno-
logic abnormalities and the neurologic manifestations
or pathology. The lymph nodes are usually abnormal
with poorly developed lymphoid collars around the
germinal centers. In a few cases, plasma cells have
been lacking. Thymic tissue may be absent and, if
present, resembles the embryonic epithelial thymus
with sparse lymphocytes, no cortex, and no Hassall’s
corpuscles. There is also a high incidence of lym-
phoreticular malignant changes complicating this
disease.
Cellular Immunity (Delayed Hypersensitivity)
Delayed hypersensitivity can be divided into two
classic types.31 One is induced by infection and the
other results from exposure of the skin to a variety
of substances. The term "delayed” refers to charac-
teristics of the elicited reactions rather than time
sequence pertaining to induction of the hypersen-
sitivity. Classic examples of delayed hypersensitivity
are the PPD reaction, fungal reactions, and contact
dermatitis. Present evidence seems to indicate that
it is this type of phenomenon that is primarily respon-
sible for homograft rejection.32 The cells specifically
responsible for mediating delayed hypersensitivity are
unquestionably of "lymphoid origin.”31
Sarcoidosis and Hodgkin’s diseases are diseases
which are associated with a loss of cellular immunity.
Another syndrome associated with an abnormal im-
mune capacity apparently involving cellular immunity
is the Wiskott-Aldrich syndrome. This syndrome
is transmitted genetically as a sex linked recessive
trait and, therefore, involves males only. The syn-
drome is characterized by eczema, thrombocytopenia,
and recurrent bacterial and viral infections. Immuno-
globulin synthesis appears normal with normal serum
immunoglobulin levels. There is a good antibody
response to antigenic challenge although the isohem-
agglutinins may be slightly decreased. Plasma cells
appear normal although there is an absolute lympho-
penia. Induction of delayed hypersensitivity is ex-
tremely difficult. The lymphoid tissue shows reticular
cell hyperplasia with a deficit of mature lymphocytes.
It is felt, therefore, that there may be a deficit in the
development of the lymphoreticular systems.33
Conclusion
In the past decade, great strides have been made
in the classification and understanding of the many
syndromes associated with immunologic deficits. In
patients with unexplained recurrent infections, meas-
urement of the antibody response to various antigenic
stimuli is indicated. If the response is impaired,
immunoelectrophoresis, quantitation of the serum im-
munoglobulin, and thorough evaluation of the lym-
phoreticular system is indicated to determine the type
of deficit involved.
1160
The Ohio State Medical Journal
ADDENDUM
Since this paper was submitted for publication, data
have been published which strongly suggest that
reaginic (allergic) antibody is carried in a fifth im-
munoglobulin.34 The nature of this new immuno-
globulin has not yet been completely elucidated and
therefore it has not been officially named.
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33. Cooper, M. A.; Chase, P.; St. Geme, J. W., Jr.; Krivet, W.,
and Good, R. A.: Wiskott-Aldrich Syndrome: Model of Impaired
Defense Mechanisms, abstracted, /. Lab. Clin. Med., 64: 849 (No-
vember) 1964.
34. Ishizaka, K.; Ishizaka, T., and Lee, E. H.: Physicochemical
Properties of Reaginic Antibody. II. Characteristic Properties of
Reaginic Antibody Different from Human gamma-A-isohemagglutinin
and gamma-D-Globulin. J. Allerg., 37:336-349, 1966.
MYOPATHY IN ALCOHOLISM. — A characteristic clinical syndrome and
associated group of biochemical abnormalities were observed in cases of
chronic alcoholism studied within forty-eight hours after acute alcoholic intoxica-
tion. The features of this syndrome were as follows: muscle tenderness, cramps
and weakness; myoglobin or related proteins in the urine; increased serum creatine
phosphokinase activity; poor lactic acid response to ischemic exercise; variable
muscle phosphorylase activity; and recovery in two to four weeks. The disorder
resembles hereditary phosphorylase deficiency, or McArdle’s syndrome, but is
reversible.
Except for its clear temporal relation to excessive drinking, and its reversibility
when drinking stops, the pathogenesis of the syndrome is unknown. Several
possible mechanisms are discussed. — Gerald T. Perkoff, M. D., Patrick Hardy,
M. D., and Enrique Velez-Garcia, M. D., St. Louis, Mo.: The Neiv England
Journal of Medicine, 274:1277-1285, June 9, 1966.
for November „ 1966
1161
Hypersensitivity Diseases
Of the Lung
A Review
JON P. TIPTON, M. D.
AS PROGRESS is made in medical science, physi-
>Lj\ cians are becoming more aware of the many
forms in which hypersensitivity manifests it-
self in the respiratory tract. The hypersensitivity is
of both the immediate and delayed types and varies
from the well defined to the obscure. This article
is intended to discuss the pathophysiology and eti-
ology of some of these disease processes.
Asthma
Asthma is an episodic disease process characterized
by expiratory dyspnea, overinflation of the lungs,
cough, expiratory wheezing and rhonchi. These find-
ings are attributed to partial bronchial airway obstruc-
tion. This obstruction represents a narrowing of the
lumen, occurring primarily in the smaller bronchi
distal to the portion containing cartilage. This nar-
rowing is due to (a) excessive tenacious mucus
which accumulates in the lumen, (b) edema and
vascular engorgement, as well as proliferation of the
glands of the bronchial epithelium, and (c) constric-
tion of smooth muscle in the bronchial wall, decreas-
ing the cross-sectional area of the bronchi.
The primary effect of a decrease in the lumen of
the bronchi and bronchioles is to increase the resist-
ance to air flow. In large airways, slight irregularities
in the lumen result in turbulence which contributes
most to the rhonchi that are present. In small air-
ways, viscosity of the gas is important in determin-
ing the amount of resistance to airflow. Ordinarily,
with quiet normal inspiration, the bronchi elongate
and dilate. On expiration, the process is reversed
with relative airway constriction. Thus, it is apparent
why impingement of the airway manifests itself most
readily on expiration. The airways become obstructed
early in the expiratory phase of respiration and the
air is trapped in the alveoli.
A consequence of the airway obstruction is an in-
crease in the residual air in the lung, with a cor-
responding decrease in inspiratory and expiratory
reserve. Vital capacity may be decreased during an
From the Department of Medicine and Divisions of Pulmonary
Diseases and Allergy, The Ohio State University Hospitals,. Colum-
bus, Ohio.
Submitted April 18, 1966.
The Author
• Dr. Tipton, Fellow, Division of Allergy and
Pulmonary Diseases, Duke University Medical
Center, Durham, North Carolina; formerly (1964-
1966), Resident in Medicine, Ohio State University
Hospital, Columbus.
acute attack. Tidal volume is increased. The timed
vital capacity is decreased, generally being less than
75 per cent of the vital capacity in the first second.
Maximal breathing capacity is frequently decreased
to 50 to 75 per cent of that anticipated because of
the inability to move the air rapidly enough. There
is reversible impairment of intrapulmonary gas mix-
ing. During the asymptomatic phase, pulmonary
function studies may be completely normal, and
usually are.
Signs and Symptoms
Initially, asthma tends to occur in intermittent at-
tacks. However, in many patients, the attacks be-
come remittent. The patients are frequently found
sitting in a chair, leaning forward to help force their
diaphragms up on expiration and allow for greater
inspiratory reserve. These patients are generally di-
aphoretic and very anxious. With inspiration, there
is diaphragmatic contraction with elevation of the
ribs and retraction of the intercostal spaces. Acces-
sory muscles are tense and participate in the respi-
ratory effort. Expiration is somewhat forceful as
opposed to normal passive expiration. The chest
does not return to the relaxed volume, as the trapped
air overexpands the lungs. The patients generally
exhibit a tachycardia and increased systolic blood
pressure. Neck vein distention and paradoxical
pulse may be present. In severe, refractory cases,
the patients may appear cyanotic, exhausted, agitated
or confused, and dehydrated.
Audible wheezing is frequently prominent and
rhonchi can usually be felt. On percussion, the chest
is hyper- resonant and the diaphragms typically are
low and move poorly. On auscultation, breath sounds
1162
The Ohio State Medical Journal
are faint and obscured by musical or wheezing
rhonchi. These are primarily expiratory.
Children may have right middle lobe collapse. In
patients with progression to C02 intoxication and
narcosis, there may be altered consciousness, papil-
ledema, hyper- or hypo-reflexia and muscle twitching.
These patients tend to become adrenalin resistant.
Etiology and Types
Asthma is generally considered to be of three basic
types — (1) extrinsic. (2) intrinsic, and (3) mixed.
Extrinsic asthma is commonly considered synonymous
with allergic asthma. This syndrome is often related
to hypersensitivity to airborne allergens such as the
pollens of grass, trees, and weeds as well as dust,
molds, and animal danders. Less often, foods, other
inhalants and drugs, such as aspirin, are incriminated.
Extrinsic asthma generally occurs in the early decades
of life in atopic patients with an allergic family his-
tory who demonstrate skin sensitizing antibodies by
skin testing. Allergic asthma may be seasonal if
caused by the pollens of trees, grasses or weeds. It
may occur at any time if caused by dust, molds,
danders or other nonseasonal allergens. Frequently,
these patients give a history' of having experienced
"hay fever” during the same season in previous years
or having noted sneezing or nasal congestion when
in contact with house dust, moldy environments or in
proximity to certain animals. This finding usually
represents a progression of their allergic disease to
involve the lower, as well as the upper respiratory-
tract. In some instances, it seems to represent an
increase in the total allergenic load.
Atopic patients develop a special nonprecipitating,
thermolabile antibody called reagin which fixes to the
skin and mucous membranes as well as the smooth
muscles of the lungs and intestines. Reagin, pre-
viously thought to be an IgA antibody, now appears
to be of the recently described IgE type. It, in ad-
dition to skin and mucous membrane fixation, cir-
culates in small quantities. Contact with the im-
plicated antigen or antigens results in antigen-anti-
body reactions with release of intermediary' substances
(probably including histamine, serotonin, and acetyl-
choline) which precipitate the bronchial changes im-
plicated in asthma. Reagin tends to locate near mast
cells. It is postulated that the antigen-antibody re-
actions injure the mast cells and that they release
most, or all, of the intermediary' substances. It is
probable that this reaction is initiated in the small
bronchioles with subsequent involvement of the entire
respiratory' mucosa.
As approximately one tenth of our population is
atopic, it is easy to see why allergic asthma afflicts
large numbers of people. Segal states that 70 per
cent of asthma in the 5 to 15 age group is due to
inhalants as compared to 50 per cent between the
ages of 15 and 40, and 10 per cent over 40. Inhalant
allergy is an uncommon cause of asthma under the
age of five.
Intrinsic asthma generally begins in the later dec-
ades of life without a family history of allergic dis-
orders or evidence of specific sensitivities. Precipitat-
ing factors include infections, emotions, smoke, toxic
agents, climatic changes, various odors, etc. This
type of asthma, is, in general, more severe and de-
bilitating. Chronic bronchitis tends to be closelv re-
lated to this condition, perhaps playing an integral
part. This problem is frequently associated with
varying degrees of obstructive pulmonary emphysema
as the years progress. These changes may, in pare,
reflect the inflammatory component of this disease
process.
Commonly, these patients suffer from chronic rhi-
nitis or rhinosinusitis with aggravating, frequently
infected, posterior nasal drainage. They are disabled
by the low humidity in heated rooms in the winter
and the high humidity in the summer. Forty' per
cent humidity is ideal for these patients. It has been
postulated that emotional or neurogenic asthma may
be mediated by neurogenic stimulation of mast cells
in the lungs, with subsequent release of histamine.
It has been estimated that up to 90 per cent of
attacks of "asthma” in children under five years of
age are related to infection. However, many experts
choose to diagnose many of these cases as bronchitis
or bronchiolitis with a bronchospastic component.
Thus a debate rages as to what is asthma and what
is infection with airway impingement. Freeman
found that, in his series, 57 per cent of prepubertal
asthmatics lost their disease before or during adoles-
cence. Those with hay fever and perennial rhinitis
were more apt to retain their allergy into adolescence.
Those developing asthma at a later age had a much
poorer prognosis. It should be noted that those with
childhood "infectious asthma” are more likely to lose
their disease. Atopic patients frequently develop new
allergies as the years pass. Asthma may recur at a
later age.
Of note is the fact that frequently "normal flora”
is cultured from expectorated bronchial mucus. Ac-
tually, the normal flora of the pharynx is quite ab-
normal in the lower bronchial tree. The academic
battle rages as to whether patients are hypersensitive
to the infectious organisms, whether the infectious
process makes the patient more sensitive to environ-
mental changes and irritants, or, indeed, a subclinical
state is converted to clinical allergy. H. Influenza,
Hemolytic Streptocci, Pneumococci, Para-influenza,
and Klebsiella are most frequently considered path-
ogenic in infectious asthma.
Mixed asthma involves a combination of the two
types discussed. Most frequently, the process starts
as pure allergic asthma with secondary intrinsic-type
involvement. However, it is fairly common for a
respiratory infection to precipitate the first in a series
of asthma attacks held to be allergen mediated. Some
observers have postulated that infections convert sub-
clinical to clinical allergies. As mixed asthma pro-
gresses, factors such as infection, weather and emotion
for November, 1966
1163
assume a more dominant role and the inhalant al-
lergens, although still exacerbating and aggravating
the process, tend to assume a secondary role.
Serotonin release in patients with carcinoid syn-
drome is known to cause asthmatic symptoms. It has
been observed that pulmonary emboli are associated
with wheezing bronchospasm which has been at-
tributed to the release of serotonin from platelets.
Also, some patients have been observed who de-
velop bronchospasm following abnormal histamine
release on exercise or under emotional stress. Cho-
linergic dmgs and insecticides, as well as nitrogen
dioxide fumes, all can precipitate bronchospastic at-
tacks. Bradykinin has also been noted to initiate an
asthma-like syndrome.
Laboratory Evaluation
Chest roentgenograms commonly demonstrate dark-
ened lung fields with low diaphragms. The ribs
tend to be elevated with widened interspaces. It is
important to rule out pneumonitis, pneumothorax and
foreign body or tumor obstruction, and emphysema.
The EKG may demonstrate right-side strain or hy-
pertrophy patterns. The hemogram may manifest a
moderate polycythemia in patients with recurrent
asthma. During acute attacks in patients with an
allergic component, eosinophils may be increased.
They usually comprise less than 15 per cent of the
white blood cells. Sputum examination may disclose
a large number of eosinophils (in all types of asthma)
in addition to Curschmann spirals and Laennec pearls.
Sputum smear and culture may reveal normal or
pathogenic flora. Immune globulin determinations
often show increases in IgG and IgA levels in chronic
asthmatics. Kaiser and Beall report that the second
component of complement (C’2) is generally elevated
in patients with bronchial asthma.
Pulmonary Infiltration with Eosinophilia
There are several syndromes producing infiltration
in the pulmonary parenchyma which have associated
eosinophilia. These range from Loeffler’s syndrome
with transient migratory infiltration associated with
high eosinophilia to periarteritis nodosa, a progressive
arteritis with areas of infarction and necrosis ac-
companied by a modest eosinophilia.
Benign Loeffler’s Syndrome
This syndrome consists of recurrent, transient,
frequently migratory areas of pulmonary infiltration.
It may be unilateral or bilateral. Benign Loeffler’s syn-
drome frequently occurs in atopic individuals with
a pre-existing diagnosis of asthma. Often, the pa-
tients are asymptomatic. Allergens are rarely demon-
strated and parasites have not been found. Eosin-
ophilia reaching 50 to 60 per cent has been present
during the acute phase. Some observers believe that
there are transient infiltrates or areas of atelectasis
which develop with intermittent airway obstruction.
Biopsies have demonstrated eosinophilic infiltrates in
the interstitial tissue and mononuclear cell infiltrations
of the alveolar exudate. Recovery is spontaneous.
Steroids shorten the recovery time.
Chronic and Benign Loeffler’s Syndrome
This syndrome has features almost identical to the
benign syndrome. However, this type may persist as
long as six months. Relapses are more common and
the clinical picture is more severe. Biopsies have
demonstrated eosinophils and giant cells along with
interstitial fibrosis. Rarely, granulomatous lesions
and necrotizing arteritis have been observed.
Antigen Related Loeffler’s Syndrome
Mycotic lesions, including aspergillosis, coccidiomy-
cosis and histoplasmosis, have simulated Loeffler’s
syndrome. Likewise, parasitic infestations are capable
of producing pulmonary infiltrations and eosinophilia.
The pulmonary changes tend to occur during the pas-
sage of the parasites (ie, ascarides) through the lungs
during the larval phase of their life cycles.
Asthma with Intercurrent Pneumonia
Some patients with chronic asthma have a persist-
ent eosinophilia. Occasionally, pneumonitis compli-
cates their pulmonary picture. These infiltrates are
fixed and respond to appropriate antibiotic therapy.
Tropical Eosinophilia
This syndrome is endemic in South America and
Asia, particularly in India and Ceylon. The patients
develop severe cough, wheezing and paroxysmal dys-
pnea. It is a relapsing disease and tends to become
chronic. On chest roentgenogram, one frequently
notes increased hilar infiltration with diffuse, mottled
densities. Less often, soft confluent infiltrates are
seen. The sputum may contain many eosinophils
and there may be a 20 to 80 per cent peripheral
eosinophilia. A high titer of cold agglutinins is com-
mon as is a positive Wassermann or Kahn test.
Parasitic infestations are found in about 50 per cent
of these patients. However, specific anti-parasite
therapy is ineffective. It is postulated that this is a
condition of hypersensitivity to histamine. Its release
is, perhaps, conditioned by the parasites. Effective
therapy has been carried out with arsenicals in about
35 per cent of the cases.
Allergic Granulomatosis
This is a syndrome of recurrent episodes of pneu-
monia associated with moderate eosinophilia. In ad-
dition to eosinophilic and mononuclear cell infiltrate,
there are areas of necrotizing angiitis and healing as
well as extravascular granulomatous lesions. These
lesions are not found in the upper respiratory tract.
This syndrome is prone to develop in the terminal
stages of chronic, severe asthma. Preceding bouts of
Loeffler’s syndrome are not uncommon.
Wegener’s Granulomatosis
This syndrome consists of a triad of findings: (a)
necrotizing granulomatosis of the upper respiratory
1164
The Ohio State Medical Journal
tract; (b) (focal) necrotizing vasculitis involving
the arteries and veins, usually widely disseminated:
and (c) focal glomerulonephritis. Klinger reported
the first case in 1931 and Wegener described the
features which distinguish this syndrome from other
forms of angiitis. It has been regarded as a mani-
festation of abnormal immune mechanisms. Hyper-
globulinemia is frequent. High fever, arthritis, and
hemorrhagic lesions of the skin and mucous mem-
branes may be prominent.
Wegener’s granulomatosis is most prevalent in the
fourth and fifth decades. The characteristic clinical
triad consists of intractable rhinitis and sinusitis, nod-
ular pulmonary infiltrates, and terminal uremia. The
combination of granulomatous disease, plus vasculitis
of the pulmonary arteries may result in pneumonitis,
necrosis, cavitation, hemoptysis, and, infrequently, in-
farction. Giant cell infiltrate results in nodulation.
Peripheral involvement may result in pleuritis.
Hypertension and eosinophilia are relatively rare.
Allergic background is variable. Life expectancy is
generally 7 to 12 months. In intermittent or sub-
acute cases, survival may exceed two years. Death is
usually due to renal failure.
Hypersensitivity Angiitis
This syndrome involves a diffuse, necrotizing vas-
culitis involving both small arteries and veins in addi-
tion to the larger pulmonary vasculature. The lesions
are distinguishable from those of periarteritis, al-
though the overall syndrome is similar. This syn-
drome follows the therapeutic administration of
agents such as penicillin and sulfonamides. A more
benign syndrome called allergic vasculitis also occurs
which involves small arteries, veins and capillaries. A
moderate eosinophilia is generally present in both
syndromes. The vasculitis is usually accompanied
by an intense cellular reaction of pleomorphic char-
acter and frequently containing eosinophils.
Periarteritis Nodosa
This necrotizing, inflammatory reaction of the vas-
cular tree involves principally the smaller arteries or
arterioles. All vascular coats are involved. Initial
changes generally consist of necrosis and fibrinoid
change in the inner media. As the intima thickens,
thrombi tend to form and result in occlusion of the
vessel with resultant infarction and cavitation. It is
held that up to 29 per cent have pulmonary involve-
ment. Also noted is the fact that, if pulmonary in-
volvement is present, it is present from the outset.
Lesions in the submucosal vessels of the trachea and
bronchi may produce ulceration. A few cases have
developed pulmonary cavitation. Necrotizing alveo-
litis has also been described. Biopsies have demon-
strated numerous eosinophils in acute arteritic lesions.
There are focal granulomatous lesions, unrelated to
blood vessels, in the liver, spleen, kidneys, lymph
nodes, and the heart.
Eosinophilia rarely exceeds 30 per cent, those with
pulmonary lesions seeming to manifest the highest
levels. Hemoptysis and pleural effusions are not un-
common. Clinically, the disease presents as asthma,
bronchitis, or pneumonitis. There appears to be a
relationship to pulmonary7 disease in early life, or
chronic pulmonary disease, and periarteritis. Fifty
to 80 per cent present as "intrinsic asthma.” Roent-
genogram findings are nonspecific. There may be
migratory pulmonary infiltrates. Lesions may look
like carcinomatosis, miliar}7 tuberculosis, cavitation,
abscesses, or pneumonitis. Serial x-rays are required
to evaluate the patient adequately.
Sullivan and Miller have postulated that the respir-
ator}7 tract is the site of entry of the antigenic
stimulus in the greatest number of patients. Re-
cently, a number of cases have been thought related
to the therapeutic use of penicillin and sulfonamides
in patients usually having allergic backgrounds.
Autospecific antigen-antibody interaction has not been
demonstrated in the vessel wall. Some postulate that
circulating antigen-antibody complexes damage the
vessel wall. Thus, they consider this the arthus type
of humoral hypersensitivity. It has been found that
about 28 per cent of the cases are associated with
preceding respirator}7 infections and 8 per cent have
active or quiescent rheumatoid arthritis while other
cases are associated with rheumatic fever following
streptococcal infections. Some cases have been as-
sociated with systemic lupus erythematosus.
Leys has postulated that genetically predisposed
infants, when sensitized by contact with streptococci,
develop an incomplete immunity. In later years,
when autogenously or exogenously challenged, they
react in different ways: (1) polyarthritis and the
specific cellular reaction of the Aschoff body; (2)
in the basal ganglia as chorea; (3) as localized tissue
reaction in the capillaries, as in the Henoch-Schon-
lein complex, and possibly in the glomerular tufts
as nephritis; (4) in the arterial wall as periarteritis
nodosa; and (5) in the lung as rheumatic or rheu-
matoid pneumonia.
(To Be Concluded)
SELECTIVE CORONARY ANGIOGRAPHY does not induce persistent or
significant hemodynamic abnormalities provided a serious arrhythmia does not
supervene. — Alberto Benchimol, M. D., and Edward M. McNally, M. D., Lajolla,
California: The New England Journal of Medicine, 274:1217-1224, June 2, 1966.
for November, 1966
1 165
Endoscopy Revisited
F. L. MENDEZ, Jr., M. D., C. W. HOYT, M. D.,
and E. R. MAURER, M. D.
'C AHE first attempts at peroral endoscopy were
carried out by Phillip Bozzine (1807) and John
Fisher (1925). Although admittedly some-
what crude, these efforts set in motion the impetus
to develop endoscopy as we employ it today. Pre-
vious to the work of Gottstein (1891), endoscopy
was attempted only under general anesthesia. Over
the years our efforts have revolved 360 degrees with
a return to a type of general anesthesia. During the
interim, however, endoscopy has been conducted pri-
marily under local anesthesia or to be more correct,
topical anesthesia. We feel that the time has ar-
rived when such practice should be re-evaluated and
possibly discontinued. In our opinion, peroral en-
doscopy is best performed under total medication.
We can see little value in the use of only a topical
anesthetic and we decry the severe anxiety which
such attempts produce in the patient. We would
like, therefore, to set forth a simple, safe technique
for all peroral endoscopy.
Technique
The principle that must be grasped in this tech-
nique is that we are combining the salient features of
topical and general anesthesia. The topical anes-
thesia negates the tracheobronchial reflexes and the
intravenous medication produces general hypnosis
without fear of apnea.
Preparation for peroral endoscopy correctly begins
the evening before the scheduled procedure. Pre-
operative medication of adequate strength and dura-
tion of action is a prerequisite of the technique. The
patient must approach the intended examination in a
calm, tranquil state. Efforts to indicate what will be
done and how it will be accomplished have been
well rewarded. Such information greatly allays the
patient’s fears and many acquired misconceptions
of the procedure.
An adequate sedative medication is given at the
hour of sleep on the evening preceding the exami-
nation. Such medication is again repeated one and
one-half hours before the scheduled endoscopy. If
the intramuscular route is utilized, the time interval
can be reduced. A combination of morphine sul-
fate in the amounts of 15 mg. combined with
Presented before the Section on Anesthesiology, May 26, 1966, at
the Annual Meeting of the Ohio State Medical Association, Cleve-
land, Ohio.
The Authors
9 Dr. Mendez, Cincinnati, is a member of the
Attending Staff, Bethesda Hospital, and of the
Attending Staff, Christ Hospital.
® Dr. Hoyt, Cincinnati, is Director, Department
of Anesthesiology, Bethesda Hospital; Assistant
Clinical Professor of Anesthesiology, The Univer-
sity of Cincinnati College of Medicine.
• Dr. Maurer, Cincinnati, is Associate Clinical
Professor of Surgery, The University of Cincinnati
College of Medicine.
atropine sulfate in the amount of 0.4 mg. is given
by hypodermic approximately one hour before the
procedure. Previous to this, the patient has been
held in a fasting state since the previous midnight.
With such premedication, the patient arrives in the
surgical suite in a calm state with adequate analgesia.
It is not essential that slavish attention to these
specific medicants be observed. It is essential, how-
ever, that adequate medication of a similar type and
strength be employed.
With the arrival of the patient in the operating
room the topical anesthesia is carried out. Tetracaine
( Pontocaine®) 2 per cent, in the amount of 2 to 4
cu.cm, is rapidly and adroitly injected transtracheally.
A disposable 20 gauge needle with a 5 cu.cm, syringe
attached is employed in this maneuver. While intn>
duction of the needle through the cricothyroid carti-
lage (or triangle) is taught as the method of choice,
we do not feel that this is essential. A simple pene-
tration of the trachea at an intercartilaginous area
will suffice. The spread of the medication is greatly
facilitated if the injection is made immediately fol-
lowing an exhalation by the patient.
We hasten to point out that transtracheal anesthesia
is not a new procedure. It was first described by
George Canuyt and published by Labat almost 50
years ago. It was advocated for use in bronchoscopy
by D. E. Harken and A. M. Salzberg in 1948 and has
long been used by anesthesiologists as a simple
means to facilitate intubation. The topical anes-
thesia thus produced becomes the second cornerstone
of the technique.
1166
The Ohio State Medical journal
After the necessary equipment has been properly
checked and all is in readiness, Pentothal® Sodium in
2.5 per cent solution is administered through the
previously started intravenous infusion. At this point
it is essential to understand that the Pentothal is
utilized to produce only a light state of hypnosis.
Excessive use of this drug or deletion of the top-
ical and premedication agents will result in an un-
desirable anesthetic. The Pentothal is given to act
synergistically with the local and premedication and
cannot serve to substitute for them. It is essential
that all three segments be fused at the moment of
endoscopy. It will produce a safe, extremely satis-
factory anesthetic without the danger of inadequate
ventilation.
At the proper moment of sleep relaxation, the
larynx or esophagus can be readily entered. In the
instance of bronchoscopy, once the larynx has been
entered, the patients airway is assured and any danger
of inadequate ventilation is easily and readily con-
trolled. In some cases, oxygen may be diffused
through the side arm of the scope, if this type of
bronchoscope is employed. We have found this
addition of value in cases of pulmonary insufficiency
from any cause. Oxygen may also be added in cases
where the procedure is unduly prolonged as in teach-
ing or biopsy endoscopies.
This method of anesthesia allows excellent relaxa-
tion for the viewing of the tracheobronchial tree,
esophagus and upper gastric pouch. Only on very
rare occasions have we found it necessary to place
an endotracheal tube in the bronchus when doing
esophageal endoscopy. The authors have found
direct visualization of the upper lobe bronchi and
their divisions to be a routine procedure. The use
of lenses and mirror systems have been unnecessary
and only add complications to a relatively simple
procedure.
Following complete visualization of the tracheo-
bronchial anatomy, a lavage with isotonic saline is
carried out. The return is collected in a suction
trap for examination by the laboratory. If the anes-
thetic level is correct, the cough reflex will be de-
pressed but retained and thus will enable the col-
lection of an adequate specimen from the minor
bronchi. Additional topical anesthesia, bronchial
dilating drugs and/or antibiotics may readily be ad-
ministered in the lavage solution. An adequate
biopsy, when desired, can be carried out. We make
it a routine practice to take a biopsy specimen of
the bronchial membrane for evaluation of its micro-
scopic anatomy.
In addition to the patient’s comfort, this technique
allows the operator to further eliminate the tradi-
tional endoscopic legacies. The "headholder” can be
readily dispensed with. Control of the patient’s posi-
tion on the table is easily carried out by moving the
headrest and/or the table. The operator must guard
against pressure on, or injury to, the mouth since
pain from any source will arouse the subject and
require additional anesthesia. The gentle manipula-
tion of the head and neck is essential.
The second but more deadly legacy is that of the
lightless room. We can find no reason for the tradi-
tionally darkened room to persist. Constant appraisal
of the patient’s condition is necessary and to accom-
plish this important task the anesthesiologist must be
able to see his patient well and clearly. Today’s
standards of instrument illumination no longer neces-
sitates this dangerous and outmoded darkness.
At the completion of the examination, the bronch-
oscope is withdrawn and an oral-pharyngeal airway is
inserted. The patient is transferred to the recover}7
room. It has been our experience that a high per-
centage of these patients are aw^ake by the time they
are transported to the recover}7 room. We might also
point out that. wffiile topical anesthesia has depressed
the cough reflex, it has not been completely ob-
tunded. Hence these patients quickly regain their
protective mechanism. Once the basic understanding
of the cooperative action of the various anesthetic
agents has been appreciated, the amount of Pen-
tothal given will be minimal. We usually give be-
tween 200 and 300 milligrams of the drug and rarely
use up to 500 milligrams. The procedure is ap-
preciated by the patient and often is completed with-
out his knowdedge that the "dreaded” endoscopy has
taken place. Our happiest patients are those that
have had a previous endoscopy done under local
anesthesia.
Results
During the preceding three years, nearly 2,000
peroral endoscopies have been successfully completed
employing the method herein described. In this
period, no complications attributable to the method
of anesthesia has been encountered. Acceptance by
the hospital surgical personnel has been complete.
Appreciation showrn by the patients has been gratify-
ing. Acquisition of the necessary information and
specimen by the operators have been most satisfactory
in all respects. Therefore, w7e feel that peroral en-
doscopy performed under this type of combined
anesthesia to be superior in all respects. Continued
use of topical anesthesia alone, with the obvious
disregard of the patient’s discomfort, needs to be
seriously questioned. Employment of darkened sur-
roundings should be discontinued in the best interest
of all concerned. We do not indicate that this
method of endoscopy is superior to all others, how-
ever, wre strongly feel that it is a marked improvement
over wffiat has become common practice.
References
1. Transtracheal Anesthesia for Endotracheal Intubation. Anes-
thesiology. 10:736-738 (Nov.) 1949.
2. Harken. D. E.. and Salzberg, A. M.: Transtracheal Anesthesia
for Bronchoscopy. New England J. Aled., 239:383-385 (Sept. 9)
1948.
3. Labat, G.: Regional Anesthesia, Philadelphia, Pa.: W. B.
Saundeis Co., 1930.
4. Lederer. F. L.: Diseases of the Ear, Nose and Throat, ed 3,
Philadelphia, Pa.: F. A. Davis Co., 1942.
for November, 1966
1167
Intracranial Anenrysm
A Nine-Year Study
WILLIAM E. HUNT, M.D., JOHN N. MEAGHER, M. D.,
and ROBERT M. HESS, M.D.
RUPTURE of intracranial aneurysms due to con-
genital weakness in the vessels of the circle
- of Willis is a significant cause of death and
disability in young and middle-aged adults.1 Because
of this high mortality,2 it is important to identify in-
tracranial aneurysms early so that measures to prevent
further or fatal hemorrhage can be instituted.
The diagnosis of unruptured aneurysm is only oc-
casionally possible. Unruptured aneurysms were
found in only 6 per cent of this series. Three per
cent appeared with optic or abducens nerve deficits.
One and one-half per cent presented with a third
cranial nerve palsy. One and one-half per cent ap-
peared with headache considered significantly focal
to warrant angiography. The appearance of such
cranial nerve palsies, or of fixed retrobulbar head-
ache, is an indication for angiography.
Aneurysms usually show their presence by an
acute subarachnoid or intracerebral hemorrhage. Most
observers have reported a mortality of 44 to 70 per
cent in patients not subjected to surgical treatment.2
Our mortality in operated and nonoperated cases of
intracranial aneurysm is 38 per cent.
Little can be done if the hemorrhage does not
stop spontaneously. If bleeding stops, the first goal
of treatment is to minimize the likelihood of rebleed-
ing while the patient is recovering from the effects
of the first episode. Surgical treatment, based upon
accurate angiography, is then planned to eliminate the
danger of further bleeding. As will be shown, the
surgical risk is low in patients who have not sustained
serious brain damage as a result of the first hemor-
rhage, or who recover from the effects of that hemor-
rhage (Table 2).
The physician, therefore, must be aware of the
significance of instantaneous onset of headache, fol-
lowed by nuchal rigidity. If the hemorrhage is of
brief duration, the headache may not be severe, or
may be delayed for as long as 24 hours. The dan-
ger of recurrent hemorrhage is greater in these
cases than in the more easily diagnosed cases in which
coma and neurologic deficits are present.
Bloody spinal fluid with a yellow supernatant layer
From the Department of Surgery, Division of Neurological Sur-
gery, The Ohio State University College of Medicine, Columbus,
Ohio. Submitted July 1, 1966.
The Authors
• Dr. Hunt, Columbus, is a member of the At-
tending Staff, University Hospital; Associate Staff.
Children’s Hospital; Professor and Director, Di-
vision of Neurological Surgery, The Ohio State
University College of Medicine.
• Dr. Meagher, Columbus, is Chairman, Surgi-
cal Staff, Children’s Hospital; Clinical Associate
Professor, Division of Neurological Surgery, The
Ohio State University College of Medicine.
• Dr. Hess, Columbus, is Instructor, Department
of Surgery, Division of Neurological Surgery, Ohio
State University Hospital.
is diagnostic of subarachnoid hemorrhage. Angi-
ography should be performed as soon as it appears
that the patient will survive the first hemorrhage and
that definitive treatment to prevent further bleeding
may be possible.
There is a strong correlation,3- 4 between the pa-
tient’s clinical status and the surgical morbidity and
mortality (Tables 1 and 2). We have graded this
series by Botterel’s method5:
Grade I
Grade II
Grade III
Grade IV
Grade V
Asymptomatic, or minimal headache and
slight nuchal rigidity.
Moderate to severe headache, nuchal rigid-
ity without neurologic deficit.
Drowsiness, confusion, or mild focal deficit.
Stupor, moderate to severe hemiparesis, pos-
sibly early decerebrate rigidity and vegeta-
tive disturbances.
Deep coma, decerebrate rigidity, moribund
appearance.
Coexistent hypertension, diabetes, severe arteri-
osclerosis, uremia, or chronic pulmonary disease af-
fect the prognosis unfavorably in all grades.
Table 1. Aneurysms at Admission
Grade
Number
Deaths
%
Mortality Rate
I
33
5
15
II
51
12
23
III
37
20
54
IV
15
12
80
V
4
4
100
140
53
38
1168
The Ohio State Medical Journal
Table 2. Intracranial Aneurysmonhaphy
Grade
Number
Deaths
% .
Mortality Rate
I
49
2
4
II
23
3
13
III
11
3
27
IV
7
4
57
V
3
3
100
93
15
16
By our criteria, mild subarachnoid hemorrhage de-
mands immediate diagnosis and treatment, whereas
a period of supportive care is indicated after severe
hemorrhage. Figure 1 shows a posterior communi-
cating artery aneurysm with spasm of the adjacent
Fig. 1. Posterior communicating artery aneurysm. Severe
middle cerebral artery spasm.
arteries. Such spasm seems to play a major role in
the production of neurologic deficit after subarach-
noid hemorrhages. Figure 2 shows the same arterial
tree ten days after clip ligation of the aneurysm.
We have reviewed the 235 cases of subarachnoid
hemorrhage or aneurysms without hemorrhage ad-
mitted between January 1, 1954 and March 1, 1963
(Fig. 3, Chart 1). All cases have been documented
by either angiographic, operative, or necropsy find-
SUBARACHNOID HEMORRHAGE
Figure 3 (Chart 1)
ings. The series has been analyzed by recording 40
items of pertinent data for each patient.
A previous review of our series was completed in
1961. At that time we had treated 91 aneurysms
with a survival rate of 59 per cent.4
In the present series, 62 per cent, or 87 of 140
patients with aneurysm survived. By contrast, 72
per cent, or 53 of 65 patients with subarachnoid
hemorrhage without demonstrable etiology survived,
as did 73 per cent, or 22 of 30 patients with arteri-
ovenous malformations.
The overall mortality rate for subarachnoid hemor-
rhage, regardless of cause, is 31 per cent; the rate
with aneurysm alone is 38 per cent. This series is
unselected and includes moribund patients who died
soon after admission and were shown at autopsy to
have ruptured intracranial aneurysms.
Of the 140 aneurysms, 103 had surgery; 37 did
not. Figure 4, Chart 2 shows an 82 per cent survival
rate in the operated group, and an 8 per cent survival
rate in the nonoperated group.
There is evidence that the danger of recurrent
bleeding is greatest in the first few days following
the initial rupture. We have found that the lower the
grade, i.e., the better the patient, the greater the risk
of rebleeding. Table 1 shows the mortality rate by
grade at admission, and Table 2 shows the rate by
grade at the time of intracranial surgery. The con-
jor November, 1966
1169
OPERATIVE MORTALITY, ANEURYSM SURGERY
TOTAL CASES 140
OPERATED NON- OPERATED
Figure 4 (Chart 2)
spicuous difference in mortality rates will be analyzed
with our results.
Cervical Carotid Ligation
Table 3 shows the results of cervical carotid ligation.
Table 3. Direct Intracranial Ligation vs. Cervical Carotid
Artery Ligation
Number
Deaths
% Mortality
Direct Ligation
93
15
16
Carotid Ligation
10
4
40
103
19
18
In three additional cases, cervical carotid ligation
has been performed since March 1, 1963. Two
have been successful; the other patient died of in-
farction of the hemisphere and massive cerebral
edema.
Our opinion is that cervical carotid ligation, except
in selected cases, is not as satisfactory as the intra-
cranial approach. The risk of rebleeding after liga-
tion still exists. Mortality has been 38 per cent.
Nonfatal complications include two patients with hem-
iplegia and aphasia.
Ninety-three patients had intracranial ligation or
aneurysm strengthening procedures. The operative
mortality for Grades I and II was 7 per cent. There
were five deaths of which four must be put down
to technical failures. In two patients, the clip be-
came dislodged and rebleeding resulted. A postopera-
tive epidural hematoma caused another death. One
patient died of cerebral infarction attributed to
vasospasm, and perhaps should have been graded
III instead of II. The fifth death was caused by
overwhelming postoperative pneumonia.
Results in Grades I and II
Because the overall mortality (Table 1) was so
much greater than the surgical mortality (Table 2)
in Grades I and II, these cases were subjected to
intensive review. Tables 1 and 2 show that 84 such
patients were admitted. Seventy-two were operated
upon and five died, a mortality of 7 per cent. Twelve
1170
patients not operated upon also died. The overall
mortality in patients graded I and II was thus 20 per
cent. Eight deaths were adjudged preventable.
There were three avoidable delays in diagnosis, two
failures to perform vertebral arteriography, one ill-
advised cervical carotid ligation, one postoperative
epidural hematoma, and one error in patient classi-
fication. Nine deaths were adjudged nonprevent-
able. Six patients died from rapid rebleeding.
One had rebleeding after cervical carotid ligation.
One had cerebral infarction after cervical ligation.
Another had ligation of multiple aneurysms but post-
operative cerebral infarcts occurred from severe cere-
bral arteriosclerosis. Clearly the danger of early
rebleeding is present in patients classified Grade I
or Grade II at the time of admission.
Results in Grade III
Because of the high mortality (54 per cent) in
cases considered Grade III at admission, this group
was reviewed to determine whether the policy of
delayed intervention was justified (Table 4).
Table 4. Analysis of Grade III Patients on Admission
6
Operated at Grade
I
SURVIVORS
7
2
II
III
17
1
1 Not Operated
IV
1
Operated at Grade
I
DEATHS
3
2
II
III
20
1
13
Not Operated
IV
Of the deaths, 13 patients were not operated; seven
of these died in deepening stupor without rebleed-
ing. Four patients had rapid rebleeding less than
24 hours after admission. One had a vertebral basi-
lar aneurysm and died awaiting definitive treatment.
Another probably rebled from an unrecognized
aneurysm at the basilar termination. We do not
think that any of these nonoperative deaths could
have been salvaged.
Analysis of deaths of Grade III patients at ad-
mission showed that seven were operated. One had
surgery at Grade I and died because of technical
failure. Three were operated at Grade II and in this
classification, two were craniotomies and one a cervi-
cal carotid ligation. Two were operated at Grade III.
One was operated early in the series at Grade IV as
a measure of desperation.
Table 4 shows 17 survivors who were Grade III
upon admission. Thirteen improved with conserva-
tive therapy to Grades I and II, and two were oper-
ated at Grade III. One was operated at Grade IV
(evacuation of temporal lobe hematoma), and sub-
sequent arteriography showed the aneurysm and par-
ent vessel obliterated. One patient was not operated
and survived in a vegetative state without evidence
of rebleeding.
In this group, then, the risk with immediate oper-
ation is high, the risk of rebleeding is low, and much
The Ohio State Medical Journal
of the mortality is related to cerebral infarction, not
to secondary hemorrhage.
Morbidity
In 26 patients having either intracranial ligation
or cervical carotid ligation, eight were seriously handi-
capped with aphasia, hemiplegia, psychosis, or pro-
longed coma. One half of the patients writh serious
morbidity had had cervical carotid ligation. Eighteen
patients had had minor deficits such as dysphasia,
hemiparesis, cranial nerve palsy, mild intellectual
defect, or temporarily reduced visual acuity.
Summary
It is our polity to treat proved aneurysm by
intracranial operation whenever possible, employing
ligation of the neck of the aneurysm or external
reinforcement of the sac. Trapping procedures or
ligation of the cervical carotid artery may be considered
wdien direct attack is not possible. Cervical carotid
ligation has not been totally satisfactory in our hands
because of the incidence of rebleeding or infarction.
Our mortality for this procedure is 40 per cent. Our
recommendation is that its use should be confined to
instances where direct attack is patently impossible.
We advocate craniotomy without delay in Grades I
and II because our experience shows that the risk of
early rebleeding is great in these groups. No patients
were lost in the last 24 months of this survey be-
cause of diagnostic delay.
By contrast, in Grades III, IV, and V, the risk of
rebleeding is less, and the danger of surgery is
greater. These patients are not subjected to immedi-
ate operation until they improve to a better grade.
The risk inherent in this policy is that a certain num-
ber of patients may be lost from rebleeding during
the waiting period. However, most of the mortality7
is from causes that cannot be prevented by early sur-
gery, and the operative risk is much less after the
patient has improved. Therefore, unless repeated
bleeding occurs, a period of conservative therapy
seems justified. Our statistics support the thesis
that patients in this group survived who would have
been lost had they been operated upon earlier.
As a mle, patients graded at IV and V upon ad-
mission cannot be helped by surgery. Our mortality
with Grades IV and V has been 80 and 100 per cent
respectively.
The exception to the polity of delayed surgery in
Grades III through V is that a large intracerebral
hematoma, threatening life, should be evacuated.
Definitive repair of the aneurysm may be postponed
to avoid manipulating vessels in spasm.
Conclusions
1. Intracranial obliteration of aneurysms to pre-
vent further hemorrhage is indicated whenever
possible.
2. Surgical risk is low in patients who are in good
condition at the time of operation.
3. Surgical risk is related to signs of meningeal
irritation and neurologic deficit.
4. Surgical intervention is urgent in patients ad-
mitted in good condition, but delay of operation until
patient's condition improves is justifiable in the more
seriously ill.
5. Progressive encephalopathy, presumably due to
vasospasm and ischemia, is a more common cause of
death than is recurrent hemorrhage in the poor risk
patient.
6. Cervical carotid ligation should be reserved for
cases in which direct attack is not practicable.
References
1. Hamby. W. B.: Intracranial Aneurisms. Springfield. Illinois:
Charles C. Thomas. 1952. p. 99.
2. Bucy. P. C.; Grinker, R. R., and Sahs, A. L. : Neurology . ed.
5, Springfield. Illinois: Charles C. Thomas, I960, p. 782.
3. Pool, J. L.; Ransohoff, J.; Yahr, M. D.. and Hammill, J. F.:
Early Surgical Treatment of Aneurysms of the Circle of Willis.
Neurology. 9:478-486. 1959.
4. Hunt. W. E.; Meagher, J. N., and Barnes, J. E.: The Man-
agement of Intracranial Aneurysm. J. Neurosurg., 19:34-40, 1962.
5. Botterel, E. H.; Lougheed. W. M.; Scott, J. W., and Vande-
water, S. L.: Hypothermia, and Interruption of Carotid, or Carotid
and Vertebral Circulation, in the Surgical Management of Intra-
cranial Aneurysms. J. Neurosurg.. 13:1-42, 1956.
A RUPTURED ANEURYSM of the anterior communicating artery usually
is manifested only by the headache characteristic of intracranial sub-
arachnoid hemorrhage. Probably these patients more consistently localize the
initial pain in the "front of the head" or "behind the eyes," but more often the
initial complaint is simply an extremely severe headache.
Of the more common intracranial aneurysms, those of the anterior communicat-
ing artery least often produce a lateralizing neurologic deficit upon rupturing.
An aneurysm of the anterior communicating artery may bleed into the substance
of the adjacent cerebral hemisphere as well as into the subarachnoid space. Thus,
such aneurysms, upon rupturing, may cause loss of consciousness more often than
those at other sites.
Although aneurysms of the anterior communicating artery are close to the
optic chiasm, they rarely cause a visual deficit. It has been observed, however,
that hemorrhage from these aneurysms seems more likely to extend along the optic
nerves and be seen as small collections of blood in the optic fundus. — Homer
D. Kirgis, M. D., Ph. D., John D. Jackson, M. D., William L. Fisher, M. D.,
and Edward McC. Peebles, Ph. D., New Orleans: Aneurysms of of the Anterior
Communicating Artery, Southern Medical journal , 59:733-759, July 1966.
for November, 1966
1171
Subdural Hematoma in
Posterior Fossa
Report of a Case Complicated by Meningitis in a Newborn Infant
C. NORMAN SHEALY, M. D.
The Author
• Dr. Shealy, La Crosse, Wisconsin, formerly As-
sistant Neurosurgeon, University Hospitals, and
Assistant Professor of Neurosurgery, Western Re-
serve University, Cleveland, is now a member of
the staff of Gundersen Clinic in La Crosse.
OSTERIOR FOSSA subdural hematomas are
rare lesions which should have a good prognosis
if treated early. Recently we encountered an
unusual example of this entity complicated by neo-
natal meningitis in a newborn infant.
Case Report
This 4 day old boy was transferred to Babies and Chil-
drens Hospital because of a bulging fontanel and a single
generalized seizure. Pregnancy had been complicated by
excessive weight gain and some bleeding in the last trimester.
Labor was unremarkable, but the child was noted to have a
hematoma on the right side of his face at birth. On the
third day of life the fontanel was noted to be quite full.
Physical Examination: The child’s length was 53 cm;
weight 3.2 kilograms; and head circumference 38 cm.
There was no significant residual sign of birth trauma. The
fontanel was bulging and quite firm and the sutures were
separated. He was generally hypotonic with respirations
ranging between 15 and 40 per minute and pulse ranging
between 80 and 120/minute. Fundi were unremarkable.
Moro reflex was very poor, and suck was fair at best. His
cry was very high pitched.
Laboratory Data: Hematocrit was 32 per cent; white
blood cell count 16,500; differential shifted to the left; bili-
rubin 12.2 mg per 100 ml total; blood sugar 147 mg per
100 ml; prothrombin time 34 per cent; and platelets
158,000.
Course in Hospital: Shortly after admission bilateral
subdural taps were done and these were negative. After the
child was given whole blood, a ventricular tap revealed
slightly yellow ventricular fluid, which was loaded with
bacteria on microscopic examination and which contained
12 white cells /cu.mm.; protein 154 mg/ 100 ml; sugar 7 mg/
100 ml. Cultures grew Escherichia coli. Air study revealed
that there was a complete block at the posterior third ventricle
and moderate hydrocephalus. He was treated with chloram-
phenicol and tetracycline and received intraventricular poly-
myxin B for three days. Although the ventricular fluid became
sterile, it continued to run a low sugar and up to 100 white
cells/cu.mm. He required ventricular taps every two to
three days because of pressure, but generally he was eating
well, became afebrile, and began to gain some weight. A right
retrobrachial arteriogram demonstrated only hydrocephalus.
Repeat ventriculogram revealed forward displacement of
the aqueduct which was confirmed by a Pantopaque® ven-
triculogram (Fig. 1). However, the ventricular system
remained midline. The possibility of posterior fossa abscess
was strongly considered, but because of the child’s very
poor condition, posterior fossa exploration was not per-
formed and a ventriculoperitoneal shunt was planned. How-
ever, on September 29, 1964 he developed seizures and
became obtunded. Ventricular tap revealed the fluid to be
From the Division of Neurosurgery, Western Reserve Univer-
sity School of Medicine and University Hospitals, Cleveland, Ohio.
Submitted March 21, 1966.
very hazy whereas it had been clear previously. There were
1200 white cells /cu.mm.; 69 per cent monocytes; 31 per
cent polymorphonuclear cells; sugar 4 mg/ 100 ml; and
protein 400 mg/ 100 ml in the spinal fluid. The child
rapidly deteriorated and died on September 29, 1964.
Autopsy revealed mild meningitis, moderate hydrocephalus,
and a large subdural hematoma of the posterior fossa ex-
tending through the tentorial notch to the torcular.
Discussion
Extradural and subdural hematomas of the posterior
fossa are rare lesions. Most reports have consisted of
single cases which have followed external trauma.1'3
The period between injury and diagnosis ranged
from a few hours to five months and symptoms of
these lesions are the nonlocalizing ones of posterior
fossa mass lesion. Birth trauma with mild subarach-
Fig. 1. Pantopaque ventriculogram, demonstrating hydro-
cephalus and anteriorly displaced fourth ventricle and
aqueduct.
1172
The Ohio State Medical Journal
noid hemorrhage is relatively common and lacerations
of the torcular or other sinuses are seen not infre-
quently. Nevertheless, a sizeable hematoma in such
a situation is a rare finding.
More commonly these birth lesions are associated
with widespread cerebral bruising. Some authors be-
lieve that most communicating hydrocephalus de-
velops from posthemorrhage arachnoiditis. Neonatal
meningitis is also a rarity and the coexistence of these
two entities has not been previously reported.
The patient presented here was never in satisfactory
physical condition to allow consideration of surgery
and it seems unlikely that evacuation of the hematoma
would have been successful. Relapsing meningitis
should always lead to suspicion of mass lesion and this
case demonstrated additionally that any block to cere-
brospinal flow can produce stasis preventing anti-
biotic sterilization, even when the organism is sensitive.
Summary
This report concerns a newborn infant with re-
lapsing meningitis, hydrocephalus, and a posterior
fossa subdural hematoma due to a tear of the torcular.
The latter lesion should be suspected in infants who
rapidly develop hydrocephalus. Successful therapy
must depend upon prompt diagnosis.
References
1. Estridge, M. N., and Smith, R. A.: Acute Subdural Hemor-
rhage of Posterior Fossa. /. Neurosurg., 18:248-249 (Mar.) 1961.
2. Horvath, L., and Marinescu, V.: Chronic Subdural Haematoma
of the Posterior Cranial Fossa. Acta Neurochir., 11:579-582, 1964.
3. Lemmen, L. J., and Schneider, R. C.: Extradural Hematomas
of the Posterior Fossa. /. Neurosurg., 9:245-253 (May) 1952.
4. Norlen, Gosta; Radberg, Claes, and Granholm, Lars: Infantile
Hydrocephalus and Hematoma in the Posterior Fossa. /. Neurosurg.,
21:309-310 (Apr.) 1964.
CHRONIC SUBDURAL HEMATOMA may simulate intracerebral hemor-
rhage. In such patients, somnolence or unconsciousness for prolonged
periods alternates with periods of alertness.
The patient whose condition is diagnosed as cerebral hemorrhage who has
coma persisting longer than twenty-four hours is doomed to a fatal termination,
but his life may be saved if burr holes, arteriography, or air studies reveal a sub-
dural hematoma or other space-occupying lesion. If such studies do not reveal
a removable lesion, evacuation of the intracerebral clot may save a life. — Abraham
M. Rabiner, M. D., Brooklyn, N. Y.: New York State Journal of Medicine,
66:947-950, April 15, 1966.
CARING FOR THE PATIENT. — The physician of fifty years ago had,
in many situations, only himself to offer, and though incomparably less
effective in terminating certain diseases, notably the infections, he knew how to
throw his weight into the balance on the patient’s side. There is nothing in
today’s advances that need prevent us from emulating him.
The statement that "we should not treat diseases but people” is often quoted
and much more often disregarded. When one tells students and house officers,
"At times what you say to patients is more important than what you do for them,
and it may be more damaging to say the wrong thing than to give the wrong
medication,” one is telling a truth that all practicing physicians have had to learn.
Success in this important phase of therapy is the result of the development
of a real golden-rule policy by the physician. When he has developed the es-
sential habit of trying to find out just what the patient is feeling and fearing
— in other words to imagine himself in the patient’s situation, anxieties and
worries included — he will be able to avoid everything disturbing and to build
up the patient’s morale. As Charcot said, "The best inspirer of hope is the best
physician.” — Alex M. Burgess, M. D., Providence, R. I., and Alex M. Burgess,
Jr., M.D., Boston: The New England Journal of Medicine. 274:1241-1244,
June 2, 1966.
for November, 1966
1173
Aneurysmal Bone Cyst
Of the Calvarium
Report of a Case with Isotopic Visualization
OSCAR A. TURNER, M. D., THOMAS LAIRD, M. D.,
and LEON L. BERNSTEIN, M. D.
7\ NEURYSMAL bone cyst is not a common le-
/_j\ sion, constituting about 1 per cent of all bone
^ tumors according to Guy, et al.5 They are
not regarded generally as true neoplasms and rarely
have they been known to undergo neoplastic change,
despite the fact that they may become massive in size.
One case has been reported in which a fibrosarcoma
developed at the site of an aneurysmal bone cyst sub-
jected to intense radiation on the mistaken premise that
it was a giant cell tumor.9 Lichtenstein8' 9 believes
that they are the result of some persistent local alter-
ation in hemodynamics, such as a venous thrombosis
or arteriovenous fistula, leading to the development of
a dilated and engorged vascular bed. This concept
is accepted by most writers, although recently Edling4
has proposed the name of subperiosteal dysfibroplasia.
considering these lesions to be one of the manifesta-
tions of dysfibroplasia of bone.
About three fourths of aneurysmal bone cysts
involve the shaft of a long bone or some part of the
vertebral column,10 although they have been re-
ported in the clavicle, ribs, scapula, and small tubular
bones of the hands and feet, occurring in the skull
most infrequently. The present report is of the occur-
rence of an aneurysmal bone cyst in the frontal bone,
this case incidentally being the first in which localized
uptake by a radioactive isotope was demonstrated.
Case Report
The patient was a 21 year old woman seen in November,
1963, with the complaint of a "lump” in the frontal region.
There was a history that about nine years previously she
had been struck in the right frontal area with a golf ball.
Following this, a local swelling developed which never
completely disappeared although it remained otherwise
asymptomatic. About five weeks prior to examination,
progressive enlargement began, this being associated with
an increasingly severe, dull frontal headache. Three weeks
before examination, the mass became soft, described by the
patient as feeling as if it had "fluid in it.” The headache
was confined to the right frontal and adjacent parietal area
with occasional discomfort about the right eye, but without
visual disturbance. On examination the significant findings
were related to the local lesion. The tumor was in the right
From the Division of Neurosurgery and the Department of
Radiology, The Youngstown Hospital Association, Youngstown,
Ohio.
Submitted April 13. 1966.
The Authors
• Dr. Turner, Youngstown, is a member of the
staff, Division of Neurosurgery, The Youngstown
Hospital Association.
• Dr. Laird, Youngstown, is Radiologist, The
Youngstown Hospital Association, North Unit.
• Dr. Bernstein, Youngstown, is a member of the
staff, Division of Neurosurgery, The Youngstown
Hospital Association.
frontal area immediately behind the hairline, was not par-
ticularly tender, did not pulsate and had no bruit. The
tumor mass, while soft, was not fluctuant and measured
about 4 cm. in diameter. Neurologic examination was
otherwise normal.
Roentgenographic examination revealed a 3.5 cm. lytic
lesion in the right frontal bone. The margins of the lesion
were scalloped but fairly well maintained, some areas show-
ing mild sclerosis. A few remnants of bone spicules could
be identified but septae could not be seen (Fig. 1-A).
Tangential views demonstrated thinning of the bone edges
and in some areas a very narrow subperiosteal rim of bone
remained (Fig. 1-B).
A brain scan employing 804 microcuries of Hg203 re-
vealed an abnormal concentration of the isotope coinciding
with the tumor mass in the right frontal bone (Fig. 2).
At operation the reflected scalp revealed the tumor mass
to have a bluish-grey, fibrous wall. When this was incised,
a cavity containing old blood and some yellow fluid was
disclosed. Evacuation of the contents exposed a trabecular
inner wall containing a few spicules of bone with some
adherent tissue. Frozen section showed osseous tissue with
fibroblastic proliferation. Block excision was done, the
tumor being only loosely adherent to the underlying dura.
The floor of the bony cavity was extremely thin to the point
where a flat instrument passed between it and the dura
could be seen through the bony layer. The cystic cavity
measured 1.5 cm. in depth and, where the bone was intact,
small dark areas, having the appearance of dilated vessels,
could be seen (Fig. 3-A).
Microscopically the inner table showed small spicules of
cancellous bone undergoing resorption and areas where new
bone stroma was being formed (Fig. 3-B). The lining of the
large cystic cavity was composed of a cellular stroma of long
fusiform cells and a scattering of large, multinucleated.
syncytial giant cells. There were numerous, large, thin-
walled, tortuous, vascular spaces separated by fibrous strands.
Many of these spaces contained blood whereas others were
empty.
1174
The Ohio State Medical Journal
Discussion
A review of the considerable literature which has
appeared in the past ten years since aneurysmal bone
cyst was defined as a clinical entity by the work of
Lichtenstein8 and of Jaffe6 indicates that there has
been little reference to its appearance in the bones
of the calvarium. Of Lichtenstein’s8 17 cases, the
skull was involved in only one instance, this being
in the occipital bone. In the 26 cases reported by
Dahlin, et al.,3 one occipital lesion was mentioned.
Cruz and Coley2 reported 20 cases and Sherman and
Soong11 43 cases with no involvement of the skull.
Jeremiah7 has reported surgical removal of a large
aneurysmal bone cyst of the temporal region in a
A B
Fig. 1. (A). Roentgenogram of skull showing scalloped margins and remnants of bone spicules. (B). Tangential view show-
ing expanding character of lesion and thinning of bone.
!
A
Fig. 2. Lateral (A) and frontal (B) Hg20S brain
B
scan showing increased uptake of lesion.
for November, 1966
1 175
A B
Fig. 3. (A). Gross illustration showing cavity of cystic lesion. (B). Photomicrograph illustrating vascular spaces, giant cells,
fibrous stroma and bone spicules.
24 year old woman, who four months previously had
subtotal excision done with the diagnosis of giant cell
tumor. Lichtenstein9 has more recently reported his
observations on 50 cases and mentions three occurring
in the skull.
The relationship of trauma to the aneurysmal bone
cyst is not clear, most authors tending to discount it
as a causative factor but accepting trauma as a pos-
sible aggravating circumstance. In the five cases re-
ported by Phelan10 two patients mentioned trauma
as a possible precipitating element. Guy, et al., 5 in
reviewing 66 recorded cases, found a positive history
of trauma in about 50 per cent, while Cruz and Coley2
quote Thompson12 as reporting a history of trauma
in 6l per cent of the cases in the literature. At the
same time these authors express the view that trauma
plays no role other than to call attention to a pre-
existing lesion.
In the present case there was an apparent rela-
tionship between the first appearance of the lesion
and local injury. If one rejects Cone’s1 concept
of the lesion as an excessive reparative process sec-
ondary to a traumatic subperiosteal hematoma, it
is still quite possible that trauma may in some in-
stances initiate the local circulatory disturbance re-
ferred to by Lichtenstein.
The radiologic picture in the present case was fairly
characteristic except that at the time the patient was
seen the bone destruction had progressed to the stage
where ridges or septae were not prominently visible.
To the writer’s knowledge, this is the first reported
instance in which this type of lesion has been vis-
ualized by isotopic scan, the selective uptake of the
isotope not being unexpected in view of the vascular
nature of the lesion.
Summary
A case of aneurysmal bone cyst of the right frontal
bone has been reported in which trauma appeared to
have been an initiating factor. Selective uptake by
Hg203 has been demonstrated. The literature relative
to involvement of the calvarium by this lesion has
been briefly reviewed.
References
1. Cone, S. M.: Ossifying Hematoma. /. Bone Joint Surg.,
10:474-482 (July) 1928, referred to by Phelan.10
2. Cruz, M., and Coley, B. L.: Aneurysmal Bone Cyst. Surg.
Gynec. Obstet., 103:66-77 (July) 1956.
3. Dahlin, D. C.; Beese, B. E., Jr.; Pugh, D. G., and Ghormley,
R. K. : Aneurysmal Bone Cysts. Radiology, 1955, 64:56-65 (Jan.)
1955.
4. Edling, N. P. G. : Is the Aneurysmal Bone Cyst a True
Pathologic Entity? Cancer, 18:1127-1130 (Sept.) 1965.
5. Guy, R.; Raymon, D. O.; Samson R., and Samson, J. E.:
Aneurysmal Bone Cyst. J. Canad. Ass. Radiol., 7:40-50 (Dec.) 1956.
6. Jaffe, H. L., and Lichtenstein, L.: Solitary Unicameral Bone
Cyst, with Emphasis on the Roentgen Picture, the Pathologic Ap-
pearance and the Pathogenesis. Arch. Surg., 44: 1004-1025 (June)
1942.
7. Jeremiah, B. S.: Aneurysmal Bone Cyst of the Temporal
Bone. /. Int. Coll. Surg., 43:179-183 (Feb.) 1965.
8. Lichtenstein, L. : Aneurysmal Bone Cyst; Further Observa-
tions. Cancer, 6:1228-1237 (Nov.) 1953.
9. Lichtenstein, L. : Aneurysmal Bone Cyst: Observations on
Fifty Cases. /. Bone Joint Surg., 39A:873-882 (July) 1957.
10. Phelan, J. T.: Aneurysmal Bone Cyst. Surg. Gynec. Obstet..
119:979-983 (Nov.) 1964.
11. Sherman, R. S., and Soong, K. Y.: Aneurysmal Bone Cyst:
Its Roentgen Diagnosis. Radiology, 68:54-64 (Jan.) 1957.
12. Thompson, P. C. : Subperiosteal Giant-Cell Tumor. J. Bone
Joint Surg., 36A:281-291 (Apr.) 1954.
I
1176
The Ohio State Medical Journal
A Clinicopathological Conference
From The Ohio State University Hospital, Columbus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
J. B. McMILLAN, M. B., Ch. B., President
Presented by
• Norton J. Greenberger, M. D., Columbus, and
• Emmerich von Haam, M. D., Columbus ;
Edited by Dr. von Haam.
PRESENTATION OF CASE
Admission: Eight years prior to the final
I (third) admission, this 6 5 year old white man
was admitted to University Hospital with a his-
tory of painless hematuria for the past three months.
A well differentiated transitional cell carcinoma of
the bladder was resected, and the patient apparently
did well until his second University Hospital admis-
sion two months prior to his final admission.
Second Admission
The patient noted the onset of weakness, easy fatig-
ability, and anorexia four months prior to the second
hospital admission, with a weight loss of 15 lbs. A
blood count done six weeks prior to this admission
revealed anemia and he was started on oral iron
therapy. On the day prior to admission he had an
episode of hematemesis followed by melena. He
denied previous melena or hematemesis, pyrosis, food
intolerance, nausea or vomiting. He had no previous
history of icterus or hepatitis or any episodes of
pruritus. He had received no blood transfusions. He
had once been examined at the Mayo Clinic because
of multiple subcutaneous nodules that had been
present for 20 to 25 years.
Physical examination revealed a chronically ill ap-
pearing white man. The vital signs were normal.
On the extremities and trunk were multiple, freely
movable, nontender, subcutaneous nodules of various
sizes. No areas of hyperpigmentation or spiders were
noted. The sclerae were slightly icteric; the fundi
appeared normal. No lymphadenopathy was noted.
The lungs were clear. The heart was not enlarged;
the rhythm was regular. A grade II/VI apical sys-
tolic ejection murmur was heard. The abdomen was
not distended; the upper right quadrant was slightly
tender. The liver was palpable 6 cm. below the right
costal margin and was nontender. The spleen was not
palpable, nor were any abdominal masses. A tarry,
guaiac-positive stool was found on rectal examination.
There was no edema of the extremities. The neuro-
logical examination revealed no abnormalities.
Laboratory examinations revealed a hemoglobin
of 9.6 Gm., hematocrit of 29 per cent, 5,000 white
Submitted August 17, 1966.
blood cells with a normal differential count. The
urine was not remarkable. The serum sodium was
138, the potassium 4.8, chlorides 113, and C02
combining power 26 mEq./liter. The blood urea
nitrogen (BUN) was 27, the creatinine 0.8 mg./lOO
ml. The inorganic phosphorus was 2.8 mg./lOO ml.;
alkaline phosphatase 11.9 Shinowara- Jones -Reinhart
units; serum cholesterol 187 mg./lOO ml. with 67
per cent esterification; total bilirubin 4.2 mg./lOO ml.
with 1.8 mg. direct- reacting bilirubin; cephalin floccu-
lation 2 plus; thymol 60 mg./lOO ml.; total protein
6.0 Gm./lOO ml. (albumin 3.1, globulin 2.9);
bromsulphalein 30.7 per cent; prothrombin time 40
per cent; the serum glutamic oxalacetic transaminase
(SGOT) was 59 units, the glutamic pyruvic trans-
aminase (SGPT) 19 units, and the lactic dehydro-
genase (LDH) 472 units.
The electrocardiogram was within normal limits.
On chest x-ray the heart and lungs were within nor-
mal limits. An upper gastrointestinal film showed
esophageal varices, cholelithiasis, and splenomegaly.
The intravenous pyelogram and the barium enema
showed no abnormalities.
A nasogastric tube was inserted and clear fluid was
aspirated. Over the first 36 hours he received 4
units of whole blood; his hemoglobin rose to 11-12
Gm. and stabilized at that level. He gained weight
and developed ascites. On paracentesis a clear yellow
fluid was obtained which had a specific gravity of
1.002, an amylase of 7 units, and a class II Papani-
colaou smear reading.
The patient was then given diuretics and during
his 20 day hospital stay responded with a 12 lb.
weight loss on sodium restriction, chlorothiazide, and
Aldactone®. He was also treated with multivitamins
and Mephyton®. The prothrombin time increased to
for November, 1966
:1 177
65 per cent. The total bilirubin dropped to 1.4 mg.
A percutaneous liver biopsy was considered unsatis-
factory for accurate pathologic diagnosis but was
interpreted as essentially normal. On splenoporto-
gram a pressure of 420 mm. of water was obtained.
A retrograde flow through the inferior mesenteric
vein and also through a large coronary vein with
fundo-esophageal varices was demonstrated. No evi-
dence of thrombi in the splenic or portal venous system
was seen. After a surgical consultation, it was de-
cided that the patient should be kept under medical
management for six to eight weeks and then be
evaluated as a possible candidate for portacaval shunt.
Final Admission
In the interim of two months, the patient con-
tinued to have easy fatigability and anorexia. No
further episodes of melena or hematemesis occurred.
He gained 12 to 15 lbs. and had abdominal swell-
ing and pedal edema in spite of frequent injections of
mercurial diuretics. He also experienced frequent
episodes of sharp right upper quadrant and right
flank pain.
Physical examination on admission revealed a pale,
wasted white man with no obvious icterus. The sub-
cutaneous nodules were again noted. There was no
lymphadenopathy. Dullness to percussion, decreased
breath sounds, and tactile fremitus were noted at
the base of the right lung posteriorly. No rales or
rhonchi were heard. There was no change on exami-
nation of the heart. The abdomen was distended
with obvious ascites. The liver was palpable 6 cm.
below the right costal margin and was moderately
tender. A suggestion of fullness and a possible in-
discrete mass were palpable in the left upper quadrant
and the left flank. There was 3 plus pitting pretibial
and pedal edema. The patient was alert and no
asterixsis was demonstrated.
Laboratory data showed a hematocrit of 40 per
cent, hemoglobin 12.7 Gm., and a white blood cell
count of 6,000 with a normal differential count. The
urinalysis was not remarkable. The serum sodium
was 132, potassium 4.0, chloride 102, and the CCL
combining power 28 mEq.; bilirubin 2.2 mg. with
1.2 mg. direct; SGOT 104, LDH 520 units. The
BUN was 16 mg., cholesterol 193 mg. with 63 per
cent esterification; prothrombin time 60 per cent;
alkaline phosphatase 24 units; total protein 7.8 Gm.
(3.3 albumin, 4.8 globulin). Serum protein electro-
phoresis on 7.7 Gm./lOO ml. protein showed albumin
38.6 per cent, alphaj 8 per cent, alpha2 11.4 per
cent, beta 1 6.6 per cent, gamma globulin 25.4 per
cent.
X-ray film of the chest revealed evidence of mini-
mal pleural fluid bilaterally. An esophogram con-
firmed the presence of very large varices. The elec-
trocardiogram was within normal limits.
During his hospital stay of 25 days the patient
remained afebrile. Attempts at diuresis resulted in
a 20 lb. weight loss. He complained frequently of
moderately severe back, and generalized abdominal,
pain. A diagnostic paracentesis yielded a clear yel-
low fluid containing 200 erythrocytes, 100 leukocytes
(88 per cent lymphocytes), 400 mg. of protein, and
was Papanicolaou class I. An inferior venacavagram
was interpreted as normal. Carbon dioxide study
of the hepatic veins was attempted but was unsuc-
cessful. Liver scan with both radioactive gold and
rose bengal was consistent with a small liver and an
enlarged spleen.
On the 18th hospital day he was given Thorazine®
because of nausea and vomiting. Following this he
became extremely drowsy and difficult to arouse. On
the 22nd hospital day he had an episode of hema-
temesis followed by melena. During the next few
days the patient deteriorated rapidly and he died on
the 25th hospital day.
CLINICAL DISCUSSION
Dr. Greenberger: This case concerns a 65 year
old white man who eight years prior to his final ill-
ness had a resection of a transitional-cell carcinoma
of the bladder. He then did well until his final
illness, which spanned seven months and was char-
acterized by weakness, easy fatigability, anorexia, a
weight loss of at least 15 lbs., wasting, right upper
quadrant and flank pain, at least two distinct episodes
of upper gastrointestinal bleeding with hematemesis,
an adverse reaction to Thorazine characterized by
drowsiness and obtundation, and terminal coma
which was most likely hepatic in origin. He had sub-
cutaneous nodules; he had mild but persistent jaun-
dice; he had recurrent ascites and edema; he had
hepatomegaly with a tender liver; a heart murmur.
We are told that he also had a pleural effusion al-
though we may not be able to see these on the x-rays,
a questionable left upper quadrant mass, anemia due
to blood loss, and clear-cut portal hypertension as
reflected by the fact that he had esophageal varices, a
very high intrasplenic pressure, ascites, and sple-
nomegaly. Any diagnosis or diagnoses that are go-
ing to be invoked must account for all of these.
On the second admission he had significant hyper-
bilirubinemia, a slightly increased SGOT, and de-
pressed prothrombin time which improved to near
normal after vitamin K, an abnormal cephalin floc-
culation and thymol, a depressed albumin, normal
globulin, a long BSP retention, and a slightly ele-
vated alkaline phosphatase. I would interpret this
set of chemistries as being most consistent with hep-
atocellular rather than obstructive disease. At his
third admission his bilirubin was still elevated and
his transaminase was now 104 units, his globulins 4.7
Gm. His alkaline phosphatase had increased to 24
units, which is a very strong straw in the wind that
this man had either infiltrative or neoplastic liver
disease because the alkaline phosphatase is dispropor-
tionately elevated as compared to his serum bilirubin
levels.
In the interval between his second and third ad-
1178
The Ohio State Medical Journal
missions this patient developed refractory ascites
despite diuretic therapy. This is a fairly common
occurrence in cirrhotics in our clinic population be-
cause they are unable to stay on a diet that is rigidly
restricted in sodium. Alternatively, the refractor}’
ascites might be due to progressive liver disease.
After he received Thorazine he became drowsy and
then had another episode of gastrointestinal bleeding
with hematemesis, which was probably due to esoph-
ageal varices. We know that significant gastroin-
testinal hemorrhage is a common precipitating cause
of hepatic encephalopathy and it is not surprising
then that he deteriorated and died in coma, very
likely hepatic coma.
His x-rays showed that this man had unequivocal
portal hypertension with esophageal varices and a
patent extrahepatic portal system. I think the vena-
cavagrams may offer us a clue; we can’t be dogmatic
about it but I think that they are abnormal. The
failure of the C02 study again is a straw in the wind
that there may be something wrong with his hepatic
veins. I think that the crux of this case is then an
interpretation of the portal hypertension, splenomeg-
aly, jaundice, and ascites.
Pathophysiology of Portal Hypertension
I thought it would be worth while to review very
briefly some of the pathophysiology of portal hyper-
tension as it relates to differential diagnosis. Portal
hypertension is usually classified into presinusoidal
and postsinusoidal causes. Presinusoidal causes are
extrahepatic and intrahepatic. Common extrahepatic
presinusoidal causes include portal vein thrombosis,
splenic vein thrombosis, or pancreatic lesions. In
these disorders the intrasplenic pressure is high be-
cause the lower circuit is blocked. The wedge pres-
sure is normal. The patients usually have sple-
nomegaly, and jaundice and ascites are rare. In
intrahepatic presinusoidal portal hypertension, which
might be exemplified by schistosomiasis, congenital
hepatic fibrosis, portal zone infiltration such as Hodg-
kin’s, leukemia, sarcoid, etc., again the intrasplenic
pressure is high, the wedge pressure is normal, sple-
nomegaly is frequent, but jaundice and ascites are
infrequent.
In postsinusoidal extrahepatic portal hypertension,
the entity that we can be very concerned about today
is hepatic vein thrombosis, or Budd-Chiari syndrome.
Where there is thrombosis of just the hepatic veins,
the wedge pressure may be high but the splenic
pressure may be normal or slightly increased. Pa-
tients who have hepatic vein thrombosis and also
have a high intrasplenic pressure, usually have throm-
bosis of their portal system as well, and at least at
the time of this examination our patient did not have
this. Splenomegaly accordingly is less frequent, jaun-
dice is infrequent; ascites is usually present and is
often refractive. The commonest cause of intra-
hepatic postsinusoidal portal hypertension is cirrhosis,
where both the intrasplenic and the wedge pressure
are elevated; splenomegaly, jaundice, and ascites are
all common.
With this as a background then, I think we should
proceed to the differential diagnosis. First of all,
what about tuberculous peritonitis ? Tuberculous
peritonitis has to be considered in any patient who
has persistent ascites and chronic liver disease. The
absence of fever and a positive skin test does not rule
out the diagnosis. But actually there is very little else
to suggest this diagnosis and I think that tuberculous
peritonitis is unlikely in this individual.
Hepatitis ?
Could he have had viral hepatitis with submassive
necrosis ? If this man had had antecedent viral
hepatitis, I think after six to seven months he
would have had cirrhosis. I think the difficulty in
making this diagnosis is that there is no clear-cut ante-
cedent etiologic insult. There was no contact with
jaundiced persons and, more importantly, he had had
no blood or blood products, and hepatitis in persons
over 40 is almost always associated with serum
hepatitis.
We are told that this man had had a carcinoma
of the bladder resected eight years previously. Could
he have had recurrent carcinoma of the bladder with
metastases to his liver? I think that this is unlikely
for three reasons: First of all, the incidence of liver
metastases in bladder carcinoma is reasonably low.
Second, most patients who have bladder carcinoma
and die, die either a renal or a septic death. And
third, there was no clue during his final admission
that he had recurrent carcinomatous disease in his
bladder.
Hypernephroma and Budd-Chiari Syndrome
We are told that this man had a questionable
left upper quadrant mass and we have to seriously
consider hypernephroma because these tumors are
prone to involve the hepatic veins and give a Budd-
Chiari syndrome. The usual clinical presentations of
hypernephroma are pain, a palpable mass, and hema-
turia in about 50 per cent of the patients. The most
significant finding is a positive I VP. I think the fact
that the IVP was negative in this case is strongly but
not conclusively against the diagnosis of a hyper-
nephroma.
One of the entities that we very seriously have to
consider is a carcinoma of the pancreas, and you are
all familiar with the symptoms and the physical
findings of patients with carcinoma of the pancreas.
I think that this man’s story is certainly consistent
with a neoplastic process and certainly consistent with
a carcinoma of the pancreas. The things that bother
me are that in patients with carcinoma of the pan-
creas who have ascites I would like to see portal vein
invasion, or I would like to have evidence of peri-
toneal implants, and an analysis of his peritoneal
for November , 1966
1179
fluid gave no such evidence. So I think that this
diagnosis is going to be a little less likely than some
of the others that we are going to come to.
Could this patient have a stone in his common duct
that was leading to incomplete obstruction, which
was of long standing and which led to secondary
biliary cirrhosis? I don’t think this man had sec-
ondary biliary cirrhosis for a number of reasons.
First of all, it usually takes at least 9 to 12 months
of high-grade obstruction or incomplete obstruction
to get this picture. Second, almost all patients who
have biliary cirrhosis of the secondary variety have
a triad of findings: They have elevated blood lipids,
they have xanthomatous skin lesions, and they have
pruritus. Our patient had none of these. And
lastly, portal hypertension, varices, ascites, and liver
cell failure are late complications and take as long
as five years to develop. For these reasons I do not
think that this diagnosis applies in this case.
Now we come to one of the two major possibilities
and that is an occlusion of the hepatic veins — the
so-called Budd-Chiari syndrome. The commonest
known causes of hepatic venous thrombosis are poly-
cythemia vera and hypernephroma. The cardinal sign
of this condition is recurrent and significant ascites.
Hepatomegaly, abdominal pain, and edema occur
frequently; splenomegaly is less frequent, and jaun-
dice is infrequent and usually of mild degree. The
points to be emphasized here are that splenomegaly,
jaundice, ascites, esophageal varices, and hydrothorax
are distinctly uncommon in patients who have the
idiopathic variety. However, in patients who have
the neoplastic variety these findings are perhaps more
frequent. We will come back to a consideration of
this entity later.
Hepatoma ?
The last entity that has to be seriously considered
is that this man had a hepatoma. Three-quarters of
the patients with a hepatoma have underlying cir-
rhosis, more commonly the postnecrotic and infre-
quently the nutritional type. The symptoms of hepa-
toma are those you would expect in a patient with
neoplastic disease. Hepatomegaly is almost a uni-
form finding; ascites and jaundice are less frequent;
edema, tender liver, and splenomegaly a little in-
frequent; terminal coma occurs in about one fifth
of the patients. The most common presentation of
patients with a hepatoma is that they look like a
cirrhotic and they may have known cirrhosis, and
they start to go downhill and deteriorate without ap-
parent reason. This is when you should be seriously
thinking about hepatoma.
The important point here is that these patients can
also present with a Budd-Chiari syndrome due to
hepatic venous occlusion. When should this diag-
nosis be thought of? In a cirrhotic who starts to
deteriorate, in a patient who has hepatomegaly and
a disproportionately elevated alkaline phosphatase
versus his bilirubin level, in a patient who has hem-
orrhagic ascites although malignant cells are not
found very commonly. Conversely, if a patient has
a normal alkaline phosphatase and no increase in his
liver size, it’s very hard to make a diagnosis of a
hepatoma.
I think, as I indicated previously, that the diag-
noses in this case certainly have to account for sev-
eral observations. First, the patient had portal hyper-
tension. This was probably intrahepatic and post-
sinusoidal because he had a patent extrahepatic portal
system, and it was probably of long duration because
of the marked esophageal varices. He had mild but
persistent jaundice, he had refractory ascites, and
terminally he had coma which might well have been
the hepatic type. I think that he did have hepatic
venous occlusive disease, and I think that his progres-
sive deterioration over a seven month period smacks
of neoplastic disease.
So how do you tie all this together? I think the
one diagnosis that would most satisfactorily account
for all of his symptoms is cirrhosis with the develop-
ment of a hepatoma, and associated with the hepa-
toma he had hepatic venous occlusion with thrombosis
of his hepatic veins, or occlusion of the veins by
tumor thrombi. The alternative diagnosis that I
cannot exclude is that he had a Budd-Chiari syn-
drome, that is, thrombosis of his hepatic veins asso-
ciated with underlying tumor. There are four tumors
that are likely to give rise to a Budd-Chiari syndrome:
carcinoma of the kidney, which we can’t diagnose
with a normal I VP; carcinoma of the lung, for
which there is really no clinical evidence; carcinoma
of the liver, which I think is the most likely car-
cinoma that he could have had, or carcinoma of the
pancreas, which is known to be associated with a
high incidence of venous thrombosis. I think that
our patient had venous occlusive disease and a malig-
nant neoplasm. I think the tumor was most likely a
hepatoma but I wouldn’t be surprised if it was found
in the pancreas.
General Clinical Discussion
Dr. Wall: We have had a very comprehensive
review of hepatic disease and I think the only things
we haven’t mentioned are Clonorchis sinensis and
Fasciola hepatica. One thing I would like to ask
our discussant is : What about these subcutaneous
bumps he had had all this time?
Dr. Greenberger: When somebody has pain-
less subcutaneous nodules of long standing, the dif-
ferential diagnosis would be von Recklinghausen’s
disease or lipomatosis. I am really unable to link
the subcutaneous nodules with his liver disease and
his portal hypertension.
Question : As long as you have been entertaining
a diagnosis of possible pancreatic carcinoma, why not
do a secretin stimulation test and look for malignant
cells in the duodenal juice?
1180
The Ohio State Medical Journal
Dr. Greenberger: I have had some experience
with the secretin-pancreozymin test. This is a tedious
procedure and if it is not done properly the results
are very hard to interpret.
Question : I wondered whether there is any pos-
sibility that the Thorazine he was given on his last
day may have been a precipitating factor in his death ?
Dr. Greenberger: Post-Thorazine-induced hep-
atitis is a hepatitis either with or without cholestasis.
It very rarely, if ever, produces massive liver cell
necrosis. I think that the problem here is that these
people don’t handle any type of sedative very well.
You have seen hepatic coma induced by Librium®,
Thorazine, what have you, even in modest doses.
Question: Dr. Greenberger, would you like to
comment about the association of hepatomas and cir-
rhosis ?
Dr. Greenberger: This is a knotty question in
a way. I think most people agree that about three
quarters of all hepatomas are associated with under-
lying cirrhosis, and since I think this man had a
hepatoma I am almost obligated on the basis of this
statistical probability to say that he had cirrhosis.
But I also felt that the cirrhosis would best account
for the severe long-standing portal hypertension that
he had.
CLINICAL DIAGNOSIS
1. Budd-Chiari syndrome due to hepatic vein
obstruction by:
(a) Hepatoma
(b) Carcinoma of the pancreas.
2. Hepatic cirrhosis, postnecrotic type.
PATHOLOGIC DIAGNOSIS
1. Infectious hepatitis with postnecrotic cirrhosis.
2. Mixed type of cholangiohepatoma with in-
vasion of the hepatic veins and the inferior
vena cava and widespread metastasis.
DISCUSSION OF PATHOLOGY
Dr. von Haam: The body was that of a slightly
jaundiced, moderately cachectic individual with severe
pedal edema. There were only a small amount of
ascites in his abdominal cavity and a moderate bilat-
eral hydrothorax. The heart was small. The right
atrium contained a large tumor thrombus which
obviously represented a continuation from a similar
thrombus in his inferior vena cava. The latter did
not completely obstruct the lumen of the vessel. Both
lungs were studded with numerous tumor nodules
which showed a yellowish-green discoloration and
central necrosis. The spleen was markedly enlarged
and firm. The portal vein was completely free of
thrombosis, and there was marked dilatation of the
branches leading towards the stomach and esophagus.
The liver was of normal size and showed a marked
nodularity, the nodules measuring 1 to 6 mm. in
diameter. In addition numerous tumor nodules could
be distinguished separated by areas of fibrosis. All
hepatic veins were completely occluded by soft,
necrotic tumor tissue which extended into the vena
cava. The esophagus showed partially eroded varices.
The stomach showed numerous recent erosions. Only
a moderate amount of brownish-black material was
present in the small intestine. The right adrenal was
completely replaced by a large tumor mass which
seemed to be continuous with the tumor in the right
lobe of the liver. Examination of the genitourinary
system showed no remarkable changes. The blad-
der showed no evidence of tumor recurrence. The
retroperitoneal lymph nodes and the lymph nodes at
the liver hilus were enlarged and replaced by tumor.
Microscopic sections showed mural thrombi com-
posed of tumor cells in the right atrium and ventricle.
The myocardium showed the nonspecific myocarditis
often seen in viral infections. The metastatic nodules
in the lung showed a well differentiated liver-cell
hepatoma with formation of trabeculae and evidence
of bile production. Sections through the spleen
showed congestive splenomegaly with marked myeloid
metaplasia. The pancreas was not remarkable.
Sections through the liver showed a rather exten-
sive postnecrotic cirrhosis with many foci of active
viral hepatitis. There was typical ballooning degen-
eration of the liver cells with massive cytoplasmic
inclusion bodies. The tumor itself showed varying
pictures of liver cell hepatoma of the mature and
embryonal types with adenocarcinoma of the cho-
langiocarcinoma type. Bile could be demonstrated in
some of the glands by special stains. In many re-
spects the tumor resembled histologically the hepa-
toma found in trout. Most of the hepatic veins were
filled with tumor emboli. Sections through the bone
marrow showed extensive replacement of the bone
marrow by tumor metastases of the well differentiated
hepatoma type. We believe this fact accounts for the
compensatory myeloid metaplasia in the spleen.
The histological picture of his subcutaneous nod-
ules was that of benign fibrolipoma.
In conclusion then, we feel that the patient suf-
fered from a slowly progressive infectious hepatitis
which was still active at the time of his death but had
already caused considerable scarring leading to post-
necrotic cirrhosis. He subsequently developed a
hepatoma of the mixed-cell type which occluded the
hepatic veins and produced tumor thrombi in the vena
cava and the right atrium with extensive metastases
to the lungs, adrenals, and lymph nodes. That post-
necrotic cirrhosis and hepatoma have some etiologic
relationship has been postulated many times but never
proved. We know that most, but not all, hepatomas
develop in a cirrhotic liver particularly of the post-
necrotic type.
I would like to commend the clinical discussant,
who recognized the Budd-Chiari syndrome as the
basic factor in the patient’s symptoms.
for November, 1966
1181
Proceedings of The Council . . .
A Report of Matters Discussed and Actions Taken
At Regular Meeting in Columbus, September 9-11
A REGULAR MEETING of The Council of the
Ohio State Medical Association was held
- September 9-11, 1966, at Stouffer’s Univer-
sity Inn, Columbus. All members of The Council
were present except Dr. Theodore L. Light, Dayton,
Councilor of the Second District; Dr. Robert N.
Smith, Toledo, Councilor of the Fourth District; and
Dr. George Newton Spears, Ironton, Councilor of
the Ninth District. Others attending the meeting
were: Drs. Edwin H. Artman, Chillicothe, John H.
Budd, Cleveland, Richard L. Meiling, Columbus,
Frederick P. Osgood, Toledo, Charles A. Sebastian,
Cincinnati, George W. Petznick, Cleveland, Carl A.
Lincke, Carrollton, Edmond K. Yantes, Wilmington,
Robert E. Tschantz, Canton, AMA delegates; Drs.
J. Robert Hudson, Cincinnati, H. T. Pease, Wads-
worth, Kenneth D. Arn, Dayton, Harry K. Hines,
Cincinnati, AMA alternate delegates; Dr. Perry R.
Ayres, Columbus, Editor, The Ohio State Medical
Journal;
Mr. Wayne E. Stichter, Toledo, OSMA legal coun-
sel; Mr. David B. Weihaupt, Chicago, AMA field
representative; Dr. Wendell A. Butcher, Columbus,
chairman of the OSMA Committee on Mental
Health; Dr. Emmett W. Arnold, Columbus, Ohio
director of health; Dr. Oscar W. Clarke, Gallipolis;
Dr. Neil C. Andrews, Columbus, coordinator of re-
search for Public Law 89-239; Messrs. Mike Asher,
president, Richard McDermott, vice-president, and
Joel Ginsberg, representing the Student AMA Chap-
ter, Ohio State University College of Medicine; and
Messrs. Page, Edgar, Gillen, Traphagan, Campbell,
and Moore of the OSMA staff.
Minutes Approved
Minutes of the meeting of The Council held July
23-24 were approved by official action.
Ninth District Councilor
The resignation of Dr. George Newton Spears,
Ironton, Councilor of the Ninth District, was ac-
cepted with regret.
Dr. Oscar W. Clarke, Gallipolis, was selected by
The Council to serve as Ninth District Councilor
until the next Annual Meeting of the House of Dele-
gates, at which time the office will be filled as pro-
vided for in the Constitution and Bylaws.
Auditing and Appropriations
Committee Appointment
Dr. Richard L. Fulton, Columbus, was appointed
to serve on the OSMA Auditing and Appropriations
Committee to succeed Dr. Spears.
Civil Rights Pledges
The Council approved a letter dated September 12
from Dr. Meredith to the Honorable Denver L.
White, director of the Ohio Department of Public
Welfare, seeking the elimination of the civil rights
pledges and agreements.
Membership Statistics
The following membership statistics were an-
nounced by Mr. Page: OSMA membership as of Sep-
tember 7, 1966, was 9,997, compared to a total mem-
bership of 9,905 on September 7, 1965, and 10,042
on December 31, 1965. He reported that of the
9,997 members, 8,941 were affiliated with the AMA.
Policy on Waiver of Dues for 1967
By official action, The Council adopted the follow-
ing policy with regard to waiver of annual dues for
the calendar year 1967:
A. That dues for new members in practice, affil-
iating with the OSMA during the last six months
1182
The Ohio State Medical Journal
of the calendar year 1967, namely, July 1 to De-
cember 31, inclusive, shall be $25.00, one-half
the regular per capita dues of $50.00. The pro-
rating of dues shall not apply to former members
reaffiliating.
B. That the following procedures shall apply
during 1967 with respect to OSMA annual dues
of members on temporary military service and not
making military medicine a career.
1. State Association dues for 1967 shall be
waived for members on temporary military serv-
ice and not making military medicine a career.
2. State Association dues for 1967 shall be
waived for physicians who were members of the
Association in 1966 and who enter such services
during the calendar year 1967 before the pay-
ment of 1967 dues.
3. A refund of membership dues will not be
made if a member enters such services in 1967
after his 1967 dues are received at the Colum-
bus office of the Association.
4. The secretary- treasurer of each county
medical society shall be requested to cooperate
with the Columbus office in assembling the
names of physicians entitled to waiver of dues
under the foregoing provisions.
C. Annual Ohio State Medical Association dues
for 1967 for a physician serving in an internship
or residency program approved by the AMA Coun-
cil on Medical Education who meets the member-
ship eligibility requirements of the OSMA and
who is accepted into membership by a component
medical society shall be $7.50. Such intern or resi-
dent shall be entitled to receive The Ohio State
Medical Journal as a part of his membership
privileges.
Dues Exemption for Financial Emergencies
It was the interpretation of The Council that Reso-
lution No. 2, adopted by the 1966 House of Dele-
gates regarding waiver of dues for hardship cases,
is to be effective January 1, 1967.
Report of Ohio Director of Health
Dr. Emmett W. Arnold, Ohio director of health, ad-
dressed The Council on current and future develop-
ments concerning public health in Ohio. Dr. Arnold
announced that his department is developing regula-
tions for submission to the Ohio Public Health Coun-
cil which will permit the integration of clean gyne-
cological patients on obstetric floors of general hos-
pitals.
Discussing the PKU (phenylketonuria) program,
Dr. Arnold said that he would designate as regional
laboratories certain ones which may be approved for
conducting PKU tests. Approval will be restricted to
those laboratories doing a large number of such
tests.
Dr. Arnold then discussed the possibility of legis-
lation being introduced in the next Ohio General
Assembly for the establishment of a hospital licensure
program.
The Council directed the OSMA Committee on
Hospital Relations to give attention to this matter.
With regard to nursing homes, Dr. Arnold an-
nounced that the regulations governing the homes
have been implemented and revised and that 1,087
homes are under "permanent licensure.”
Turning to Federal legislation, Dr. Arnold dis-
cussed Senate Bill 3008, the public health bill de-
veloped by the state and territorial health officers to
stabilize grant programs to public health departments.
He told The Council that two billion dollars a year
in grants are predicted if this legislation passes and
that they will be administered by the State Health
Departments. He said the bill would permit a cer-
tain flexibility in the way the money is spent and
would do away with categories.
Meeting of AMA Delegates and Alternates
Dr. Budd reported on the meeting of the AMA
delegates and alternates held September 9. The report
as a whole was approved. It included a request that
a letter be sent from the OSMA president and chair-
man of the Ohio delegation to the chairman of the
Board of Trustees of the AMA inquiring as to how
and when the AMA councils and committees are
carrying out AMA policy concerning qualifications
for staff membership and maintenance of the "open
staff” concept as set forth in the reference committee
action on Resolution No. 58, as approved by the
House of Delegates.
Also included in the report was the approval of
two resolutions. One resolution would require that
published reports of the reference committees be
available to members of the AMA House of Dele-
gates at least 24 hours prior to the call to order of
the session of the House at which they are to be con-
sidered. The other resolution would require that reso-
lutions and reports of the Board of Trustees and
Councils of the AMA be at the AMA headquarters
at least 30 days prior to the opening session of the
House of Delegates at annual and clinical conven-
tions, except resolutions of an emergency nature
which could be introduced at the opening session of
the House if accepted by two-thirds of those present
and voting.
Dr. Budd was re-elected chairman and Dr. Petz-
nick was re-elected vice-chairman of the Ohio dele-
gation.
Hospital-Based Physicians
Dr. Meredith appointed the following committee
to draft a resolution on hospital-based physicians for
presentation at the regular session of the AMA: Dr.
Robechek, chairman, Drs. Tschantz, Budd and
Schultz. Dr. Meredith requested the OSMA legal
counsel to assist the committee.
for November, 1966
1183
Quarterly AMA Sessions
The Council directed the Executive Secretary to
send a communication to the American Medical As-
sociation requesting that representatives from Ohio
be heard on AMA Resolution No. 2 (1966 Annual
Convention), proposing quarterly sessions of the
AMA House of Delegates. This matter is being
studied by the AMA Board of Trustees and a report
is expected at the Clinical Convention in November
at Las Vegas.
Definition of "Usual and Customary"
The Council authorized Dr. Budd and members
of the staff to appear before the AMA Committee
on Insurance and Prepayment Plans, September 25,
with regard to presenting testimony on the definition
of the term "usual and customary fee." The Council
approved a discussion of the problem with other in-
terested state medical associations in connection with
preparing testimony for the meeting.
Asks Education on "Direct Billing"
The Council instructed President Meredith to write
a letter to the American Medical Association, advis-
ing that many physicians do not understand "direct
billing" and asking for the implementation of the
substitute resolution (Res. 73 and Res. 105) which
asks that the membership be informed that Medicare
Regulation No. 5 will not apply to physicians who
have no financial relationship with a hospital cover-
ing medical services to patients and who do not
accept assignments but bill directly.
Supports New Jersey Letter
A copy of a letter from the Medical Society of
New Jersey to the AMA Board of Trustees, protest-
ing sections of an article written by Russell B. Roth,
M. D. in the August 1, 1966, Volume 197, No. 5
of the JAMA under the title "Medicare: Its Problems
for Practicing Physicians," was considered by The
Council. The protest involves the author’s suggestion
that Part B Medicare funds might be adapted to pay
residents if residents were given a different title. The
New Jersey letter also pointed out that the author
suggested that it might be necessary to change the
Medicare law so that residents could be paid from
Part B funds.
As the communication from the Medical Society of
New Jersey pointed out, the AMA House of Dele-
gates in June, 1963, adopted a policy "... opposed
to any system or program by which any part of an
intern’s or resident’s salary is paid out of fees col-
lected by the attending physician or out of fees col-
lected under any type of medical-surgical insurance
coverage."
The Council voted to support the protest of the
Medical Society of New Jersey and requested the
Executive Secretary to send a letter advising of this
action.
Presidential Communication
A communication from Dr. Charles L. Hudson,
Cleveland, President of the American Medical As-
sociation, was accepted for information.
Executives’ Conferences
Dr. Crawford and Dr. Howard reported on the
Ohio Medical Society Executives Conference held in
connection with the AMA Public Relations Institute
and the Association of American Medical Executives
in Chicago, August 23.
Mr. Weihaupt discussed a proposed AMA seminar
for new medical society executives.
1967 County Society Officers’ Conference
Plans for the 1967 County Society Officers’ Con-
ference to be held late in February at the Fort Hayes
Hotel, Columbus, were approved by The Council.
Military Advisory Committee
In connection with the activities of the Ohio Mili-
tary Advisory Committee, a request by Dr. Drew L.
Davies, chairman, dated August 16, 1966, to the
National Selective Service System for funds to be
applied to the committee’s expenses of operation,
was approved.
Committee Reports
Scientific Work — The minutes of the meeting of
the Committee on Scientific Work held July 30-31
were presented by Mr. Traphagan. The report was
approved with the following exceptions:
1. The meeting of the House of Delegates was
shifted from 2 p.m., Tuesday, May 16, to 8 P.M.,
Monday, May 15.
2. All Tuesday sessions were shifted to the Shera-
ton Columbus Motor Hotel.
3. The meetings of the House of Delegates Ref-
erence Committees were scheduled for Tuesday morn-
ing.
4. The Montgomery County Medical Society Glee
Club to be invited in lieu of "Sing Out ’67.”
Insurance Committee — Mr. Campbell presented
the report of the OSMA Committee on Insurance,
which held a meeting on August 14. He advised The
Council that investigation continues with regard to
travel accident insurance proposals covering commit-
teemen, officers and staff of the OSMA.
The Council approved a long term disability plan
covering employees of the Ohio State Medical Asso-
ciation and stipulated that a 90-day waiting period
be incorporated in lieu of the 180-day waiting period.
The Council re-referred to the Insurance Committee
the implementation of Amended Resolution No. 24
(OSMA 1966) with regard to the development of
a suggested billing form for Ohio physicians. Addi-
tional information obtained by the staff in conference
with the author of the resolution indicated that the
1184
The Ohio State Medical Journal
intent of the resolution was the development of a
billing form rather than a claims form as assumed by
the committee. The Council also asked that the avail-
ability of the previously developed OSMA standard
claims form be publicized to the membership.
The Council approved the stepping up of the
Ohio State Medical Association Blue Cross coverage
for employees from 70 to 120 days and stipulated
that diagnostic x-ray be excluded since this is a cov-
erage provided by Blue Shield.
A statement on coordination of benefits in health
insurance coverages was re-referred to the committee
for additional study.
The goals of Amended Resolution No. 32 (OSMA
1966), asking the voluntary health insurance indus-
try not to cancel contracts but to continue to offer
contracts for persons 65 and older, were approved,
as well as the committee’s suggestion for implemen-
tation.
The action of the committee tabling further im-
plementation of Amended Resolution No. 37 regard-
ing health insurance for migrant workers was
approved.
The report as a whole was approved as amended.
Mental Health — Dr. Butcher reported for the
OSMA Committee on Mental Health. The Council
approved a proposal of the committee to sponsor
and support in the 107th Ohio General Assembly
legislation to provide statutory autonomy for mental
retardation within the Division of Mental Health of
the Department of Mental Hygiene and Correction
and to provide for leadership by the medical profes-
sion in the mental retardation field.
Also approved by The Council was the commit-
tee’s proposal that the OSMA sponsor and support
legislation in the 107th Ohio General Assembly to
create a regulatory Board of Mental Health.
A proposal to require a separation of the Depart-
ment of Mental Hygiene and Correction into two
departments, one of mental hygiene and one of cor-
rection, was tabled indefinitely.
The Council authorized Dr. Butcher to work with
the director of the Department of Mental Hygiene
and Correction in developing the best legislation pos-
sible and stipulated that the draft be brought to The
Council for consideration before introduction.
The Council recommended Dr. Butcher for ap-
pointment to the Ohio Citizen’s Committee on Com-
prehensive Mental Health Planning.
Amendments to Constitution and Bylaws
The Council voted final approval to the amend-
ments to the Constitution and Bylaws of the Cleve-
land Academy of Medicine. It was suggested that
the Academy be notified that no provision is included
in the current bylaws for giving notice of special
membership meetings. The Council expressed the
Dr. Clarke Named by The Council
As Ninth District Councilor
The Council at its meeting on September 10-11 ap-
pointed Dr. Oscar W. Clarke, of Gallipolis, to serve
as Councilor of the Ninth Councilor District until the
1967 OSMA Annual Meeting.
The vacancy in the District was occasioned by the
resignation of Dr. George
N. Spears, of Ironton, who
was first elected to The
Council in 1964 and re-
elected at the last annual
meeting of the House of
Delegates. His resignation
was for personal reasons,
and The Council accepted
his request with regrets.
Dr. Clarke is a practicing
physician in the Gallipolis
area, specializing in internal
medicine, and is chief of the
Department of Internal Medicine at the Gallipolis
Clinic and the Medical Center Hospital.
He is a graduate of the Medical College of Vir-
ginia, a diplomate of the American Board of Inter-
nal Medicine, a Fellow of the American College of
Physicians, and a charter member and former trustee
of the Ohio Society of Internal Medicine.
Dr. Clarke is a past president of the Gallia County
Medical Society. On the state level he has served
on the OSMA Committee on Hospital Relations and
the Committee on Workmen’s Compensation.
In Heart Association activities he is a member of
the council of the Gallia County Heart Association,,
a trustee of the Central Ohio Heart Association, and
a member of the Education Committee of the Ohio
Heart Association.
He is president of the Gallipolis City Board of
Health, a past president of the Gallipolis Rotary
Club, past president of the Tri-County Community
Concert Association, member of the executive com-
mittee of the Gallia County Community Industrial
Council, and a trustee of the Medical Memorial
Foundation.
Mrs. Clarke, the former Susan Frances King of
Kalispell, Montana, is a member-at-large of the
Woman’s Auxiliary to the OSMA. The Clarkes
have three daughters, Susan, Elisabeth, and Jennifer.
Family affiliation is with the First United Presbyterian
Church of Gallipolis.
]■■
opinion that a provision for a minimum number of
days notice should be established.
Ohio Medical Indemnity, Inc.
A proposal for the development of a "deferred
income’’ plan in connection with Ohio Medical In-
fer November, 1966
1185
demnity was submitted in w riting by Mr. Toseph V.
Lane, Jr. The Council expressed the opinion that
such a plan was not feasible and the executive secre-
tary was instructed to so notify Mr. Lane.
Billing Procedures for Specialists
Considerable correspondence concerning the activ-
ities of radiologists, pathologists and other specialists
in establishing their own billing procedures for pro-
fessional sendees was reviewed by The Council and
progress reports w-ere discussed.
A letter from Dr. Oscar M. Weaver, Kenton, Ohio
was presented to The Council. The Executive Secre-
tary was instructed to communicate with Dr. Weaver
and thank him for his interest.
Hospital Prepayment Plans
The Council discussed the implementation of Sub-
stitute Resolution No. 1 6 (1966 OSMA) to petition
the Ohio director of insurance to require removal of
medical service benefits from hospital prepayment
plans. It was The Council’s opinion that the time has
not yet arrived to implement this resolution and it
was decided to defer action on this petition until the
appropriate time, as determined by The Council.
Public Law 89-239
Dr. Meiling presented for the information of The
Council developments in the regional medical pro-
grams to combat heart disease, cancer, stroke, and
related diseases. Such information was supplemented
by a report from Dr. Neil C. Andrews, coordinator
of research for planning the project under P.L. 89-239
in this area. An article covering the reports of Drs.
Meiling and Andrews is presented on page 1191
in The Ohio State Medical Journal.
Miscellaneous Correspondence
A communication from Dr. Arthur Collins, chair-
man of the OSMA Committee on Eye Care, was re-
ceived for information.
A communication from the Cosmetic Therapy As-
sociation of Ohio was received for information.
To Study "Pima County Plan"
A file on proposals, such as the Pima Count)- Plan
and the New Jersey Plan, to deal with malpractice
suits was referred to the Judicial and Professional Re-
lations Committee for study.
Report of Auditing and
Appropriations Committee
The Council approved the report of the Auditing
and Appropriations Committee which met on Sep-
tember 9. Such report included the authorization for
the purchase of a graphotype machine so that ad-
dressograph plates may be prepared in the State
Association office.
The purchase of a new- file cabinet for the mem-
bership department w-as also approved.
The bill submitted by the OSMA general counsel
for services from December 1, 1965 to July 31, 1966
w-as approved as a part of the report.
Renew-al of subscriptions to Today's Health for 37
Ohio colleges was authorized by The Council.
OSU Student AMA Chapter
Messrs. Asher, Ginsberg and McDermott, OSU
medical students, discussed with The Council the
proposal from the executive committee of the OSU
Student AMA Chapter. Such proposal involved the
development of a constitution and bylaws by the
chapter modeled after that of the Ohio State Medical
Association. In addition, the chapter asked the
OSMA to share the expense of distributing the quar-
terly chapter newsletter, SAMAntics , to ever)- OSMA
member and to ever)- medical student in Ohio, the
OSMA part of the expense to be $350 per issue. The
Council approved the proposals with the stipulation
that the publication and distribution of the news-
letter SAMAntics be on an experimental or trial
basis for the remainder of the year.
Journal Editorial Committee
By a vote of The Council there w-as established an
editorial committee for The Ohio State Medical Jour-
nal to be composed of the follow-ing: President,
President-Elect, Past President, Executive Secretary,
Director of the Department of Public Relations of the
Ohio State Medical Association and the Executive
Editor of The Journal. The Executive Editor w-as
authorized to act with regard to a proposed con-
tractural change with the State Medical Journal Ad-
vertising Bureau.
Cancer Tests
A communication proposing routine Pap smears
on all women admitted to hospitals w-as referred to
the Cancer Committee of the Ohio State Medical
Association for study.
AMA-ERF Campaign
It was decided by The Council that solicitation of
funds for the AMA-ERF should take place in the
Fall as previously.
Travel Committee
With regard to a proposal for a travel committee
under the auspices of the Ohio State Medical Associa-
tion, The Council voted not to establish such a com-
mittee.
There being no further business, The Council
adjourned.
Attest: Hart F. Page,
Executive Secretary
1186
The Ohio State Medical Journal
• • •
Heart -Cancer -Stroke Plan in Ohio
Ohio State University Applies for Planning Grant
To Organize Regional Program in 61 Ohio Counties
OHIO STATE University College of Medicine
has applied for a planning grant to organize,
implement and prepare a regional medical
program in accordance with the intent of Public Law
88-239, or the Heart Disease, Cancer and Stroke
Amendments of 1965. The proposed regional medi-
cal program concerning heart disease, cancer, stroke
and related diseases would encompass 6l counties oc-
cupying the southern two-thirds of the State of Ohio,
with the exception of the Cincinnati area excluding
Hamilton, Butler, Warren, and Clermont Counties.
Dr. Richard L. Meiling, dean of the OSU College
of Medicine, and Dr. Neil C. Andrews, member of
the OSU faculty and coordinator in behalf of the uni-
versity of research for the heart, cancer, and stroke
program, presented a summary of the proposed plan
at the September meeting of The Council of the Ohio
State Medical Association.
Both Dr. Meiling and Dr. Andrews emphasized that
the plan would encourage the care of the patient
in his own community, the regional center providing
pertinent knowledge of research and instrumentation
as provided by law to physicians on the local scene.
Following is a summary of the proposed plan:
Ohio State University with its past experience of
patient care, research programs, undergraduate, grad-
uate and postgraduate training, programs of continu-
ing education and its Ohio Medical Education Net-
work for physicians and nurses, proposes to:
A. Establish a Regional Advisory Committee in
accordance with the suggestions and regulations of
Public Law 88-239. This Committee will meet regu-
larly and provide advice, review and evaluation to the
program.
B. Organize a Medical Program Planning Com-
mittee which will prepare the regional medical pro-
gram. Initially this Committee will be composed of
members of the medical school faculty, but will be
enlarged as the need becomes apparent to include
those individuals from the communities of action
within the regional program.
C. Survey individuals and representatives of or-
ganized professional groups, hospitals and volunteer
health organizations in the 61 counties included in
the regional program to assess their needs, so that
better care can be provided to their patients affected
by heart disease, cancer, stroke and related diseases
in their communities.
D. Plan and develop a Demonstration Unit for
the diagnosis, instrumentation, and treatment of pa-
tients with cardiovascular disease which will be
used for the education of physicians, nurses,
physiotherapists, occupational therapists, and other
related personnel. This unit will serve as an ex-
emplary prototype for additional units to be estab-
lished throughout the region.
E. Plan and develop a Demonstration Unit for
the diagnosis, instrumentation, and treatment of pa-
tients with stroke which will be used for education
of physicians, nurses, physiotherapists, occupational
therapists and other related personnel. This unit will
be as an exemplary prototype for additional units to
be established throughout the region.
F. Evaluate the feasibility of a central cancer
registry for the region and investigate the feasibility
of establishing coronary artery disease, heart dis-
ease, and stroke and other related disease registries.
G. Plan and aid in developing an informational
retrieval system concerning the literature of coro-
nary artery disease through the Heart Hot Line of the
Cox Coronary Heart Institute and Data Corporation
of Dayton. The potential value of this system which
will provide abstracts, as well as bibliography, will sup-
plement the objectives of the MEDLAR System of the
National Library of Medicine which will become
functional at the Ohio State University College of
Medicine during the present year.
H. Plan and develop a feasibility study for tele-
vision for consultation and education in the areas of
heart disease, cancer, stroke, and related diseases by
a two-way audio-video communication system be-
tween a relatively remote area in southeastern Ohio
and the Ohio State University College of Medicine.
I. Establish a program of education throughout
the region to assure physicians, medical organizations,
hospitals, and other interested institutions that the
purpose of The Ohio State University College of
Medicine in the areas of heart disease, cancer,
stroke, and related diseases is to encourage the care
of the patient in his own community by providing
all pertinent knowledge of research and instru-
mentation to the physician practicing in that area.
J. Plan for the evaluation of medical achievement
within the regional program by established systems of
evaluation such as the medical audit program (MAP)
and the professional activities study (PAS).
for November, 1966
1191
Orthopaedists T o Convene in Cleveland ...
Comprehensive Course in Treatment of Fractures
And Other Injuries Scheduled for Nov. 28 - Dec. 1
T
^HE COMMITTEE ON INJURIES of the Ameri-
can Academy of Orthopaedic Surgeons, in con-
junction with Region 6 of the Academy, and
Western Reserve University School of Medicine, is
presenting a program November 28 - December 1
entitled "A Comprehensive Postgraduate Course in
the Treatment of Fractures and Other Injuries.”
Under the direction of George E. Spencer, Jr.,
M. D., associate professor of orthopaedic surgery,
Western Reserve, the course has been accepted for
credit by the American Academy of General Practice.
The place is the Hollenden House, 610 Superior Ave-
nue, N. E., Cleveland.
The fee is $75 for other than interns or residents
who present letters from their chiefs of service.
The program has been announced as follows:
Epiphyseal Injuries, W. Robert Harris, M. D.,
associate in surgery, Toronto, Ontario, General Hos-
pital.
Acute Chest Injuries, Harvey J. Mendelsohn,
M. D., associate professor of thoracic surgery, West-
ern Reserve.
Acute Head Injuries (Closed), Frank E. Nulsen,
M. D., Harvey Huntington Brown, Jr., professor of
neurosurgery, Western Reserve.
Renal Problems Related to Trauma, Robert S.
Post, M. D., assistant professor of medicine, Western
Reserve.
Evaluation and Management of Injuries of the
G. U. Tract, Lester Persky, M. D., professor of
urology, Western Reserve.
MONDAY MORNING, NOV. 28
Presiding: Dr. Spencer.
Welcome: Samuel W. Banks, M. D., Chicago, chair-
man, Committee on Injuries, American Academy of
Orthopaedic Surgeons.
Welcome: Frederick C. Robbins, M. D., Cleveland,
dean, Western Reserve University School of Medicine.
Circulation of Bone in Non-Displaced Fractures,
Frederick W. Rhinelander, M. D., professor of ortho-
paedic surgery, Western Reserve.
Plastic Surgery in Acute Trauma to Soft Tissue
of Extremity, Clifford L. Kiehn, M. D., clinical pro-
fessor of plastic surgery, Western Reserve.
Circulation of Bone in Displaced Fractures, Dr.
Rhinelander.
Management of Open Fractures, Thomas F. Linke,
M. D., assistant clinical professor in orthopaedic sur-
gery, Western Reserve.
Anesthesia in the Injured Patient, Robert A.
Hingson, M. D., professor of anesthesiology; and
John G. Fraser, M. D., senior clinical instructor in
anesthesiology, Western Reserve.
MONDAY AFTERNOON, NOV. 28
Presiding: J. I. Kendrick, head of the Department
of Orthopaedic Surgery, Cleveland Clinic.
TUESDAY MORNING, NOV. 29
Presiding: John A. Murphy, M. D., assistant clini-
cal professor of orthopaedic surgery, Western Reserve.
Audio-Visual Presentation.
Arterial Injuries — Diagnosis and Management,
John H. Davis, M. D., professor of surgery, Western
Reserve.
Traumatic Amputations, Herbert E. Pedersen,
M. D., Detroit, professor and chairman, Department
of Orthopaedic Surgery, Wayne State University.
Cardiac Injuries, Claude S. Beck, M. D., emeritus
professor of cardiovascular surgery, Western Reserve.
Fractures of the Forearm (Adults), Fred P. Sage,
M. D., Memphis, instructor in orthopaedic surgery,
University of Tennessee.
Fractures of the Os Calcis, Nicholas J. Gianne-
stras, M. D., chairman, Department of Fractures and
Orthopaedics, Good Samaritan Hospital, Cincinnati.
TUESDAY AFTERNOON, NOV. 29
Presiding: Charles H. Herndon, M. D., Rainbow
Professor of Orthopaedic Surgery, Western Reserve.
Special Panel on Multiple Injury Patients, Wil-
liam R. Drucker, M. D., professor and head of the
Department of Surgery, Toronto General Hospital;
Dr. Giannestras, Dr. Pedersen, and Dr. Sage.
1 192
The Ohio Stale Medical Journal
WEDNESDAY MORNING, NOV. 30
Presiding: Joseph E. Brown, M. D., head of the
Orthopaedic Department, St. Luke’s Hospital, Cleve-
land.
Audio-Visual Presentation.
Fractures of the Elbow (Children), Walter P.
Blount, M. D., Milwaukee, clinical professor and
chairman, Department of Orthopaedic Surgery, Mar-
quette University School of Medicine.
Fractures of the Elbow (Adults), Norman J.
Rosenberg, M. D., attending orthopaedic surgeon,
Mount Sinai Hospital, Cleveland.
Shoulder Separations, John C. Kennedy, M. D.,
associate professor of surgery, University of Western
Ontario.
Fractures of the Patella, Walter A. Hoyt, Jr.,
M. D., chief of orthopaedic sendee, Akron City
Hospital.
Acute Knee Injuries, Dr. Kennedy.
WEDNESDAY AFTERNOON, NOV. 30
Presiding: Sam G. Stubbins, M. D., clinical in-
structor in orthopaedic surgery, Western Resent.
Fractures of the Forearm (Children), Dr.
Blount.
Primary Care of the Injured Hand, George S.
Phalen, M. D., associate professor of orthopaedic
surgery, Cleveland Clinic Foundation.
Fractures and Dislocations of the Hand and
Wrist, Elden C. Weckesser, M. D., clinical profes-
sor of surgery, Western Reserve.
Injury of the Extensor Tendons, Kingsbury G.
Heiple, M. D., assistant professor of orthopaedic
surgery, Western Reserve.
Injury of the Flexor Tendons, Alfred B. Swan-
son, M. D., chief of orthopaedic surgery, Blodgett
Memorial Hospital, Grand Rapids, Mich.
THURSDAY MORNING, DEC. 1
Presiding: Rudolph S. Reich, M. D., consultant
orthopaedic surgeon, Mount Sinai Hospital, Cleveland.
Audio-Visual Presentation.
Fractures and Dislocations of the Cervical Spine,
J. Neill Garber, M. D., Indianapolis, professor of
orthopaedic surgery, Indiana University School of
Medicine.
Decompression of the Spinal Cord Following
Trauma, John A. Jane, M. D., senior instructor in
neurosurgery, Western Reserve.
Fractures of the Tibia, Ian MacNab, M. D., assist-
ant in surgery, University of Toronto.
Fractures and Dislocations of the Ankle, Dr.
Hoyt.
Fractures of the Femoral Neck, Dr. MacNab.
Cleveland Physician Appointed
To the State Medical Board
Dr. Henry A. Crawford, of Cleveland, Immediate
Past President of the Ohio State Medical Association,
has been appointed a member of the State Medical
Board of Ohio by Governor James A. Rhodes. He
was named to complete the unexpired term of Dr.
Donald F. Bowers, of Co-
lumbus, who resigned after
many years of sendee on the
Board. The term expires
March 14, 1970.
Dr. Crawford completed
his year as OSMA President
in May of this year and is
serving an additional year on
The Council as Immediate
Past President. Before being
named President-Elect of the
State Association in 1964,
he sensed four years as Coun-
cilor of the Fifth District. He is a graduate of
Western Reserve University School of Medicine, a
diplomate of the American Board of Surgery, and a
Fellow of the American Proctological Society. His
practice is limited to surgery and proctology.
Dr. Crawford is a Past President of the Academy
of Medicine of Cleveland and Cuyahoga County and
a former member of its Board of Directors. In 1961,
Dr. Crawford completed 37 years of military sendee
with the Air Force and the National Guard. From
1940 to 1946, he was on active duty.
The State Medical Board is the state agency charged
with the responsibility of licensing physicians and
limited practitioners in Ohio and enforcing the law
as it applies to the healing arts.
Other members of the Board are the following:
Domenic A. Macedonia, Steubenville, president; Mer-
vin F. Steves, M. D., Cincinnati, vice-president; John
D. Brumbaugh, M. D., Akron; J. O. Watson, D. O.,
Columbus; Frederick T. Merchant, M. D., Marion,
who also is a member of the OSMA Council; Ralph
K. Ramsayer, M. D., Canton; and Lloyd R. Evans,
Columbus. William T. Washam, M. D., LL. B.,
Columbus, is executive secretary of the Board.
Dr. Herman K. Hellerstein, assistant professor of
medicine, Western Reserve University School of
Medicine, was one of five physicians named as the
16th traveling faculty of the American College of
Cardiology Circuit Course to provide educational aid
in several countries of Africa. Faculty members serve
without compensation in the program sponsored by
the Cultural Affairs Department of the U. S. State
Department.
Dr. Crawford
for November, 1966
1193
^e0\CM- ASSOC/4
vG**
Convention site “extraordinaire” that’s Las Vegas. America's entertainment
capital becomes the classroom for America’s practicing physicians — offer-
ing you a comprehensive, compact, postgraduate course in recent develop-
ments in medical science. A magnificent Convention Center, fine hotels
and motels, excellent restaurants plus star studded entertainment await
you and your family.
The AMA’s first clinical convention in Las Vegas offers a top notch scientific
postgraduate program.
Scientific sessions will be held on the following topics: Scintillation Scan-
ning • Radiation and Cancer • Clinical Pulmonary Physiology • Gastroenter-
ology • Futuristic Diagnostic and Therapeutic Tools • Neck Pain • Anti-
biotics • Urology • Aerospace Medicine • Unconsciousness • Dermatology
• Juvenile Diabetes • Endocrine and Metabolic Diseases • Pediatrics •
Surgery • Hematology • Psychiatry • Otolaryngology.
Three Postgraduate Courses will be presented: Obstetrics and Gynecology
• Fluid and Electrolyte Balance • Cardiovascular Disease. Each Course will
consist of three half-day sessions, and there will be a registration fee of
$10.00 for each course, payable with your advance registration.
Four Breakfast Round Table Conferences will be held on the following
topics: The Management of Metabolic Bone Disease • Indication for Cardio-
version • The Problems and Potential of L.S.D. • An Agonizing Reappraisal
of Cancer Chemotherapy • Closed Circuit Television • Medical Motion
Picture Programs • Over 275 Scientific and Industrial Exhibits.
The complete scientific program, plus forms for advance registra-
tion and hotel accommodations, will be featured in JAMA October 24.
1194
The Ohio State Medical Journal
27-30,196©
Support for Medical Education . . .
Ohioans Again Offered Opportunity To Help Keep Medical
Students and Medical Schools Independent and Solvent
OHIO’S annual campaign in behalf of the
Medical Education Loan Guarantee Program
and the Funds for Medical Schools Program
of the American Medical Association Education and
Research Foundation is now underway.
Dr. Robert S. Martin, Zanesville, is Chairman of
the Ohio AMA-ERF Committee, which is composed
of the chairman and the 11 District Councilors of
the Ohio State Medical Association.
Since 1951, when the
AMA established its Funds
for Medical Schools Pro-
gram, members of the pro-
fession have contributed an
average of more than a mil-
lion dollars a year through
this channel. Four times this
amount is contributed an-
nually by physicians directly
to the nation’s medical
schools.
Grants to Ohio’s three
medical schools resulting
from 1965 contributions to the Funds for Medical
Schools Program were: Ohio State University Col-
lege of Medicine, SI 3,489.08; University of Cincin-
nati College of Medicine, S17,549.28; Western Re-
serve University School of Medicine, $13,196.72.
School May Be Specified
Money contributed to AMA-ERF Funds for Medi-
cal Schools may be designated for a specific school
by the donor or for medical education in general.
In the latter case, funds are distributed equally
among the medical schools. Deans of the medical
schools may use Foundation grants at their discre-
tion for special projects or expenses outside of their
budgets.
The Medical Education Loan Guarantee Program,
administered by AMA-ERF, guarantees long-term
bank loans to medical students, interns and residents
for essential training and living expenses. Each
SI 00 that is contributed to this Program, secures a
loan of $1,250. Some 27,511 loans have been made
since this Program was initiated in March, 1962,
totaling $32 million.
Prior to this program’s start, there was no adequate
loan source readily available to medical students. In
plans which were available, rates were high and
deferred repayment usually could not be arranged.
Now a medical trainee may borrow up to SI, 5 00
per year over his training period to a total of S10,-
000. He defers repayment until five months after
completion of all his full time training, and then
may take ten years to repay in monthly installments.
Contributions to this program may be earmarked to
guarantee loans in a particular state or area.
Last Year Response Good
Last year more than half of the members of the
Ohio State Medical Association made contributions
to medical education, either through AMA-ERF or
directly to their own schools.
Realizing the importance of keeping medical edu-
cation independent through private initiative and
voluntary effort, Dr. Martin, members of the 1966
Ohio AMA-ERF Committee and the local chairmen
urge Ohio physicians to respond generously in this
year’s campaign.
Cleveland Clinic Foundation
Announces PG Courses
The Cleveland Clinic Educational Foundation, has
announced a number of postgraduate courses of in-
terest to physicians and allied groups.
Details on these and other activities of interest may
be obtained from Walter J. Zeiter, M. D., director
of education, Cleveland Clinic Educational Founda-
tion, 2020 East 93rd Street, Cleveland, Ohio 44106.
The following courses have been announced:
November 16 and 17 — Diagnosis and Treatment
of Neuromuscular Disorders.
December 7 and 8 — Postgraduate Course in Oph-
thalmology.
January 11 and 12 — Advances in Dermatology.
January 18 and 19 — Controversies in General
Surgery.
February 1 and 2 — General Practice.
Dr. George W. Wright, Cleveland, is a member of
a national task force on the prevention and control of
emphysema and chronic bronchitis. The 2 5 -mem-
ber group recently met in Princeton, New Jersey,
under cosponsorship of the U. S. Public Health Serv-
ice and the National Tuberculosis Association.
R. S. Martin, M.D.
for November, 1966
1195
Whe
thiazide
o
reserpine
alone
won’t
keep
Establish and
maintain early,
more decisive
control of
blood pressure
Cryptenamine 1.0 mg.* Methyclothiazide 2.5 mg. Reserpine 0.1 mg.
When blood pressure won’t stay down despite initial therapy—
when complaints of headache, fatigue or dizziness are often voiced —
it may be time for a change to Diutensen-R.
Diutensen-R is thiazide and reserpine plus cryptenamine— a rational,
comprehensive therapy to help establish and maintain early,
more decisive control of blood pressure.
The cryptenamine in Diutensen-R helps improve normal vasodilating
reflexes while the thiazide and reserpine components maintain
vasorelaxant, sedative, and saluretic benefits. Cryptenamine lowers
pressoreceptor reflex thresholds (which may be abnormally high in
hypertension) —“resets” pressoreceptors to function at more nearly
normotensive levels.
Early, more decisive control with Diutensen-R helps secure
continuing benefits — may reduce or even obviate the need for poorly
tolerated drugs later in therapy.
. . quite apart from the problem of vascular damage, there
arises a possibility of virtual ‘cure’ or remission of hypertension
when treatment is early, i.e., before too many other secondary
pressor systems have entered into the disequilibrium of pressor con-
trol, and when it is adequately suppressive.”
Corcoran, A. C.: The choice of drugs in the treatment of hypertension. In: Drugs
Of Choice 1966-67, W. Modell, Ed., St. Louis, C. V. Mosby Company, 1966, p. 417.
Indications: Diutensen-R may be employed in all grades of essential hypertension.
Dosages: Usual dose is 1 tablet twice daily, at morning and evening meals.
However, adjustment of dosage to suit individual circumstances may be
required. Please refer to package insert for full particulars. Side effects and
precautions: The side effects observed with patients on Diutensen-R have
been of a mild and nonlimiting nature. These include occasional urinary frequency,
nocturia, nasal congestion, muscle cramps, skin rash, joint pains due to gout
symptoms and nausea and dizziness which have been reported for the individual
components. Most of these symptoms disappear while the drug is continued at
the same or lower dosage level. The concomitant use of digitalis and Diutensen-R
may increase the possibility of digitalis-like intoxication. If there is
evidence of myocardial irritability (extrasystoles, bigeminy or AV block), dosage
of Diutensen-R should be reduced or discontinued. Nocturia in patients
with marginal cardiac status and salt and fluid retention can be effectively
controlled by limiting the time of administration to early afternoon.
Diutensen-R should not be used in patients with a known intolerance to reserpine.
Package inserts furnish a complete summary of recommended cautions related to
each of the ingredients of Diutensen-R.
*As tannate salts equivalent to 130 Carotid Sinus Reflex Units.
NEISLER
NEISLER LABORATORIES, INC. • DECATUR, ILLINOIS
SUBSIDIARY OF UNION CARBIDE CORPORATION
Outstanding Scientific Exhibit
At OSMA Annual Meeting
OUTSTANDING FEATURE at the 1966 OSMA Annual Meeting in Cleveland, May 24-28,
was the Scientific and Health Education Exhibit. In keeping with a policy recommended
by the Committee on Scientific Work and approved by The Council, awards were authorized
for certain exhibits designated as outstanding by the judging committee. This year seven exhibits
were selected to receive the special honors which included mounted and engraved plaques, certifi-
cates and monetary awards. The committee designated three exhibits in the field of teaching, and
three in the field of original investigation to receive respectively the gold, silver, and bronze awards,
and named a seventh exhibit to receive a special award. Following is a brief description of one
of these award-winning exhibits.
Gold Award in Teaching Field
Goes to “G-Suit” Exhibit
The Gold Award in the Field of Teaching at the
1966 OSMA Annual Meeting was presented to spon-
sors of the exhibit, entitled "Control of Bleeding by
G-Suit.’’ Sponsors were Dr. John Storer and Dr.
W. James Gardner, of the Huron Road Hospital,
Cleveland.
This exhibit depicted the historical development
of the G-Suit and its current application in combating
hypovolemic shock and controlling bleeding.
Crile, in 1903, fabricated a crude inflatable suit
made of India rubber, which was used to treat shock.
Its use was short lived because of his mounting in-
terest in blood transfusion and the technical difficul-
ties encountered with the suit. The next application
of the principle of circumferential pneumatic com-
pression was represented by the antigravity garment
fabricated for use in aviation. In the early 1940’s
and thereafter, one investigator used this principle
extensively in sustaining the blood pressure in pa-
tients operated on in the sitting position.
In 1955, as a last resort, the G-Suit was used to
combat shock in a patient with uncontrollable ab-
dominal bleeding. Surprisingly, it controlled both
shock and bleeding. In an effort to ascertain the
mechanism whereby bleeding was controlled, an ex-
periment was undertaken. Eight mongrel dogs were
anesthetized with pentobarbital sodium and a portion
of their abdominal aorta occluded in a Cooley clamp.
A 0.5 cm. longitudinal incision was made in the
anterior wall of the aorta, the clamp released and an
experimental model of the G-Suit inflated rapidly
to 40 mm. Hg. Carotid pressures were monitored
during the entire experiment. The G-Suit was de-
flated at the end of one hour. These studies con-
sistently demonstrated the ability of the suit to sustain
arterial pressures one and one-half to two and one-
half times that of the G-Suit pressures. At the end
of one hour, the G-Suit was deflated and all animals
expired.
Aortograms done with the G-Suit inflated for one
hour following aortic laceration depicted the aortic
continuity to be intact and showed perfusion of the
tissues distal to the laceration. There was no ap-
parent escape of dye into the abdominal cavity.
The mechanism responsible for "closure” of the
laceration is thought to be a manifestation of the
Law of LaPlace. This ancient law states that the
tangential tension on the wall of a vessel, tending
to pull it apart, is proportional to the product of the
hydrostatic pressure within the vessel and the radius.
In this equation, R is the most important and
most frequently variable factor. This explains the
mechanism involved in the rupture of a balloon at its
weak point. The balloon, though having a common
intracavitory pressure, has greater tension on the
area involving the "weak spot” and thus will break
in this area. The reason for the greater tension be-
ing that this is the area of the greater radius. Cir-
cumferential pneumatic pressure decreases the radius
in the instance of the lacerated vessel to the point
where the incision is actually closed. It is not able
to completely occlude the vessel, because in the ulti-
mate it is compressing liquid (blood) which within
the limitations of these pressures is virtually incom-
pressible.
Certain other applications of this principle are
exhibited. Its use as a splinting device for fractured
extremities is well known and has come about through
this investigation. As the splint is inflated, it elon-
gates and thus is able to immobilize the extremity.
In addition to its splinting property, it is able to
control arterial or venous bleeding from the extremity
in a manner as described above. It has also been
used to act as a pressure dressing after joint opera-
tions (meniscectomy) and in the treatment of post
mastectomy edema of the upper extremity.
1198
The Ohio State Medical Journal
of a modern
corticosteroid
economy of
hydrocortisone
Now... a choice of 3
economical sizes
120 Gm. jar 15 Gm. tube 45 Gm. tube
fluocmolone acetomde — an original steroid from
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LABORATORIES INC . PALO ALTO. CALIF.
Obituaries
Ad Astra
William H. Caine, M. D., Antwerp; Ohio State
College of Homeopathic Medicine, Columbus, 1916;
aged 78; died September 24 as the result of a traffic
accident; former member of the Ohio State Medical
Association and the American Medical Association.
Dr. Caine practiced in the Antwerp area from 1928
to 1963, after moving there from the Cleveland
vicinity. He was a veteran of World War I. Sur-
viving are his widow, a son, a daughter, and a sister.
Wilson Smith Chamberlain, M. D., East Cleve-
land; Western Reserve University School of Medicine,
1916; aged 78; died September 28; member of the
Ohio State Medical Association and the American
Medical Association. A general practitioner of long
standing in Cleveland, Dr. Chamberlain was a former
assistant coroner, and a medical director of the Chil-
dren's Fresh Air Camp during its earlier years. A
veteran of World War I, a member of the American
Legion, and was affiliated with several Masonic bodies.
His widow and a daughter survive.
Martin Luther Crawford, M. D., Cleveland; How-
ard University College of Medicine, 1915; aged 75;
died September 8. Dr. Crawford was a practicing
physician of more than 50 years standing in the
Cleveland area. During World War I, he served in
the Army Medical Corps. Among survivors are his
widow, a sister, and a brother.
Benjamin Fletcher Cureton, M. D., Walhonding;
Starling Medical College, Columbus, 1903; aged 89;
died September 19; former member of the Ohio State
Medical Association and the American Medical As-
sociation. A practicing physician of long standing in
the Coshocton County community, Dr. Cureton lived
in retirement for a while in Mt. Vernon. He was a
veteran of World War I. A sister and a brother
survive.
Harry A. Duncan, M. D., Millersburg; Medico-
Chiurgical College of Philadelphia, 1904; aged 89;
died September 16; member of the Ohio State Medi-
cal Association and the American Medical Associa-
tion. After a long practice in the Philadelphia area,
and distinguished teaching career at Temple Univer-
sity, Dr. Duncan retired in 1951 and moved to Mil-
lersburg where he founded the Holmes County Cancer
Detection Clinic at Pomerene Hospital. A native of
Holmes County, a member of the local Masonic
Lodge, an elder in the Presbyterian Church, and a
member of the Rotary Club, he found time to write
histories of these organizations. A daughter is among
survivors.
Cemal M. Ergene, M. D., Bloomfield Hills, Mich.;
graduate of the Medical Faculty of the University of
Istanbul, Turkey, 1937; aged 50; died September 27.
A native of Turkey, Dr. Ergene served for 18 years
as a medical officer in the Turkish Navy before com-
ing to this country. He was licensed in Ohio and was
a former staff member at Sunny Acres Tuberculosis
Hospital in Cleveland. Only recently he had ac-
cepted an appointment with the Oakland County
Sanitorium, in Pontiac, Michigan. His widow and
two sons survive.
John Gaston Mateer, M. D., Detroit, Mich.; Johns
Hopkins University School of Medicine, 1918; aged
76; died September 3. Though a practitioner in
Established 1903
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PHARMACEUTICAL AND SICKROOM SUPPLIES %***■%} *
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The Ohio State Medical Journal
Detroit for most of his professional career, Dr.
Mateer was well known in his native Wooster area
and was a trustee of the College of Wooster. He
was the son of the late Dr. Horace N. Mateer, of
Wooster. Survivors include his widow, a daughter,
and two sisters.
Ralph Henry Miller, M. D., Cincinnati; University
of Cincinnati College of Medicine, 1933; aged 62;
died September 21; member of the Ohio State Medi-
cal Association, the American Medical Association,
and the American Academy of Ophthalmology and
Otolaryngology; diplomate of the American Board
of Ophthalmology. A specialist in ophthalmology
in Cincinnati for 34 years, Dr. Miller was head of the
ophthalmology service at Christ Hospital, and assist-
ant professor of ophthalmology at the University of
Cincinnati College of Medicine. He was a veteran
of World War II, during which he served overseas.
A member of the Presbyterian Church, he is survived
by his widow, a son, and two daughters.
Guy Anthony Parillo, M. D., Youngstown; Wayne
State University College of Medicine, 1917; aged 76;
died September 14; member of the Ohio State Medi-
cal Association, the American Medical Association,
and the American Academy of General Practice. A
general practitioner, Dr. Parillo’s professional career
in the Youngstown area extended over 49 years.
Among affiliations, he was a member of the American
Legion, as a veteran of World War I. Survivors
include four brothers and two sisters.
Raymond M. Strow, M. D., Weston; Toledo Medi-
cal College, 1900; aged 90; died September 1. A
practitioner in the Weston area of Wood County
since 1931, Dr. Strow had previously practiced in
Cygnet, West Leipsic, and Milton Center. He was a
member of the Church of Christ, and of several
Masonic bodies. Survivors include his son and a
daughter.
VA Medical Research Conference
Is Scheduled in Cincinnati
The Netherland Hilton Hotel in Cincinnati will
be the scene of this year’s Veterans Administration
Medical Research Conference. The conference, the
17th to be held since they were first initiated in At-
lanta, Georgia, in 1950, will start on Tuesday evening
November 29 and run until early Thursday after-
noon of December 1.
On Wednesday, the guest speaker Dr. William
Stewart, surgeon general, PHS, will address the gen-
eral session on the topic — "The Role of Government
in Medical Research."
This year’s program will feature four special lec-
tures by VA investigators: Dr. Thomas E. Starzl,
VAH, Denver, Colorado, on "The Status of Organ
Transplant;" Dr. Oscar Auerbach, VAH, E. Orange,
New Jersey, on "Newer Information on Emphysema;”
Dr. Leonard Skeggs, VAH, Cleveland, Ohio, on
"Progress with Automated Laboratory Systems;” and
Dr. D. Ewen Cameron, VAH, Albany, N. Y., on
"Memory in Relation to Problems of Aging.”
A highlight of the meeting will be an address
Wednesday afternoon by Dr. Rachmiel Levine,
chairman of the Department of Medicine, N. Y. Col-
lege of Medicine on the subject — "Carbohydrate
Metabolism.”
A series of 10 round-table discussions will take
place on topics of current interest.
In view of the increasing activities and interest
surrounding VA’s affiliations with the Medical
Schools, a program Wednesday evening will be pre-
sented by the VA Education Service.
Dr. George M. Owen, associate professor of pedi-
atrics in Ohio State University College of Medicine,
has been appointed to a second term of three years
on the Committee on Nutrition, American Academy
of Pediatrics.
WINDSOR HOSPITAL
A NONPROFIT CORPORATION
— ESTABLISHED 1 8 9 8 —
Chagrin Falls, Ohio 44022
247-5300 (Area Code 216)
A hospital for the treatment
of Psychiatric Disorders
Booklet available on request.
Accredited by The Joint Commission on Accreditation of Hospitals.
JOHN H. NICHOLS, M. D., Medical Director G. PAULINE WELLS, R. N., Admin. Director HERBERT A. SIHLER, Jr., Pres.
MEMBER: American Hospital Association — National Association of Private Psychiatric Hospitals — Ohio Hospital Association
for November, 1966
1205
Activities of County Societies . . .
First District
(COUNCILOR: PAUL N. IVINS, M. D., HAMILTON)
HAMILTON
The Academy of Medicine of Cincinnati held its
annual meeting and first meeting of the new season
on September 20, with installation of new officers as
one of the main features.
Installed as president was Dr. Elmer R. Maurer, who
succeeded Dr. Robert M. Woolford. Dr. Woolford
remains on the Council as immediate past president.
Dr. Stanley D. Simon was installed as president-elect.
Other officers include Dr. John J. Will, as secretary,
and Dr. Robert S. Heidt, as treasurer. Mr. Edward
F. Willenborg is executive secretary.
"The Legislative Influence on Medical Practice”
was the topic of discussion at the October 18 meet-
ing of the Academy, held in the Academy’s audi-
torium. Guest speaker for the occasion was The
Honorable Gerald R. Ford, Congressman from the
Fifth District of Michigan, and minority leader in
the Michigan House of Representatives.
Third District
(COUNCILOR: FREDERICK T. MERCHANT, M. D„ MARION)
ALLEN
At the regular meeting of the Lima and Allen
County Academy of Medicine on September 20th
86 members and guests were present. Dr. John P.
Storaasli, professor of radiation, Western Reserve
University, gave a very interesting and scholarly lec-
ture on Cancer of the Head and Neck.
Third District Councilor Frederick T. Merchant
presented a Fifty-Year pin to Dr. Gail E. Miller. Dr.
Miller received a standing ovation from the academy.
Dr. Thomas C. Rockwell was voted to membership-
in the academy. — T. D. Allison, M. D., Secretary-
Treasurer.
Fourth District
(COUNCILOR: ROBERT N. SMITH, M. D., TOLEDO)
LUCAS
The Academy of Medicine of Toledo and Lucas
County announced the following features on the
October calendar:
Meeting of the Section on Pathology, October 14.
Panel discussion on "Blood, Blood Fractions, and
Blood Volume Studies.” Participating were Drs. W.
H. Hartung, moderator, Thomas Geracioti, Richard
Schafer, H. Stewart Siddall, and Daniel Rigal.
Symposium and Discussion on "Executive Health
and Predictive Medicine,” and afternoon and evening
program on October 28 sponsored by the Western
Ohio Section of the Industrial Medical Association.
The Toledo Academy is looking forward to two
outstanding programs. On November 10 and 11 the
Inter-Hospital Postgraduate Lecture Series will be
given with Dr. Sidney Gellis, chief of pediatrics at
Tufts-New England Medical Center, as lecturer. The
theme is "Current Problems in Pediatrics.” On Janu-
ary 12 the Academy will hold its 65th annual meet-
ing. Speaker will be Henry J. Taylor, syndicated
columnist and lecturer who will use as his topic,
"Looking Ahead at Home and Abroad.”
Fifth District
(COUNCILOR: P. JOHN ROBECHEK, M. D., CLEVELAND)
CUYAHOGA
A meeting to discuss Medicare was held by the
Academy of Medicine of Cleveland on September 20
in the Statler-Hilton Hotel, of Cleveland. The meet-
ing followed a social hour and dinner.
Dr. David Fishman, president of the Academy,
presided over the meeting, while Robert A. Lang,
executive secretary, was moderator of the program
discussion.
Included as program speakers and panel discus-
sants were Dr. James Z. Appel, Immediate Past Presi-
dent of the American Medical Association; Carl D.
Donfils, administrative vice-president, Medical Mutual
of Cleveland; and Vernon R. Burt, executive vice-
president, Blue Cross of Northeast Ohio.
SUCCESSOR TO
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f ALL OF ITS ADVANTAGES
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References on request
Chloral — the “old reliable” — for more than 100 years
is dramatically improved in DriClor (5 grains chloral
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The effective sedative, hypnotic and anti-convulsant
form of Chloral Hydrate.
Also Chlorasec for quick, even sleep. DriClor inner core
(equivalent to 3.75 Grs. of Chloral Hydrate). Seco-
barbital acid outer coat (.75 Grs.)
1206
The Ohio State Medical Journal
Galileo needed the leaning tower of Pisa!
For over 1500 years the world believed that a heavy stone fell faster than a light one because
Aristotle said so. Since this made sense, Galileo thought so too. But, being a curious fellow,
he wanted to prove it; he climbed 297 steps to the top of the Leaning Tower of Pisa and
dropped 2 stones, a heavy one and a light one, over the edge. Much to his surprise, and
the surprise of everyone else, both stones struck the ground at the same time. Proof — a 1500
year old dogma destroyed in seconds by a simple experiment. It seemed that Aristotle had
been talking through his ancient hat.
And like Galileo, you probably believe a statement you have heard over and over again. How
many times have you been bombarded with the fact that brand name products are better than
generic name products? Often enough that no doubt you believe it to be true. But now let’s
do the simple test which, like Galileo’s experiment, will take but seconds.
Send for sample of West-ward’s Prednisone Tablets 5 mg., sold under the generic name, by
returning coupon below, and upon receipt do this simple test and see for yourself: Examine
tablet carefully, break it between your fingers and listen to the snap. A good snap indicates
a hard, well compressed tablet. Then take a tablet, drop it into a glass with about 20 ml.
water and swirl gently. Note that it disintegrates in a matter of seconds into finely divided
particles. Here is what this means:
A. Fast distintegration means more rapid absorption
B. Fine particles mean more complete absorption
C. Result: Optimum physiological availability1'2’3
To determine that West-ward’s Prednisone Tablets 5 mg. are the very best you need not
climb that tower; all you need do is send for sample bottle of 12 tablets and do the test.
SPECIFY “PREDNISONE TAB. 5 mg. (West-ward)”
so that your patient receives the very best at much lower costs
SEND FOR SAMPLES -DO THE TEST
West-ward, Inc., 745 Eagle Ave., Bronx, N. Y. 10456
I am interested in testing your Prednisone tablet for fast disintegration.
Kindly ship the following at no cost or obligation:
Prednisone Tablets 5 Mg. U. S. P.
Licensed under Patent 3,134,718
vial of 12 (professional sample)
Ship To: M. D.
•Zip Code
References :
1Morrison, A. B. ; and Campbell, J.
A., Journal of Pharmaceutical Sci-
ences, 54, 1 (1965)
2Campagna, F. A., Cureton, G.,
Mirigian, R. A., and Nelson, E.f
ibid., 52, 605 (1963)
8Levy, G., and Hayes, B. A., New
England Journal of Medicine ; 262,
1053 (1960)
for November, 1966
1207
GEAUGA
Members of the Geauga County Medical Society
and guests will participate in a dinner-dance recog-
nizing the One Hundredth Anniversary of the Society.
The Centennial Celebration will be held on Saturday,
December 3, at the Berkshire Hills Country Club,
located on Route 322, east of Chesterland.
Dr. Bruce F. Andreas, president of the Society, and
a committee are making preparations for celebration
of the Centennial celebration.
Sixth District
(COUNCILOR: EDWIN R. WESTBROOK, M. D., WARREN)
MAHONING
The Rev. Dr. Paul B. McCleave, director of the
Department of Medicine and Religion of the Ameri-
can Medical Association, was the speaker at the Sep-
tember 20 meeting of the Mahoning County Medical
Society. Clergymen from Mahoning County were
guests of the medical society. Dr. McCleave ad-
dressed the joint meeting on the paradoxes in modern
medicine. He discussed such things as the kidney
machine, the mechanical heart, organ transplants and
the contraceptive pill, and the moral decisions result-
ing from their use.
Dr. McCleave was introduced by Dr. Jack Schrei-
ber, program chairman. Dr. F. A. Resch, president,
presided.
Seventh District
(COUNCILOR: SANFORD PRESS, M. D„ STEUBENVILLE)
BELMONT
The Belmont County Medical Society, with the
Auxiliary, held a late afternoon program followed by
a dinner at the Belmont Hills Country Club on Sep-
tember 15.
Speaker for the occasion was Dr. Gregory B. Kriv-
chenia, Wheeling, W. Va., who discussed "Athletic
Injuries.’’
Tenth District
(COUNCILOR: RICHARD L. FULTON, M. D„ COLUMBUS)
FRANKLIN
The Academy of Medicine of Columbus and Frank-
lin County held a specialty society day program on
September 20 in cooperation with the Neuropsychi-
atric Society of Central Ohio, the Columbus Society
of Anesthesiologists, and the Columbus Surgical
Society.
The neuropsychiatric group heard a discussion by
Dr. Robert E. Litman, Los Angeles, California, en-
titled "Suicide Prevention — 1966.”
Dr. John W. Ditzler, Detroit, Michigan, discussed
the topic, "Management of Intractable Pain,” before
the group interested in anesthesiology.
Eleven speakers of a panel sponsored by the Co-
lumbus Surgical Society presented a discussion, "Re-
cent Developments in Surgery,” from the standpoints
of the various branches of surgery.
An open house reception was held prior to the
meeting at the new headquarters suite of the Acad-
emy, 17 South High Street, in downtown Columbus,
after which dinner was served in the Neil House.
Eleventh Distirct
Councilor: William R. Schultz, Wooster 44691
1749 Cleveland Road
LORAIN
Thomas M. Teree, M. D., of Cleveland, was the
featured speaker of the evening to a good representa-
tion of Lorain County Medical Society members when
they met at Oberlin Inn on October 11. Dr. Teree
is assistant professor in pediatrics at Western Reserve
University School of Medicine and Assistant Pediatri-
cian at University Hospitals of Cleveland. Since 1964
he has also been program director, NIH Clinical
Research Center for Children at University Hospitals.
Speaking on Fact, Fancy, and the Future in relation
to Prevention of Mental Retardation, Dr. Teree out-
lined the impact of technological advances in the re-
search and care of the mentally retarded. An in-
formative question and answer period followed and
President J. A. Cicerrella accorded the speaker a
warm vote of thanks on behalf of all those present.
During the business session, the following physi-
cians were unanimously voted into Associate Mem-
bership in Lorain County Medical Society:
M. A. Amiri (Lorain) : Valentine C. Marr (Avon) :
George P. Gotsis (Lorain) : Lawrence G. Thorley
(Elyria) Richard C. Wamsley (Oberlin) : and Char-
les E. Zepp (Elyria). Unanimously elected to Ac-
tive Membership were Eino Kooba of Lorain and
Thomas Sfiligoj of Lorain.
A report on the Uterine Cancer Detection Project
was given by A. Clair Siddall, M. D., chairman of the
Cancer Committee. The program has now been in
effect for six months, sponsored with funds from the
Ohio Department of Health. Marion G. Fisher,
M. D., Lorain County health commissioner, is co-
director of the Project which also has the co-operation
of the Lorain County Welfare Department, the local
Chapter of the American Cancer Society, and the
Outpatients’ Departments of Elyria Memorial Hospi-
tal and Lorain St. Joseph’s Hospital.
R. S. VanDervort, M. D., reported on the candi-
dates up for office at the November elections, and
briefly outlined their qualifications and attitudes to-
ward the medical profession.
President Cicerrella announced the appointment of
the Nominating Committee for 1967 slate of of-
ficers — Dr. John W. Wherry as chairman, Dr. John
Halley and Dr. Henry E. Kleinhenz.
The Fort Steuben Academy of Medicine opened its
21st year of activity with a meeting at the Fort Steu-
ben Hotel, Steubenville. Speaker for the occasion
was Dr. Peritz Scheinberg, professor and chairman of
the Department of Neurology, University of Miami
School of Medicine.
1208
The Ohio State Medical Journal
—
pywiiM
mssBU
Most of my patients with
high blood pressure are
as old as I am. A lot of the
are living on pensions.
They’re grateful when 1 c
keep prescription costs
Regroton
chlorthalidone 50 mg. reserpine 0.25 mg.
1 tablet daily
brings pressure down
Advantage: Both components of Regroton
are long-acting.
Average dosage: One tablet daily with
breakfast.
Contraindications: History of mental
depression, hypersensitivity, and most
cases of severe renal or hepatic diseases.
Warning: Discontinue 2 weeks before
general anesthesia, 1 week before electro-
shock therapy, and if depression or
peptic ulcer occurs. With administration
of enteric-coated potassium supplements,
the possibility of small bowel lesions
should be kept in mind.
Precautions: Reduce dosage of con-
comitant antihypertensive agents by one-
half. Discontinue if the BUN rises or
liver dysfunction is aggravated. Eiectro-
and in patients receiving corticosteroid
ACTH, or digitalis. Salt restriction is nc
recbmmended. Use with caution in
patients with ulcerative colitis, gall-
stones, or bronchial asthma.
Side effects: Nausea, vomiting, diarrhei
muscle cramps, headaches and dizzine
Potential side effects include angina ps
ris, anxiety, depression, drowsiness,
hyperglycemia, hyperuricemia, lassitud
leukopenia, nasal stuffiness, nightmare
purpura, urticaria, and weakness.
For full details, see the complete presc
ing information.
Availability: Bottles of 100 and 1000 tabl
W Oman’s Auxiliary Highlights . . .
By Mrs. S. L. MELTZER, Publicity Committee
Chairman, 2442 Dorman Dr., Portsmouth 45662
BACK IN AUGUST, Mrs. John B. Hazard,
I chairman of the state membership committee,
sent out to county chairmen what I consider
an outstanding and informative letter, full of prac-
tical workable suggestions. After all, every auxiliary
member is, in effect, part of any county’s membership
committee and I think it’s a good idea for each such
member to read Mrs. Hazard’s letter and digest it:
"In this era of antibiotic chemotherapy, preventive
vaccines, dramatic transplants and artificial replace-
ments, surely there must be some therapy to help
'close the gap’ between the potential and present
membership of the Ohio State Auxiliary. Your
state chairman does not have the answer, but since
a number of our Ohio counties have obtained 100
per cent membership and many are within reach of
this goal, I am going to share with you some of the
methods they have found successful. The following
suggestions came from reports of county membership
chairmen for 1965-66:
"Have a standing invitation to be mailed to wives
of all doctors as soon as they become members of the
medical society; enclose a calendar of events. Use
the positive approach — personal contact. Have a
hostess group at each meeting. When possible, have
a new member brought to a meeting by a committee
member and introduced. Have a courtesy committee
to keep informed as to members having babies, being
hospitalized and those with deaths and illness in the
family. Keep a file card for each member with year
of joining, professional background, hobbies, interest,
positions held in other organizations and a record of
auxiliary service; use this file to fit members to spe-
cific jobs and try to give everyone a job or have them
participate in some way. Make a personal visit to
new M. D.’s family — take an auxiliary booklet, the
News, or any local auxiliary information. Plan an
orientation for new members.
"Retrieve members by a personal call; if a griev-
ance, try to correct it. Plan an evening meeting to
encourage young mothers. Devise a distinctive name
tag for new members to wear throughout the year
to enable senior members to recognize them and
make a special effort to welcome (particularly among
large membership groups). On one meeting day
have "coffees” in different areas for new and old
members with a board member present at each coffee
to give information and answer questions (again more
practical among large membership).
"Yours is a challenging job and the three chal-
lenges you should try to meet are: To sign up the
new doctor’s wife before other groups attract her;
to win over established doctors’ wives who have never
joined; and to get the drop-outs back in the fold. Pro-
mote the joint husband-wife membership. Discuss
the plan with your advisors and get the approval of
your medical society. If you would like to have more
information regarding the 100 per cent husband-wife
team membership, let me know . . .”
Mrs. Hazard wants to give every county auxiliary
all possible help. She is at your service, just for the
asking. (Box 171, County Line Road, Gates Mills,
Ohio 44040.)
On the Local Scenes
Belmont County auxiliary held its annual Bitter-
sweet Ball on October 15 at the Belmont Hills
Country Club. Johnny Olszowy’s orchestra furnished
GROUP LIFE INSURANCE
Initiated and Sponsored by
Your OHIO STATE MEDICAL ASSOCIATION
For Information, Call Or Write
TURNER & SHEPARD, inc.
insurance
20 SOUTH THIRD STREET COLUMBUS, OHIO 43215 PHONE 228-6115 CODE 614
1210
The Ohio State Medical Journal
"Around the World”
A new idea in auxiliary luncheons is being pro-
moted by the Lucas County group. That idea is
the "Around the World in Foods” and each lunch-
eon will feature foods from a particular coun-
try. The starting point? Why good old American
cooking, of course! That "theme” prevailed at the
September luncheon at which Dr. Bryan Sutton-Smith,
professor of psychology at Bowling Green State Uni-
versity, discussed "Once Upon a Time.”
Mrs. Joseph Roshe, study groups chairman, has
reported an excellent response for this year. Septem-
ber saw the beginning sessions of these groups :
French (for beginners and for continuing in conver-
sational French); conversational Spanish; beauty
through Ballet; bridge; tennis; protocol and parli-
amentary procedure; antiques and art; gourmet group.
"Come Alive! Don’t Be a Sleeping Generation”
was the topic chosen by Mrs. Harry L. Fry, state
legislation chairman, for her talk before the Scioto
County auxiliary at its September luncheon at Har-
old’s Restaurant. Hostesses for the meeting included
Mrs. B. U. Howland, Mrs. Jack MacDonald and
Mrs. Ralph W. Lewis.
The Trumbull County group has organized a Fu-
ture Doctors’ Club for high school juniors and seniors
interested in the medical profession. Purpose of the
newly organized club is to acquaint these students
with (1) the medical profession; (2) medical school
.equirements; (3) possibilities of financial help; anu
(4) other related questions. Also invited to partici-
pate are science teachers and area counselors who are
interested. Six meetings have been schduled, the
first of which was held on Monday, October 17, in
the Trumbull Memorial Hospital auditorium. Mrs.
D. S. Hall is general chairman of the Future Doctors’
Club project.
"The Horse and Buggy Days of Medicine” were
discussed at the September luncheon meeting of the
Washington County auxiliary held at the home of
Mrs. Ford Eddy. Mrs. Asia Whitacre, Mrs. I. J.
Johnson and Mrs. E. W. Hill, Jr. were the narrators.
Mrs. Richard Hille, president, welcome two new
members: Mrs. Tom D. Halliday and Mrs. Leo
Banuelos.
Fall Conference
It’s been here (October 11 and 12) and it’s gone
— but "the melody lingers on” as it should, for all
the coming months. What those of you who at-
tended heard at this meeting is no idle chatter; it is
information carefully worked out and evaluated after
considerable study and thought by your State Board.
Everything done at Fall Conference was geared to
one purpose: to HELP each and every county aux-
iliary, big or small. I’ve said this before and I say
it again: every state officer and every state chairman
stands ready to serve you. All you have to do
is ASK.
For the treatment of
apathy
Irritability
forgetfulness
confusion
in the aging patient
EACH CEREBRO-NICIN CAPSULE CONTAINS:
Pentamethylene Tetrazole 100 mg.
Nicotinic Acid 100 mg.
Ascorbic Acid 100 mg.
Thiamine HCI 25 mg.
1-Glutamic Acid 50 mg.
Niacinamide 5 mg.
Riboflavin -. 2 mg.
Pyridoxine 2 mg.
DOSAGE: One capsule t.i.d. or as prescribed by physician.
AVAILABLE: Bottles of 100, 500, 1000 capsules.
Also elixir pint bottles.
CONTRAINDICATIONS: There are no known contraindications
to Pentamethylene Tetrazole although caution should be exer-
cised when treating patients with a low convulsive threshold.
Most persons experience a flushing or tingling sensation
after taking a higher potency niacin-containing compound.
As a secondary reaction some will complain of nausea and
other sensations of discomfort. This reaction is transient and
is rarely a cause of discontinuance of the drug if the patient
is forewarned to expect the reaction.
Federal law prohibits dispensing without a prescription.
CereAro-JVfcfn
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66% 66%
CEREBRO-NICIN® New double-blind study* shows how
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many aging patients showed striking improvement.
*A Double-Blind Study of Cerebro-Nicin, Therapy for the Geriatric Patient, R. Goldberg,
Jrn!. of the Amer. Ger. Soc., June, 1964.
Write for literature and samples . . .
THE BROWN PHARMACEUTICAL CO.
(BRC|]22Sf 2500 W. Sixth Street,
Los Angeles, California 90057
REFER TO
for November, 1966
1221
State Association Officers and Committeemen
Headquarters Office: 17 S. High St. — Suite 500, Columbus 43215. Telephone: (61U) 228-6971
OFFICERS and COUNCILORS
Lawrence C. Meredith, M. D., President
205 Elyria Block, Elyria 44035
Robert E. Howard, M. D., President-Elect
2500 Central Trust Tower, Cincinnati 45202
Henry A. Crawford, M. D., Past President
1058 Hanna Bldg., Cleveland 44115
Philip B. Hardymon, M. D., Treasurer
350 East Broad St., Columbus 43215
Paul N. Ivins, M. D., First District
306 High Street, Hamilton 45011
Theodore L. Light, M. D., Second District
2670 Salem, Avenue, Dayton 45406
Frederick T. Merchant, M. D., Third District
1051 Harding Memorial Parkway,
Marion 43305
Robert N. Smith, M. D., Fourth District
3939 Monroe Street, Toledo 43606
P. John Robechek, M. D., Fifth District
10525 Carnegie Avenue, Cleveland 44106
Edwin R. Westbrook, M. D., Sixth District
438 North Park Avenue, Warren 44481
Sanford Press, M. D., Seventh District
525 N. Fourth Street, Steubenville 43952
Robert C. Beardsley, M. D., Eighth District
2236 Maple Avenue, Zanesville 43705
Oscar W. Clarke, M. D., Ninth District
4th & Sycamore St., Gallipolis 45631
Richard L. Fulton, M. D., Tenth District
1211 Dublin Road, Columbus 43212
William R. Schultz, M. D., Eleventh District
1749 Cleveland Road, Wooster 44691
THE EXECUTIVE STAFF
Hart F. Page, Executive Secretary
Herbert E. Gillen, Administrative Assistant
W. Michael Traphagan, Administrative Assistant
Charles W. Edgar, Director of Public Relations
and Assistant Executive Secretary
Jerry J. Campbell, Administrative Assistant
R. Gordon Moore, Executive Editor
THE EDITOR: Perry R. Ayres, M. D.
COMMITTEES
Committee on Education — Thomas E. Rardin, Columbus, Chair-
man (1971) ; Clyde W. Muter, Warren (1970) ; Thomas S.
Brownell, Akron (1969) ; John G. Sholl, Cleveland (1968) ;
Elmer R. Maurer, Cincinnati (1967).
Judicial and Professional Relations Committee — Frank F. A.
Rawling, Toledo, Chairman (1968) ; Henry A. Crawford, Cleve-
land (1971) ; Homer A. Anderson, Columbus (1970) ; Chester H.
Allen, Portsmouth (1969) ; David Fishman, Cleveland (1967).
Committee on Public Relations and Economics — Frederick P.
Osgood, Toledo, Chairman (1969) ; Horace B. Davidson, Colum-
bus (1971) ; Luther W. High, Millersburg (1970) ; John H.
Budd, Cleveland (1968) ; John J. Cranley, Jr., Cincinnati
(1967).
Committee on Scientific Work — Samuel Saslaw, Columbus,
Chairman (1968) ; Jerry Hammon, West Milton (1971) ; Robert
E. Zipf, Dayton (1971) ; Jack Schreiber, Canfield (1970) ;
Walter J. Zeiter, Cleveland (1970) ; John D. Battle, Jr., Cleve-
land (1969) ; Harold J. Schneider, Cincinnati (1969) ; Isador
Miller, Urbana (1968) ; William Hamelberg, Columbus (1967) ;
F. A. Simeone, Cleveland (1967).
Committee on AMA-ERF— Robert S. Martin, Zanesville,
Chairman.
Committee on Auditing and Appropriations — William R.
Schultz, Wooster, Chairman; Edwin R. Westbrook, Warren:
Richard L. Fulton, Columbus.
Committee on Cancer — Arthur G. James, Columbus, Chair-
man ; Thomas D. Allison, Lima ; Andrew M. Barone, Lima ;
William F. Boukalik, Cleveland ; William J. Flynn, Youngs-
town ; Douglas P. Graf, Cincinnati ; Stanley O. Hoerr, Cleve-
land ; William A. Newton, Jr., Columbus ; W. D. Nusbaum,
Lancaster ; Arthur E. Rappoport, Youngstown ; Carl A. Wilz-
bach, Cincinnati.
Committee oh Disaster Medical Care — Thomas D. Allison,
Lima, Chairman ; Thomas P. Bowlus, Toledo ; Nino M. Camardese,
Norwalk ; Drew L. Davies, Columbus ; John H. Davis, Cleveland ;
Gregory G. Floridis, Dayton ; Robert D. Gillette, Huron ; Robert
S. Heidt, Cincinnati ; Robert E. Holmberg, Cleveland ; N. J. M.
Klotz, Wadsworth ; Thomas W. Morgan, Gallipolis ; Sterling
W. Obenour, Jr., Zanesville ; Vol K. Philips, Columbus ; Liaison
with the American Medical Association : Wendell A. Butcher,
Columbus.
Committee on Environmental Health — Rex H. Wilson, Akron,
Chairman ; William W. Davis, Columbus ; Larry L. Hipp, Gran-
ville; Robert C. Markey, Bowling Green; B. C. Myers, Lorain;
Tuathal P. O’Maille, Marietta ; Thomas N. Quilter, Marion ; I. C.
Riggin, Lorain ; Robert E. Schulz, Wooster ; Victor A. Simiele,
Lancaster ; John P. Storaasli, Cleveland ; Robert Vogel, Dayton ;
Robert C. Waltz, Cleveland ; Tennyson Williams, Delaware ;
John L. Zimmerman, Fremont.
Committee on Eye Care — Arthur D. Collins, Cleveland, Chair-
man ; Martin J. Cook, Springfield ; Thomas L. Edwards, Lima ;
Robert H. Magnuson, Columbus ; Russell J. Nicholl, Cleveland ;
Claude S. Perry, Columbus ; Norman W. Pinschmidt, Gallipolis ;
Barnet R. Sakler, Cincinnati ; Robert L. Willard, Toledo.
Committee on Government Medical Care Programs — H. Wil-
liam Porterfield, Columbus, Chairman ; James O. Barr, Chagrin
Falls ; Dwight L. Becker, Lima ; Robert A. Borden, Fremont ;
Edwin W. Burnes, Van Wert ; Philip T. Doughten, New Phila-
delphia ; Robert B. Elliott, Ada ; George T. Harding, Sr.,
Worthington; Roger E. Heering, Columbus; M. Robert Huston,
Millersburg ; Francis M. Lenhart, Defiance ; Harold E. Mc-
Donald, Elyria ; Elliott W. Schilke, Springfield ; Bernard A.
Schwartz, Cincinnati; Clarence V. Smith, Canton; Joseph B.
Stocklen, Cleveland ; Don P. Van Dyke, Kent ; William M.
Wells, Newark.
Committee on Hospital Relations — Robert M. Craig, Dayton,
Chairman ; L. Fred Bissell, Aurora ; L. A. Black, Kenton ;
Wendell T. Bucher, Akron ; Oscar W. Clarke, Gallipolis ; Henry
A. Crawford, Cleveland; John V. Emery, Willard; Harvey C.
Gunderson, Toledo ; Henry L. Hartman, Toledo ; E. R. Haynes,
Zanesville ; Middleton H. Lambright, Cleveland ; Lloyd E. Lar-
rick, Cincinnati ; James C. McLarnan, Mt. Vernon ; Ben V.
Myers, Elyria ; E. W. Schilke, Springfield ; Robert A. Tennant,
Middletown ; V. William Wagner, Port Clinton ; William A.
White, Canton.
Committee on Insurance — David A. Chambers, Cleveland,
Chairman; William F. Bradley, Columbus; Walter A. Daniel,
Tiffin; Chester R. Jablonoski, Cleveland; William A. Knapp,
Zanesville ; Marvin R. McClellan, Cincinnati ; William Neal,
Archbold ; Oliver E. Todd, Toledo ; Robert E. Tschantz, Canton ;
Allan L. Wasserman, Dayton; John W. Wherry, Elyria; Wil-
liam A. White, Canton.
Committee on Laboratory Medicine — Horace B. Davidson,
Columbus, Chairman; William H. Benham, Columbus; John B.
Hazard, Cleveland ; Melvin Oosting, Dayton ; Arthur E. Rappo-
port, Youngstown; William Sinclair, Cleveland; Gilbert B.
Stansell, Toledo ; Philip B. Wasserman, Cincinnati.
1222
The Ohio State Medical Journal
State Association Officers and Committeemen (Continued)
Committee on Legislation — James T. Stephens, Oberlin, Chair-
man ; Chester H. Allen, Portsmouth ; Donald R. Brumley, Find-
lay; Jonathan G. Busby, Columbus; George D. J. Griffin, Cin-
cinnati; Jack L. Kraker, Lancaster; William J. Lewis, Dayton;
Maurice F. Lieber, Canton; James C. McLarnan, Mt. Vernon;
Wesley J. Pignolet, Willoughby ; Marvin J. Rassell, Hamilton ;
Theodore E. Richards, Urbana ; Robert E. Rinderknecht, Dover ;
John H. Sanders, Cleveland ; William W. Trostel, Piqua.
Committee on Maternal Health — Anthony Ruppersberg, Colum-
bus, Chairman ; Otis G. Austin, Medina ; Raymond E. Barker,
Columbus ; William D. Beasley, Springfield ; Keith R. Brande-
berry, Gallipolis ; Thomas E. Byrne, Mentor ; Mel A. Davis,
Columbus; Marion F. Detrick, Jr., Findlay; John P. Garvin,
Columbus ; Richard P. Glove, Cleveland ; Robert A. Heilman,
Columbus; John F. Hillabrand, Toledo; Robert E. Johnstone,
Cincinnati; Albert A. Kunnen, Dayton; James F. Morton,
Zanesville ; Ralph K. Ramsayer, Canton ; Robert E. Swank,
Chillicothe ; Densmore Thomas, Warren; Robert S. VanDervort,
Elyria.
Committee on Medicine and Religion — Charles A. Sebastian,
Cincinnati, Chairman ; John D. Albertson, Lima ; Eugene F.
Damstra, Dayton ; Francis M. Lenhart, Defiance ; Ralph W.
Lewis, Portsmouth ; George W. Petznick, Cleveland ; J. Kenneth
Potter, Cleveland; John R. Seesholtz, Canton; William B.
Smith, Zanesville; James T. Stephens, Oberlin; Donald J.
Vincent, Columbus; Don G. Warren, West Lafayette.
Committee on Mental Health — Wendell A. Butcher, Columbus,
Chairman ; Homer A. Anderson, Columbus ; Robert D. Eppley,
Elyria ; Max D. Graves, Springfield ; Richard G. Griffin, Worth-
ington ; Warren G. Harding, Columbus ; Edward O. Harper,
Cleveland ; Henry L. Hartman, Toledo ; William H. Holloway,
Akron ; C. Eric Johnston, Columbus ; Robert E. Reiheld, Orr-
ville ; Philip C. Rond, Columbus ; W. Donald Ross, Cincinnati ;
Viola V. Startzman, Wooster; Victor M. Victoroff, Cleveland.
Military Advisory Committee — Drew L. Davies, Columbus,
Chairman ; Ralph G. Carothers, Cincinnati ; Homer D. Cassel,
Dayton; Henry A. Crawford, Cleveland; Walter L. Cruise,
Zanesville; Charles R. Keller, Mansfield ; Ralph W. Lewis,
Portsmouth ; Edward L. Montgomery, Circleville ; Frank T.
Moore, Akron ; Frederick P. Osgood, Toledo ; Earl Rosenblum,
Steubenville ; Richard G. Weber, Marion.
Committee on Rural Health — Robert E. Reiheld, Orrville,
Chairman ; Chester J. Brian, Eaton ; Robert R. C. Buchan,
Troy ; J. Martin Byers, Greenfield ; Walter A. Campbell, Co-
shocton ; E. Joel Davis, East Canton ; Victor R. Frederick,
Urbana; Benjamin W. Gilliotte, Zanesville; Jerry L. Hammon,
West Milton ; Jasper M. Hedges, Circleville ; Luther W. High,
Millersburg ; E. D. Mattmiller, Athens; John R. Polsley, North
Lewisburg ; Leonard S. Pritchard, Columbiana ; Harold C.
Smith, Van Wert; Kenneth W. Taylor, Pickerington.
OSMA Advisory Committee to the Ohio State Society of
Medical Assistants — Richard L. Fulton, Columbus, Chairman ;
George Newton Spears, Ironton.
Committee on School Health — Charles H. McMullen, Loudon-
ville. Chairman; Walter Felson, Greenfield; Howard H. Hop-
wood, Cleveland ; Dale A. Hudson, Piqua ; Howard J. Ickes,
Canton ; Charles L. Kagay, Dayton ; Thomas E. Wilson, Warren ;
Robert C. Markey, Bowling Green ; Robert J. Murphy, Colum-
bus; Carey B. Paul, Jr., Columbus; Carl L. Petersilge, Newark;
William H. Rower, Ashland ; Thomas E. Shaffer, Columbus ;
Aubrey L. Sparks, Warren ; Homer B. Thomas, Gallipolis.
OSMA Members of the Joint Committee on School Bus Driver
Examinations — Carey B. Paul, Jr., Columbus; Thomas N.
Quilter, Marion ; Drew L. Davies, Columbus.
OSMA Members of the Joint Advisory Committee on Athletic
Injuries — Walter A. Hoyt, Jr., Akron; John R. Jones, Toledo;
Don A. Kelly, Cleveland; Sol Maggied, West Jefferson; Marvin
R. McClellan, Cincinnati ; Robert P. McFarland, Oberlin ;
Charles H. McMullen, Loudonville ; Robert J. Murphy, Colum-
bus ; Carey B. Paul, Jr., Columbus ; Thomas E. Shaffer,
Columbus.
Committee on Workmen’s Compensation — H. P. Woratell,
Columbus, Chairman ; A. L. Berndt, Portsmouth ; Thomas H.
Brown, Jr., Toledo; Charles A. Browning, Jr., Bellefontaine ;
Oscar W. Clarke, Gallipolis ; Frederick A. Flory, Columbus ;
Lawrence T. Hadbavny, Cleveland ; Clyde O. Hurst, Ports-
mouth; Edmund F. Ley, Tiffin; Joseph Lindner, Sr., Cincinnati;
John D. Osmond, Jr., Cleveland; James G. Roberts, Akron;
George L. Sackett, Sr., Painesville ; William V. Trowbridge,
Cleveland; Rex H. Wilson, Akron; James N. Wychgel, Cleve-
land; Joseph H. Shepard, Columbus; Frederick A. Wolf,
Cincinnati.
Woman’s Auxiliary Advisory Committee — Robert C. Beard-
sley, Zanesville, Chairman ; Theodore L. Light, Dayton ; Fred-
erick T. Merchant, Marion.
Ohio Medical Indemnity Liaison Committee — Robert E.
Tschantz, Canton, Chairman ; Henry A. Crawford, Cleveland ;
Lawrence C. Meredith, Elyria ; Mr. Hart F. Page, Executive
Secretary, OSMA, Columbus.
DELEGATES AND ALTERNATES
Delegates and Alternates to the American Medical Association
— George W. Petznick, Cleveland ; H. T. Pease, Wadsworth, alter-
nate ; Carl A. Lincke, Carrollton ; Robert S. Martin, Zanesville,
alternate ; Theodore L. Light, Dayton ; Kenneth D. Arn, Dayton,
alternate; Edmond K. Yantes, Wilmington; Harry K. Hines,
Cincinnati, alternate; John H. Budd, Cleveland; P. John Robe-
chek, Cleveland, alternate ; Richard L. Meiling, Columbus ;
Frank F. A. Rawling, Toledo, alternate ; Frederick P. Osgood,
Toledo ; Robert N. Smith, Toledo, alternate ; Charles A. Sebas-
tian, Cincinnati ; J. Robert Hudson, Cincinnati, alternate ; Ed-
win H. Artman, Chillicothe ; Philip B. Hardymon, Columbus,
alternate ; Robert E. Tschantz, Canton ; Henry A. Crawford,
Cleveland, alternate.
County Societies’ Officers and Meeting Dates
First District
Councilor: Paul N. Ivins, Hamilton 45011
306 High Street
ADAMS — Gary J. Greenlee, President, Manchester 45144 ; Stan-
ley H. Title, Secretary, Manchester 45144.
BROWN — Charles H. Maly, President, Sardinia 45171 ; Charles
W. Hannah, Secretary, Sardinia 45171. 1st Monday monthly.
BUTLER — Robert Johnson, President, 500 S. Breiel Boulevard,
Middletown 45042 ; Mr. Charles G. Greig, Executive Secretary,
110 North Third Street, Hamilton 45011. 4th Wednesday
monthly.
CLERMONT — Cecil F. Barber, President, State Route 133, Feli-
city 45120 ; Phillips F. Greene, Secretary, Route 1, Box 509,
New Richmond 45157. 3rd Wednesday monthly, except July
and August.
CLINTON — Richard R. Buchanan, President, 115 West Main,
Wilmington 45177 ; Mary Ranz Boyd, Secretary, Box 629,
Wilmington 45177. 4th Tuesday monthly.
HAMILTON — Elmer R. Maurer, President, 320 Broadway, Cin-
cinnati 45202 ; Mr. Edward F. Willenborg, Executive Secretary,
320 Broadway, Cincinnati 45202. Monthly meeting dates, 1st
Tuesday ; Academy, 3rd Tuesday, except June, July and August.
HIGHLAND — Thomas L. Jones, President, 528 South St., Green-
field 45123 ; Walter Felson, Secretary, 357 South St., Greenfield
45123. 3rd Tuesday bimonthly.
WARREN — O. Williaid Hoffman, President, 20 East Fourth
Street, Franklin 45005 ; Ray E. Simendinger, Secretary, 901
North Broadway Street, Lebanon 45036. 2nd Tuesday monthly.
Second District
Councilor: Theodore L. Light, Dayton 46406
2670 Salem Ave.
CHAMPAIGN — Myron J. Towle, President, 848 Scioto Street,
Urbana 43078 ; Fred R. Denkewalter, Secretary, 848 Scioto
Street, Urbana 43078. 2nd Wednesday monthly.
CLARK — Henry M. Tardif, President, 2608 E. High Street,
Springfield 45505 ; Mrs. Marion L. Wilcoxson, Executive
Secretary, 616 Building, Room 131, 616 N. Limestone St.,
Springfield 44503. 3rd Monday monthly, except June, July
and August.
DARKE — William A. Browne, President, 722 Sweitzer St.,
Greenville 45331 ; Delbert D. Blickenstaff, Secretary, 552 S.
West St., Versailles 45380. 3rd Tuesday monthly.
GREENE — Clement G. Austria, President, 1142 North Monroe
Drive, Xenia 45385 ; Mrs. C. K. Elliott, Executive Secretary,
225 Pleasant Street, Xenia 45385. 2nd Thursday monthly
except July and August.
MIAMI — David Brown, President, 1060 North Market Street,
Troy 45373 ; Jack P. Steinhilber, Secretary, 145 Sunset Drive,
Piqua 45356. 1st Tuesday monthly.
MONTGOMERY — Charles E. O’Brien, President, 600 Fidelity
Building, Dayton 45402 ; Mr. Robert F. Freeman, Executive
Secretary, 280 Fidelity Medical Building, Dayton 45402. 1st
Friday monthly October through May — 1st Wednesday June.
PREBLE — John D. Darrow, President, 228 N. Barron St., Eaton
45320 ; Willard C. Clark, Jr., Secretary, 228 N. Barron, Eaton
45320. Irregular meetings.
SHELBY — George J. Schroer, President, 322 Second Ave., Sidney
45365 ; Alfonsas Kisielius, Secretary, Ohio Bldg., Sidney 45365.
for November, 1966
1223
County Societies’ Officers and Meeting Dates (Continued)
Third District
Councilor : Frederick T. Merchant, Marion 43305
1051 Harding Memorial Pky.
ALLEN — Carl H. Zinsmeister, President, 729 W. Market Street,
Lima 45801 ; Thomas D. Allison, Secretary, 401 Metropolitan
Bank Building, Lima 45801. 3rd Tuesday monthly.
AUGLAIZE — Robert Sobocinski, President, 75 Blackhoof Street,
Wapakoneta 45895 ; J. F. Bowling, Secretary, 319 West Spring
Street, St. Marys 45885. 1st Thursday monthly except July.
CRAWFORD — Don E. Ingham, President, 201 N. Market Street,
Galion 44833 ; Johnson H. Chow, Secretary, 1040 Devonwood
Drive, Galion 44833. Called meetings.
HANCOCK— Raymond J. Tille, President, 801 S. Main St., Find-
lay 45840 ; Herbert L. Queen, Secretary, 828 Woodworth Dr.,
Findlay 45840.
HARDIN — William D. Dewar, President, 405 North Main Street,
Kenton 43326 ; John J. Roget, Secretary, Belle Center 43310.
2nd Tuesday monthly.
LOGAN — Thomas Seitz, President, 223 E. Columbus Street,
Bellefontaine 43311 ; Glen Miller, Secretary, R. D. 2, West
Liberty 43357. 1st Friday monthly.
MARION — Ransome Williams, President, 1035 Harding Me-
morial Parkway, Marion 43302 ; Alice Fisher, Secretary, 1040
Delaware Avenue, Marion 43302. 1st Tuesday monthly.
MERCER — R. Duane Bradrick, President, Rockford 45882 ; R. L.
Dobbins, Secretary, 5402 State Route 29 East, Celina. 3rd
Thursday, monthly.
SENECA — Olgierd C. Garlo, President, 53 Clay Street, Tiffin
44883 ; Leonard M. Gaydos, Secretary, 233 South Monroe
Street, Tiffin 44883. 3rd Tuesday monthly.
VAN WERT — Norman L. Marxen, President, Medical Arts Bldg.,
Fox Road, Van Wert 45891 ; W. L. Her, Secretary, Medical
Arts Bldg., Fox Road, Van Wert 45891. 4th Friday monthly.
WYANDOT — Herschel A. Rhodes, President, 777 N. Sandusky
Ave., Upper Sandusky 43351 ; J. J. Browne, Secretary, 777 N.
Sandusky Ave., Upper Sandusky 43351. 2nd Tuesday monthly.
Fourth District
Councilor: Robert N. Smith, Toledo 43606
3939 Monroe St.
DEFIANCE — L. F. Berry, Jr., President, 1400 East Second
Street, Defiance 43512 ; W. S. Busteed, Secretary, Box 218,
Defiance 43512.
FULTON — B. H. Reed, Jr., President, Delta 43515 ; R. L. Davis,
Secretary, Wauseon 43567. 2nd Tuesday quarterly March,
June, September, December.
HENRY — J. J. Harrison, President, 113 East Clinton Street,
Napoleon 43545 ; Gamble S. Hall, Secretary, 834 Strong
Street, Napoleon 43545. 1st Tuesday monthly.
LUCAS — E. L. Doermann, President, 2001 Collingwood Blvd.,
Toledo 43620 ; Mr. Robert W. Elwell, Executive Secretary, 3101
Collingwood Blvd., Toledo 43610. 3rd Tuesday monthly except
July and August.
OTTAWA — V. Wm. Wagner, President, 122 East Perry, Port
Clinton 43452 ; William Coon, Secretary, 120 East Perry, Port
Clinton 43452. 2nd Thursday monthly.
PAULDING — Roy R. Miller, President, 220 W. Perry, Paulding
45879 ; D. Paul Ward, Secretary, Box 416, Oakwood 45873.
Meetings called.
PUTNAM — Arthur P. Daniel, President, 144 N. Walnut, Ottawa
45875 ; Oliver N. Lugibihl, Secretary, Pandora 45877. 1st
Tuesday monthly.
SANDUSKY — J. L. Zimmerman, President, Memorial Hospital
of Sandusky County, Fremont 43420 ; Mrs. Patsy J. Askins.
Executive Secretary, Memorial Hospital of Sandusky County,
Fremont 43420. 3rd Wednesday monthly.
WILLIAMS — John E. Moats, President, Central Drive, Bryan
43506 ; Neil T. Levenson, Secretary, 907 Noble Drive, Bryan
43506. 2nd Tuesday monthly.
WOOD — Roger A. Peatee, President, 140 S. Prospect Street,
Bowling Green 43402 ; Douglas Hess, Secretary, 920 North
Main St., Bowling Green, Ohio 43402. 3rd Thursday monthly.
Fifth District
Councilor: P. John Robechek, Cleveland 44106
10525 Carnegie Ave.
ASHTABULA — J. R. Nolan, President, 2736 Lake Avenue, Ash-
tabula 44004 ; Richard Millberg, Secretary, 430 West 25th
Street, Ashtabula 44004. 2nd Tuesday monthly.
CUYAHOGA — David Fishman, President, Room 404, 10515 Car-
negie Avenue, Cleveland 44106 ; Mr. Robert A. Lang, Executive
Secretary, 10525 Carnegie Avenue, Cleveland 44106.
GEAUGA — Bruce F. Andreas, President, 400 Downing Drive,
Chardon 44024 ; Mrs. Martha Withrow, Executive Secretary,
P. O. Box 249, Chardon 44024. 2nd Friday monthly.
LAKE — Robert W. Colopy, President, 89 E. High Street, Paines-
ville 44077 ; Mrs. Owen A. McLaren, Executive Secretary
7408 Cadle Avenue, Mentor 44060. 4th Wednesday evening
monthly, January, May, March, September and November
unless otherwise ordered by Council.
Sixth District
Councilor: Edwin R. Westbrook, Warren 44481
438 North Park Ave.
COLUMBIANA — Edith S. Gilmore, President, 432 W. 5th St.,
E. Liverpool 43920 ; Fraser Jackson, Secretary, 205 W. 6th
St. 3rd Tuesday monthly.
MAHONING - — F. A. Resch, President, Doctors Park, Canfield
44406 : Mr. Howard C. Rempes, Jr., Executive Secretary, 245
Bel-Park Building, 1005 Belmont Avenue, Youngstown 44504.
3rd Tuesday monthly except July and August.
PORTAGE — David Palmstrom, President, 124 North Prospect
Street, Ravenna 44266 ; William R. Brinker, Secretary, 141
East Main Street, Kent 44240. 3rd Tuesday monthly.
STARK — A. R. Furnas, Jr., President, 420 Lake Avenue, N. E.,
Massillon 44646 ; Mr. John H. Austin, Executive Secretary,
405 4th Street, N. W., Canton 44702. 2nd Thursday monthly.
SUMMIT — James G. Roberts, President, 655 West Market Street,
Akron 44303 ; Mr. Sidney H. Mountcastle, Executive Secretary,
437 Second National Building, 159 South Main Street, Akron
44308. 1st Tuesday monthly.
TRUMBULL — John F. McGreevey, President, 297 Hawthorne
Lane N. E., Warren 44484 ; Mrs. Kay Ticknor, Executive
Secretary, 280 North Park Avenue, Warren 44481. 3rd
Wednesday monthly September through May.
Seventh District
Councilor : Sanford Press, Steubenville 43952
525 North Fourth Street
BELMONT — James Sutherland, President, 9 North 4th Street,
Martins Ferry 43935 ; Bertha M. Joseph, Secretary, 100 South
4th Street, Martins Ferry 43935. 3rd Thursday of February,
March, April, June, September, October, November and
December.
CARROLL — Glen C. Dowell, President, 207 West Main, Car-
rollton 44615 ; Thomas J. Atchison, Secretary, 292 East
Main, Carrollton 44615. 1st Thursday monthly.
COSHOCTON — Don Warren, President, 600 East Main Street,
West Lafayette 43845 ; Harold Lear, Secretary, 133 South
Fourth Street, Coshocton 43812. 2nd Tuesday monthly.
HARRISON — Charles D. Evans, President, 159 South Main
Street, Cadiz 43907 ; G. E. Vorhies, Secretary, Scio 43988,
Quarterly.
JEFFERSON — Jacob R. Cohen, President, 341 Market Street,
Steubenville 43952 ; Irving Dreyer, Secretary, Ohio Valley
Hospital, Steubenville 43952. 4th Tuesday monthly except
December, January, February.
MONROE — Byron Gillespie, Secretary, Woodsfield 43793.
TUSCARAWAS — Robert J. Kuba, President, 319 Grant St., Den-
nison 44621 ; Thomas E. Ogden, Secretary, 138 E. Main St.,
Gnadenhutten. 2nd Thursday monthly.
Eighth District
Councilor: Robert C. Beardsley, Zanesville 43706
2236 Maple Ave.
ATHENS — D. R. Johnson, President, 52 West Washington
Street, Nelsonville 45764 ; L. A. Hamilton, Secretary, 400 East
State Street, Athens 45701. 2nd Tuesday monthly except July
and August.
FAIRFIELD — George W. LeSar, President, 216 Harmon Avenue,
Lancaster 43130 ; Stephen R. Hodsden, Secretary, 1423 West
Market Street, Baltimore 43105. 2nd Tuesday monthly.
GUERNSEY — A. C. Smith, President, 1115 Clark Street, Cam-
bridge 43725 ; Dayle O. Snyder, Secretary, 840 Wheeling
Avenue, Cambridge 43725. 1st Tuesday monthly.
LICKING — Carl L. Petersilge, President, 104 Hudson Avenue,
Newark 4306?' : Robert P. Raker, Secretary, 317 N. Granger
Street, Granville 43023. 4th Tuesday monthly.
MORGAN — -A. H. Whitacre, President, Chesterhill 43728 ; Henry
Bachman, Secretary, Box 199, Malta 43758.
MUSKINGUM — Paul A. Jones, President, 838 Market Street,
Zanesville 43701 ; Myron Powelson, Secretary, 2825 Maple
Avenue, Zanesville 43705. 2nd Tuesday monthly.
NOBLE — Frederick M. Cox, President, Caldwell 43724 ; Edward
G. Ditch, Secretary, 415 Main Street, Caldwell 43724. 1st
Tuesday monthly.
PERRY — Charles B. McDougal, President, 319 High St., New
Lexington 43764 ; Michael P. Clouse, Secretary, West Main St.,
Somerset 43783.
WASHINGTON — Mary L. Whitacre, President, Rt. 6, Marietta
45750 ; G. E. Huston, Secretary, 328 Fourth St., Marietta
45750. 2nd Wednesday monthly.
1224
The Ohio State Medical Journal
County Societies’ Officers and Meeting Dates (Continued)
Ninth District
Councilor: Oscar W. Clarke, Gallipolis 45631
4th & Sycamore St.
GALLIA — Quentin Korfhage, President, Gallipolis Clinic, Gal-
lipolis 45631 ; John Groth, Secretary, Holzer Clinic, Gallipolis
45631. Monthly meetings at called times.
HOCKING — Jan S. Matthews, President, 9 East Second Street,
Logan 43138 ; H. M. Boocks, Secretary, Route 3, Logan 43138.
2nd Tuesday monthly.
JACKSON — John M. Cook, President, Box 316, Oak Hill 45656 ;
Earl J. Levine, Secretary, 120 N. Ohio Ave., Wellston 45692.
LAWRENCE — Frank W. Crowe, President, 2110 South 9th
Street, Ironton 45638 ; George Newton Spears, Secretary, 2213
South Ninth Street, Ironton 45638. Quarterly at called times.
MEIGS — Charles J. Mullen, President, 210% E. Main St., Pome-
roy 45769 ; Edmund Butrimas, Secretary, 204 E. Main St.,
Pomeroy 45769.
PIKE — Robert T. Leever, President, 100 East Third St., Waverly
45690 ; Albert M. Shrader, Secretary, East Water St., Waverly
45690. 1st Tuesday monthly.
SCIOTO — Chester H. Allen, President, 1405 Offnere Street,
Portsmouth 45662 ; Erich Spiro, Secretary, 1735 Waller Street,
Portsmouth 45662. 2nd Monday in February, April and Octo-
ber ; December meeting and summer meeting decided by the
Council and members notified one month in advance.
VINTON — Richard E. Bullock, President, 203 South Market St.,
McArthur 45651.
Tenth District
Councilor: Richard L. Fulton, Columbus 43212
1211 Dublin Rd.
DELAWARE — Don K. Michel, President, 98 W. William, Dela-
ware 43015 ; Tennyson Williams, Secretary, Box 265, Delaware
43015. 3rd Tuesday monthly.
FAYETTE — R. D. Woodmansee, President, 403 East Market
Street, Washington C. H. 43160 ; M. H. Roszmann, Secretary,
1005 East Temple Street, Washington C. H. 43160. 2nd
Friday monthly
FRANKLIN — Joseph A. Bonta, President, 3100 Olentangy River
Road, Columbus 43202 : Mr. W. “Bill” Webb, Jr., Executive
Secretary, 17 South High St., Suite 528, Columbus 43215.
3rd Tuesday monthly.
KNOX — Richard L. Smythe, President, 812 Coshocton Road,
Mt. Vernon 43050 ; Robert E. Sooy, Secretary, Box 470, Mt.
Vernon 43050. 1st Wednesday evening monthly.
MADISON — Sol Maggied, President, 15 East Pearl Street, West
Jefferson 43162; Michael Meftah, Secretary, 11 East 2nd
Street, London 43140. 1st Wednesday monthly.
MORROW — Francis W. Kubb, President, 140 North Main, Mt.
Gilead 43338 ; William S. Deffinger, Secretary, Box 8, Marengo
43334. 1st Tuesday monthly.
PICKAWAY — V. D. Kerns, President, 143 E. Main Street,
Circleville 43113 ; Carlos Alvarez, Secretary, 147 Pinckney
Street, Circleville 43113. 1st Friday evening monthly, except
months of July and August.
ROSS — Joseph McKell, President, 174 W. Main Street, Chilli-
cothe 45601 ; Lowell O. Smith, Secretary, 217 Delano Avenue,
Chillicothe 45602. 1st Thursday evening monthly.
UNION — Malcolm Maclvor, President, 110 N. Court St., Marys-
ville 43040 ; May B. Zaugg, Secretary, 225 Stockdale Drive,
Marysville 43040. 1st Tuesday, February, April, October,
December.
Eleventh District
Councilor: William R. Schultz, Wooster 44691
1749 Cleveland Road
ASHLAND — Henry C. Chalfant, President, 309 Arthur Street,
Ashland 44805 ; H. W. Smith, Secretary, 414 Samaritan Ave-
nue, Ashland 44805. 1st Thursday monthly.
ERIE — Clinton F. Lavender, President, 1218 Cleveland Road,
Sandusky 44870 ; Mrs. David Wolfert, Executive Secretary,
1205 Tyler Street, Sandusky 44870.
HOLMES — Charles H. Hart, President, 109 South Clay Street,
Millersburg 44654 ; William A. Powell, Secretary, 8 West
Adams Street, Millersburg 44664. 3rd Thursday monthly.
HURON — W. R. Graham, President, 15 Main Street, Wakeman
44889 ; E. R. McLoney, Secretary, 257 Benedict Avenue, Nor-
walk 44857. 2nd Wednesday of February, April, June, Au-
gust, October, and December.
LORAIN — Joseph A. Cicerrella, President, 209 6th Street, Lorain
44052 ; Mrs. Gladys Davidson, Executive Secretary, 428 West
Avenue, Elyria 44035. 2nd Tuesday monthly except June,
July and August.
MEDINA — Myrl A. Nafziger, President, Albrecht Building,
Wadsworth 44281 ; Mr. A. Dana Whipple, Executive Secretary,
320 East Liberty Street, Medina, Ohio 44256. 3rd Thursday
monthly.
RICHLAND — C. J. Shamess, President, 74 Wood Street, Mans-
field 44903 ; Harold F. Mills, Secretary, 70 Madison Road,
Mansfield 44905. 3rd Thursday monthly except June, July and
August.
WAYNE — Howard MacMillan, President, 1740 Cleveland Road,
Wooster 44691 ; R. J. Watkins, Secretary, 1736 Beall Avenue,
Wooster 44691. 2nd Wednesday monthly, January, February,
April, September, November and December.
Study of Human Reproduction
Cleveland, November 7-9
The Institute for the Study of Human Reproduction
in association with the Saint Ann Hospital, Cleveland,
is presenting Lecture Series No. 5 entitled "New
Horizons in Reproductive Physiology and Pathology’’
Monday-Wednesday, November 7-9. Meeting place
is the Academy of Medicine of Cleveland, 10525
Carnegie Avenue. Sessions begin at 5:00 P. M. on
each day.
Additional information may be obtained from the
Institute for the Study of Human Reproduction, Saint
Ann Hospital, 2475 East Boulevard, Cleveland 44120.
Protect Your Family — Now — With the OSMA - PLAN
of comprehensive group major medical insurance sponsored by the
Ohio State Medical Association for its members and their families
NEW —
Also available to Ohio Physicians:
up to $100,000
DISABILITY
PRACTICE
ACCIDENTAL
OVERHEAD
DEATH AND
and 1 N COME and
EXPENSE
DISABILITY
PROTECTION
INSURANCE
INSURANCE
( All three at low group rates)
Call or write: DANIELS-HEAD & ASSOCIATES, INC.
Daniels-Head Building, Portsmouth, Ohio 45662 Tel. 353-3124
for November, 1966
1225
JOURNAL ADVERTISERS
Advertisers in The Journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The Journal,
and help make it a quality publication. In return we
place their messages on the desks of Ohio’s physicians.
Please familiarize yourself with their services and pro-
ducts. and let them know that you see their advertising
in The Journal.
In This Issue:
Abbott Laboratories 1139-1140-1141-1142
Ames Company, Inc 1106
Appalachian Hall 1148
Associated Credit Bureaus of Ohio 1126
Blessings, Inc 1206
The Brown Pharmaceutical Co 1104, 1221
Burroughs Wellcome & Co. (USA) Inc 1187
Carnation Company 1124-1125
Daniels-Head & Associates, Inc 1225
Dorsey Laboratories, a division of
The Wander Company 1127-1128-1129-
1130-1131, 1190, 1212-1213-1214-1215-1216-
1217-1218-1219-1220
Geigy Pharmaceuticals, Division of
Geigy Chemical Corporation 1144, 1209
Harding Hospital 1109
Hynson, Westcott & Dunning, Inc 1099
The Kendall Company 1136
Lederle Laboratories, A Division of
American Cyanamid Company 1107-1108,
1137, 1145, 1154-1155, 1228
Lilly, Eli, and Company 1156
The Medical Protective Company 1132
Merck Sharp & Dohme, Division of
Merck & Co., Inc 1110-1111, 1120-1121
Merrell, The William S., Company, Divi-
sion of Richardson-Merrell Inc 1102-1103
Neisler Laboratories, Inc., Subsidiary of
Union Carbide Corporation 1196-1197
North, The Emerson A., Hospital
Inc Inside Back Cover
Parke, Davis & Company Inside Front Cover
Philips Roxane Laboratories 1114-1115
Pitman-Moore, Division of The
Dow Chemical Company 1151
Robins, A. H., Company,
Inc 1117-1118-1119, 1203-1204
Roche Laboratories, Division of
Hoffman-La Roche Inc Back Cover
Searle, G. D., & Company 1188-1189
Smith Kline & French Laboratories 1105
Squibb, E. R., & Sons 1112, 1133, 1149
Syntex Laboratories Inc 1122-1123, 1200-1201
Turner & Shepard, Inc 1210
Tutag, S. J., & Co 1113
The Vale Chemical Company, Inc 1211
Warner-Chilcott Laboratories, Division of
Warner-Lambert Pharmaceutical
Company 1134-1135, 1146-1147
The Wendt-Bristol Company 1202
West- ward, Inc 1207
Windsor Hospital 1205
Winthrop Laboratories 1100
Wyeth Laboratories 1152-1153
Table of Contents
(Continued From 1101)
1104 Booklet on Distribution of Physicians and
Hospitals
1104 Ohioan Installed as President of American
Society of Anesthesiologists
1104 Colorado Springs Will Be Site of American
College of Surgeons Sectional Meeting
1109 Licenses for Practice in Ohio Issued by State
Medical Board
1109 National Library of Medicine Expands Com-
puter System
1113 Physician’s Bookshelf
1116 In Our Opinion:
The Bureaucrat and the Doctor
Some Interesting Background on
Chiropractic Faculties
1121 Two Columbus Physicians Launch Preschooler
Nutrition Study
1121 American Motorists Among Safest Drivers
the World Over
1126 New Members of the Association
1126 Socio-Economics of Health Care Is Topic
for Program
1132 Ohio State to Conduct Studies on Accident
Prevention
1132 Employment of Handicapped Award Goes
to Dayton Physician
1148 Extensive Cancer Survey Study Underway
at Ohio State
1148 American Heart Association Honors
Cleveland Research Physician
1150 Article in Ohio Newspaper Emphasizes
Troubles in British Health Service
1193 Cleveland Physician Appointed to State
Medical Board
1195 Cleveland Clinic Foundation Announces
Courses
1202 Obituaries
1205 VA Medical Research Conference Scheduled
in Cincinnati
1206 Activities of County Medical Societies
1210 Woman’s Auxiliary Highlights
1222 Roster of State Association Officers and
Committeemen
1223 Roster of County Medical Society Officers and
Meeting Dates
1225 Study of Human Reproduction Scheduled
in Cleveland
1226 The Journal’s Advertisers in This Issue
1227 Classified Advertisements
1227 Coming Meetings
1226
The Ohio State Medical Journal
^ke
OHIO STATE MEDICAL
journal
OSMA OFFICERS g
President g
Lawrence C. Meredith, M. D. B
205 Elyria Block, Elyria 44035 g
President-Elect g
Robert E. Howard, M. D. jj
2600 Central Trust Tower, g
Cincinnati 45202 g
Past President g
Henry A. Crawford, M. D. g
1058 Hanna Bldg., Cleveland 44115 g
T rea surer
Philip B. Hardymon, M. D. g
350 E. Broad St., Columbus 43215 ji
EDITORIAL STAFF J
Editor
Perry R. Ayres, M. D. g
Managing Editor and g
Business Manager |||
Hart F. Pace g
Executive Editor and Hi
Executive Business Manager g
R. Gordon Moore jj
OSMA EXECUTIVE STAFF jj
Executive Secretary g
Hart F. Pace jj
Director of Public Relations and g
Assistant Executive Secretary =
Charles W. Edgar Jj
Administrative Assistants g
W. Michael Traphacan g
Herbert E. Gillen §||
Jerry J. Campbell H
Address All Correspondence: g
The Ohio State Medical Journal g
17 South High Street, Suite 500 g
Columbus, Ohio 43215 g
Published monthly under the direction of the
Council for and by members of The Ohio State g
Medical Association, 17 South High Street, Suite ||s
500, Columbus, Ohio 43215, a scientific society, jg
nonprofit organization, with a definite member- g|
ship for scientific and educational purposes.
Subscription, $6.00 per year to non-members; g
single copy, 50 cents (outside Continental U.S., g
$7.50 and 75 cents). f-_
Entered as second class matter July 5, 1905, at g
the Postoffice at Columbus, Ohio, under the Act
of Congress of March 3, 1879; Acceptance for g|
mailing at special rate of postage provided for in
Section 1103, Act of Oct. 3, 1917. Authority g
July 10, 1918. Second-Class Postage Paid at Hi
Columbus, Ohio. HI
The Journal does not assume responsibility for §=
opinions expressed by the essayists. Advertisers sg
must conform to policies and regulations estab- =1
lished by The Council of the Ohio State Medical gg
Association. HI
Table of Contents
Page Scientific Section
1271 Dreamwork 1966 — A Symposium:
1271 (1) An Overview of Current Research into Sleep and
Dreams. Roy M. Whitman, M. D., Cincinnati.
1273 (2) Physical Concomitants of Dreaming and the Ef-
fect of Stimulation on Dreams. Bill J. Baldridge,
B. A., Cincinnati.
1273 (3) Dreams and Conflicts. Paul H. Ornstein, M. D.,
Cincinnati.
1277 (4) Drugs, Depression, and Dream Sequences. An
Exploration of Dream Content Changes Induced
by Medication, by Psychopathologic Conditions,
and by Variations in the Ego’s Adaptability.
Milton Kramer, M. D., Cincinnati.
1281 Introduction to Widowhood. The Role of the Family
Physician. George D. Clouse, M. D., Columbus.
1285 Hypersensitivity Diseases of the Lung. A Review (Con-
clusion). Jon P. Tipton, M. D., Durham, North
Carolina.
1290 A Clinicopathological Conference from The Ohio State
University Hospital, Columbus, Ohio.
1294 Maternal Health in Ohio: Maternal Deaths Involving
Suicide. By the OSMA Committee on Maternal
Health.
1234 The Historian’s Notebook: Health Officers of Cincinnati,
Ohio, and the Problems of Their Day — 1900 to
I960. (Part VI.) Kenneth I. E. Macleod, M. D.
Cincinnati.
Prospective scientific contributors are urged to write
for instructions before submitting manuscripts.
Special Feature
1238 Public Health in Ohio
News and Organization Section
1296 Proceedings of The Council, Special Sessions
1305 Notice to All Members Regarding Payment of Dues
1307 Joint Committee Moves to Combat Athletic Injuries
1308 Institute on Areawide Planning Scheduled January 15
(Continued on Page 1340)
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values for reference in future examinations. The 5 colorimetric
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pH — values are read numerically in the essential range
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1000 mg. %.
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plus important supportive
benefits that help her through
those critical early months
of oral contraception
low incidence of side effects
Low incidence of BTB and spot-
ting, nausea and amenorrhea
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problems and increases patient
cooperation.
no confusion about dosage
An unbreakable “confusionproof”
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to double-check dosage intake by
day and correspondingtablet num-
Contraindications : Thrombophlebitis or pul-
monary embolism (current or past). Exist-
ing evidence does not support a causal
relationship between use of Norinyl and
development of thromboembolism. While
a study which was conducted does not
resolve definitively the possible etiologic
relationship between progestational agents
and intravascular clotting, it tends to con-
firm the findings of the Ad Hoc Advisory
Committee appointed by the Food and
Drug Administration to review this possi-
bility. Cardiac, renal or hepatic dysfunc-
tion. Carcinoma of the breast or genital
tract. Patients with a history of psychic
depression should be carefully studied and
the drug discontinued if depression recurs
to marked degree. Patients with a history
of cerebral vascular accident.
Warning: Discontinue medication pending
examination if there is sudden partial or
complete loss of vision, or if there is a
sudden onset of proptosis, diplopia or mi-
graine. If examination reveals papilledema
or retinal vascular lesions, medication
should be withdrawn.
Precautions: By May 1963, experience with
norethindrone 2 mg.— mestranol 0.1 mg.
had extended over 24 months. Through
miscalculation, omission or error in taking
the recommended dosage of Norinyl, preg-
nancy may result. If regular menses fail
to appear and treatment schedule has
not been adhered to, or if patient misses
two menstrual periods, possibility of preg-
nancy should be resolved before resuming
Norinyl. If pregnancy is established,
Norinyl should be discontinued during
period of gestation since virilization of the
female fetus has been reported with oral
use of progestational agents or estrogen.
When lactation is desired, withhold
Norinyl until nursing needs are established.
Existing uterine fibroids may increase in
size. In metabolic or endocrine disorders,
careful clinical preevaluation is indicated.
A few patients without evidence of hyper-
thyroidism had elevated serum protein-
bound iodine levels, which in the light of
present knowledge, does not necessarily
imply hyperthyroidism. Protein-bound
iodine increased following estrogen admin-
istration. Bromsulphalein retention has oc-
curred in up to 25% of patients without
evidence of hepatic dysfunction. Studies
from 24-hour urine collections have
shown an increase in aldosterone and 17-
ketosteroids and decrease in 17-hydroxy-
corticoid levels. Thus, Norinyl should be
discontinued prior to and during thyroid,
liver or adrenal function tests. Because
progestational agents may cause fluid re-
tention, conditions such as epilepsy,
migraine and asthma require careful obser-
vation. Thus far no deleterious effect on
pituitary, ovarian or adrenal function has
been noted; however, long-range possible
effect on these and other organs must
await more prolonged observation.
Norinyl should be used with caution in
patients with bone, renal or any disease in-
volving calcium or phosphorus metabolism.
Side Effects: Intermenstrual bleeding;
amenorrhea; symptoms resembling early
pregnancy, such as nausea, breast engorge-
ment or enlargement, chloasma and minor
degree of fluid retention (if these should
occur and patient has not strictly adhered
to medication plan, she should be tested
for pregnancy); weight gain; subjective
complaints such as headache, dizziness,
nervousness, irritability; in a few patients
libido was increased. In a total of 3,090
patients, 2.2% discontinued medication be-
cause of nausea.
NOTE: See sections on contraindications
and precautions for possible side effects
on other organ systems.
Dosage and Administration: One Norinyl
tablet orally for 20 days, commencing on
day 5 through and including day 24 of the
menstrual cycle. (Day 1 is the first day of
menstrual bleeding.)
Availability: Dispensers of 20 and 60 tab-
lets; bottles of 100.
References: 1. Council on Drugs. JAMA 187:664 (Feb.
29) 1964. 2. Brvans, F. E.: Canad Med Ass J 92:287
(Feb. 6) 1965. 3. Goldzieher, J. W.: Med Clin N Amer
48:529 (Mar.) 1964. 4. Cohen, M. R.: Paper presented
at Symposium on Low-Dosage Oral Contraception, Palo
Alto, Calif., July 15, 1965. Reported in Med Sci 16:26
(Nov.) 1965. 5. Hammond, D. 0.: Ibid. 6. Rice-Wray, E.,
Goldzieher, J. W., and Aranda - Rosell, A.: Fertil Steril
14:402 (Jul.-Aug.) 1963. 7. Goldzieher, J. W., Moses,
L. E., and Ellis, L. T.: JAMA 180:359 (May 5) 1962.
8. Kempers, R. D.: GP 29:88 (Jan.) 1964. 9. Tyler, E. T.:
JAMA 187:562 (Feb. 22) 1964. 10. Rudel, H. W., Mar-
tinez-Manautou, J ., and M aqueo-Topete, M.: Fertil Steril
16:158 (Mar. -Apr.) 1965. 11. Flowers, C. E., Jr.: N
Carolina Med J 25:139 (Apr.) 1964. 12. Goldzieher, J.
W.: Appl Ther 6:503 (June) 1964. 13. The Control of
Fertility. Report adopted by the Committee on Human
Reproduction of the American Medical Association. JAMA
194:462 (Oct. 25) 1965. 14. Flowers, C. E., Jr.: JAMA
188:1115 (June 29) 1964. 15. Merritt, R. I.: Appl Ther
6:427 (May) 1964. 16. Newland, D. O.: Paper presented
at Symposium on Low-Dosage Oral Contraception, Palo
Alto, Calif., July 15, 1965. Reported in Med Sci 16:26
(Nov.) 1965.
norethindrone — an original steroid from
SYNTEXE
LABORATORIES INC , PALO ALTO, CALIF
Norinyl ,
(norethindrone 2 mg c mestranol 1 mg )
for multiple contraceptive action
for December, 1966
1237
Public Health in Ohio . . .
Expansion of Facilities and Services Is Theme of Talk
By State Director Before Ohio’s Health Commissioners
A JOINT MEETING was held in Columbus,
September 14-16, comprising the 47th
annual conference of the Ohio Health Com-
missioners with the Ohio Department of Health, and
the 6th annual meeting of the Association of Ohio
Health Commissioners.
One of the principal speakers at the joint confer-
ence was Dr. Lawrence C. Meredith, Elyria, President
of the Ohio State Medical Association, who discussed
matters of common interest to the medical profession
and to health commissioners and health personnel.
Dr. John E. Reed, Cincinnati, health commissioner
for Hamilton County, was installed as president of
the Association of Ohio Health Commissioners, to
succeed Dr. Robert A. Vogel, of Dayton, who re-
mains on the executive committee as immediate past
president. Dr. Ollie Goodloe, Columbus health com-
missioner, was named president-elect, and Robert Mc-
Conaughy, of Middletown, was elected secretary-
treasurer. E. A. Graber, Columbus, is executive
secretary.
A matter of much concern and one discussed in
detail by a panel was recruitment of health commis-
sioners for local districts in Ohio. Qualified health
commissioners are desperately needed in several areas,
as are trained persons in the various fields of public
health.
Other matters of prime concern were licensure
and certification of institutions, fiscal procedures, and
development of alcoholism programs in the state.
Dr. Emmett W. Arnold, director of the Ohio De-
partment of Health, presented an annual report of his
department’s program, an account that gives an excel-
lent overall picture of health activities in Ohio.
Following are excerpts from Dr. Arnold’s report:
Expansion
"The report of our Department to you this year
has one key word in it, which will be repeated again
and again,” Dr. Arnold said. "That word is 'ex-
pansion.’ The work of the State Health Department
is expanding. The work of local health departments
is expanding. The responsibilities of health depart-
ments are expanding.”
"This expansion has been steady over the last few
years. It has been particularly sharp in the past year.
The prospect is for even more accelerated expansion
in public health programs in the years just ahead of
us.”
We could start this overview of public health at any
point in our many programs and find the same signs
of growth. I was struck by the overall significance
in this situation by the opening statement in a re-
port recently submitted to me by the Chief of the
Division of Nursing in our Department.
Dr. Arnold illustrated his point with a quote from
a report by the chief: "We have found ourselves
confronted with expanding health programs needing
quality nursing services, new technicians, new dis-
ciplines, new equipment, paper work and an explosion
of facts, but through all this there have emerged
some new health services, some new methods of de-
livering nursing care to patients in their homes, and
we believe many citizens of Ohio have better oppor-
unities for more healthful living today than last year.”
Nursing Program
The nurses report showed that the amount of time
given to assistance of local health jurisdictions in the
first half of 1966 has tripled in comparison with
a similar period in 1965. The nursing staff was in-
creased, particularly in connection with special proj-
ects in such fields as maternal and child health,
tuberculosis control, migrant labor, and health in-
surance programs.
The 1966 Nurse Census shows 1,531 public health
nurses now employed in Ohio, either full time or
part time, by official health departments, boards of
education, and voluntary agencies. The need for pub-
lic health nurses is ascending rapidly. The depart-
ment is doing what it can to help fill this need by
programs of training, re-training and refresher courses
for nurses who would like to help in this critical
period of expansion.
Laboratory Services
The Bureau of Laboratories reports expansion in
many fields — including encephalitis surveillance,
streptococcus culturing for prevention of rheumatic
heart disease, blood sugar analysis for diabetes detec-
tion, phenylketonuria (PKU) testing, determination
of radionuclides, determination of pesticides, air
(Continued on page 1240)
1238
The Ohio State Medical Journal
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for December, 1966
1239
and water pollution analyses, and survey of independ-
ent laboratories for the new Medicare program.
The laboratory is running approximately 4,500
tests every week in the expanded PKU program.
One hundred and eighty-eight hospitals sent speci-
mens in August. The department purchased a sec-
ond autoanalyzer for the expanding diabetes surveys,
and is arranging to place fluorescent microscope
equipment in all branch laboratories to help speed
streptococcus determination and provide more quickly
for the application of antibiotic therapy for the
prevention of rheumatic fever and possible heart
damage.
With respect to radionuclide determinations equip-
ment has been added to make tests for strontium 89
and strontium 90 in milk. This places the laboratory
on a comparable level of attainment with laboratories
of the U. S. Public Health Service. In all, radiologi-
cal health programs have been doubled in size.
The department is now running regular analysis
of high volume air samples from 27 air sampling
stations throughout the state, and running monthly
checks for changes in chemical composition on 13
major streams at 20 different locations.
The division of Engineering during the past three
years has approved plans for more than $200 mil-
lion worth of sewerage and municipal waste treat-
ment facilities, a jump of 25 per cent from the pre-
vious three years. The Water Pollution Control
Board has lined up a program calling for an addi-
tional billion dollars worth of water pollution control
improvements in the next four years.
Pollution Control
The Ohio Water Pollution Control Board began
holding a series of public hearings this summer in
connection with the federal program for establishment
of water quality criteria for interstate waterways.
Interest in both air and water pollution control is
growing. The Ohio Legislative Service Commission
has been holding a series of hearings on both subjects.
Congress recognized the solid waste problem by
passage of the Solid Waste Disposal Act which be-
came effective last October. And the Public Health
Service set up a new Office of Solid Wastes. Re-
cently the Ohio Department was given a special grant
under this act for the development of statewide
planning on the solid waste problem. This is to be
at least a three-year project, with the planning grant
reaching $150,000 over the three years.
Maternal and Child Health
Still on the subject of expansion, programs of the
Division of Maternal and Child Health have been
expanded more than 2^/2 times in the past 3^ years.
Distribution of pharmaceuticals, such as those used
in controlling rheumatic fever in children, is up 78
per cent.
Tuberculosis hospitals that are needed in today’s
fight against tuberculosis have been officially desig-
nated. (See October issue, page 1072.)
A very much intensified tuberculosis control project
is now under way in five of the largest cities —
Cleveland, Cincinnati, Columbus, Dayton, and Toledo.
Budgets for this program, supported by federal
grants, have now been projected through 1969, and
reach a total for that period of $1,392,000. It is pos-
sible that this project, started in 1964, may be carried
over a ten-year period.
Big emphasis in this project is on the unhospital-
ized or posthospitalized tuberculosis cases. The sec-
ond priority is to the inactive cases where there has
been active tuberculosis within the last five years.
New Ohio legislation on tuberculosis, passed last
year, in addition to providing for the increased sub-
sidy and official designation of needed hospitals,
also requires the establishment of tuberculosis regis-
tries in each county. This program is moving along
well, and to date 76 of the 88 counties have estab-
lished such registries or record bureaus.
Tuberculosis Control
The new Ohio law on tuberculosis also encourages
the creation of more tuberculosis clinics for detection
and follow-up care by authorizing county commis-
sioners of two or more counties to establish joint
clinics. This law also authorizes counties to contract
for such clinic services with a county or district
tuberculosis hospital or with the State Director of
Health.
Another new point of emphasis in our tuberculosis
program is in the schools. There are two reasons
for this. First, in Ohio recently there have been
several unfortunate outbreaks of tuberculosis related
to school environments. Secondly, tuberculin testing
of school children is one of the procedures recom-
mended by the Surgeon General’s Task Force on
Tuberculosis, as part of a community program for
identifying persons and families at risk. The depart-
ment has had full cooperation of the Ohio Depart-
ment of Education in distributing to all Ohio schools
a recommended tuberculosis control program. This
includes tuberculin testing of all school enterers, with
a follow-up of reactors and their families by local pub-
lic health authorities. Pupils are to be tuberculin tested
again at 14 years of age, with x-ray examination for
reactors and annual chest x-rays thereafter so long as
these reactors remain in school. It is suggested that
schools in areas of high tuberculosis incidence may
want to expand on this.
The Department has been able to increase special
public health grants to Ohio from about $9 million
a year to over $20 million a year during the past
three years. Categorical grants at the same time have
jumped from $2.5 million to $4.2 million a year.
Special health projects for expectant mothers, in-
fants, pre-school and school-age children have been
( Continued on page 1242)
1240
The Ohio State Medical Journal
in
chronic
illness
B and C vitamins are part of therapy: An imbalance of water-soluble vita-
mins and chronic illness often go hand in hand. STRESSCAPS capsules, con-
taining therapeutic quantities of vitamins B and C, are formulated to meet the
increased metabolic demands of patients with physiologic stress. In chronic ill-
ness, as with many stress conditions, STRESSCAPS vitamins are therapy.
Each capsule contains:
Vitamin Bi (as Thiamine Mononitrate) 10 mg
Vitamin B2 (Riboflavin)
10 mg
Vitamin B6 (Pyridoxine HCI)
2 mg
Vitamin Bi2 Crystalline
4 mcgm
Vitamin C (Ascorbic Acid)
300 mg
Niacinamide
100 mg
Calcium Pantothenate
20 mg
Recommended intake: Adults,
1 capsule
daily, for the treatment of vitamin deficien-
cies. Supplied in decorative '
’reminder”
jars of 30 and 100; bottles of 500.
LEDERLE LABORATORIES, A Division of American Cyanamid Company, Pearl River, New York
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developed, amounting to $2.8 million in the last two
years in Cleveland, $990,000 this year in Cincinnati,
over $1 million this year in Columbus, and $6 50,000
authorized just last month in Dayton. These projects
are in association with local hospitals and health
agencies.
Hill-Burton Program
Ohio is joining the nation in commemorating the
20th anniversary of the Hill-Burton program. Since
its inception in 1946, this program — coauthored
by an Ohioan, the late Senator Harold Burton of
Cleveland, has been a prime example of effective
cooperative effort among agencies of federal, state,
and local governments. Ohio has received a total
of $111 million in grants under this law, more than
$30 million in the last three years alone, which has
assisted in the construction of $407 million worth of
additional health facilities in 105 different Ohio com-
munities. Included have been 23 grants to health
departments for health centers. Currently health de-
partment construction projects with Hill-Burton aid
are under way or about to start in Akron, Springfield,
Cincinnati, Cleveland, Fremont, Lorain County, and
Defiance County.
The Ohio Department of Health has been awarded
a special grant under this research and demonstration
program for a two-year study of the feasibility of
centralizing health planning information in Ohio.
The amount of money expended by local health
departments, city and county, in Ohio during fiscal
1966 was $17,486,395 — an increase of about four
per cent over the $16 million of the previous year.
Included in this amount was $420,000 of state sub-
sidy and $1,173,420 distributed by the State Health
Department from federal formula grants. As in
past years the Department will publish a complete
financial report on local health departments for 1966,
to be distributed in early 1967.
Many new programs will call for larger expendi-
tures in the years immediately ahead of us — and that
new funds will become available. Part of these new
funds will be in new types of grants. Part will be
in new types of fees, as for example those in con-
nection with the home health services for which
Medicare will pay.
In the Ohio Department of Health an entire new
unit has been created for the new programs which
are essential in the implementation of the federal
Medicare program, involving the certification of hos-
pitals, laboratories, home health service agencies and
extended care facilities. The department is reim-
bursed in full by the Social Security Administration
for costs in this field.
Work in connection with migrant farm labor
has been tripled.
This year saw the implementation of the new
uniform milk program in Ohio. Although the licen-
sing and inspection portions of this law have been
effective only since July 1, it appears that the health
departments of the state have made the transition
from the "old” to the "new” very smoothly. This
is not a mandatory program on local departments
but rather is carried out by those departments desir-
ing to do so.
Chronic Disease
Turning to programs in chronic diseases, it is note-
worthy that interest is growing steadily in commu-
nity diabetes detection screening services. From July
1, 1965, through June 30, 1966, more than 35,000
Ohio citizens were checked in these screening ac-
tivities. To date, 259 previously unknown diabetics
have been found — and it is expected that this num-
ber will be larger as private physician follow-up
procedures are completed. During 1966, diabetes
screening programs, with cooperative state and local
participation, have been conducted in Adams and
Brown Counties, Ashland City and Ashland County,
Muskingum County and Zanesville City, Athens,
Hocking, and Vinton Counties, the Cities of Paines-
ville and Martins Ferry, Medina County, Clark
County, Erie County and the City of Sandusky.
Scheduled yet this fall are diabetes detection surveys
in Oberlin and Amherst Cities, Darke and Preble
Counties, Lucas County, Gallia County and Frank-
lin County.
Cancer control activities have received a boost by
the addition of a cancer medical officer assigned to
the Ohio Department from the U. S. Public Health
Service, Dr. Bernard B. Foster. Currently projects
in cervical cancer detection in Columbiana County,
Lorain County and Ashtabula City are supported by
the department.
In connection with heart disease, the Ohio Depart-
ment of Health has arranged through local health
departments to make available free throat culture serv-
ices for physicians in an attempt to reduce the in-
cidence of rheumatic fever.
The department has added new screening armamen-
tation to help in detection of early cases of obstruc-
tive lung disease. A course in closed-chest cardio-
pulmonary resuscitation for physicians is now under
way in six cities with the cooperation of local health
departments and local heart associations.
In cooperation with federal grant programs, the
department is supporting more than 50 pilot demon-
stration projects around the state in various types of
chronic disease programs. These include such ap-
proaches as continuing chronic illness community
services, congestive heart failure nursing services,
strep throat culture rapid identification, breathing
clinic for chronic obstructive lung disease patients,
child health study of obesity in relationship to heart
disease, special training for public health nurses in
care of cardiac patients, education on cigaret smok-
ing as a health hazard, a public health outpatient
(Continued on page 1244)
1242
The Ohio State Medical Journal
CONSIDER
DEXAMYL®
FIRST
brand of dextroamphetamine sulfate and amobarbital
Often within the hour, ‘Dexamyl’ works
to help dispel such symptomsas apathy,
pessimism, loss of interest and initia-
tive, and lack of ability to concentrate.
Formulas: Each ‘Dexamyl’ Spansule® capsule (brand of sustained release capsule) No. 1
contains 10 mg. of Dexedrine® (brand of dextroamphetamine sulfate) and 1 gr, of amobarbital,
derivative of barbituric acid [Warning, may be habit forming]. Each ‘Dexamyl’ Spansule capsule
No. 2 contains 15 mg. of Dexedrine (brand of dextroamphetamine sulfate) and IV2 gr. of
amobarbital [Warning, may be habit forming].
The following is a brief precautionary statement. Before prescribing, the physician should be
familiar with the complete prescribing information in SK&F literature or PDR.
Precautions: Use with caution in patients hypersensitive to sympathomimetics or barbiturates
and in coronary or cardiovascular disease or severe hypertension. Do not use in patients
taking MAO inhibitors. Excessive use of the amphetamines by unstable individuals may
result in a psychological dependence; in these instances, withdraw the medication. Use
cautiously in pregnant patients, especially in the first trimester. Side effects: Insomnia, excita-
bility and increased motor activity are infrequent and ordinarily mild.
SMITH KLINE & FRENCH LABORATORIES
for December, 1966
1243
diagnostic clinic, and public health nurse training
in rehabilitation.
A new research and service project, which began
in June in cooperation with Ohio State University and
designed to serve an area within a 60-mile radius
of Columbus, is a field service in speech and language
for aphasics.
Alcoholism Program
In the Alcoholism Program, the last session of the
Ohio Legislature gave a positive method for financing
grant-in-aid projects, by providing the equivalent
of one per cent of liquor permit fees for this purpose.
This is expected to total close to $100,000 a year.
Since the first of this year, the department has ap-
proved 17 grants to assist local alcoholism programs
under this legislation.
Expansion again is the word in reference to pro-
grams of the Dental Division.
Moving along well is the new Health Referral
Service to assist Armed Forces rejectees in obtaining
medical care for remediable defects. Eighty of our
88 counties have joined in this program since it was
started nine months ago, and approximately 95 per
cent of the population of Ohio is now covered.
The Division of Occupational Health reports that
the concept of health maintenance in industry is be-
ing implemented.
The decennial revision of the U. S. Standard Birth,
Deaths, and Fetal Death Certificates has been com-
pleted. Revised certificates have been promulgated
by the Surgeon General and will be available for use
beginning January 1, 1968. During the coming year
the department is planning a series of at least seven
regional meetings for acquainting health department
and hospital personnel with the revisions.
Regulations comprising the Ohio Sanitary Code
have been renumbered and retyped for filing with the
Secretary of State under the uniform system required
by enactment of Section 119.04 of the Revised Code
and the regulations promulgated by the Secretary of
State. The renumbered regulations will be published
shortly after the first of the year. In the meantime,
any court action started after September 30 must be
taken under the revised numbers.
On the subject of regulations, the Ohio Public
Health Council since our last annual meeting adopted
a revision in nursing home regulations. Progress
has been made in implementing these new regula-
tions, resulting now in the permanent licensing of
1,082 nursing homes, which will be checked regularly.
r.
in the treatment of
IMPOTENCE
Android
(thyroid-androgen)
TABLETS
"A
Effectiveness confirmed by another double blind study *
ANDROID
GOOD TO EXCELLENT 75%
PLACEBO
20%
percent ^ 0 10 20 30 40 5<
SUMMARY
1. Forty cases reported.
2. Excellent to good results, 75% with Android, 20% with Placebo.
3. Cites synergism between androgen and thyroid.
4. No side effects in patients treated.
5. Alleviation of fatigue noted.
6. Case histories on 4 patients.
7. Although psychotherapy still needed, role of
chemotherapy cannot be disputed.
*" Sexual impotence treatment with methyl testosterone - thyroid (ANDROID) a
double blind study” - Montesano, Evangelista: Clinical Medicine, April 1966.
60
70
80
90
100
CONTRAINDICATIONS - Methyl testosterone is
not to be used in malignancy of reproductive
organs in male, coronary heart disease, hyper-
thyroidism. Thyroid is not to be used in heart
disease, hypertension unless the metabolic
rate is low.
CAUTION: Federal law prohibits dispensing
without prescription.
REFER TO
PDR
ANDROID
Each yellow tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. (1/6 gr.) 10 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
ANDROID-HP
Each red tablet contains:
Methyl Testosterone 5.0 mg.
Thyroid Ext. (1/2 gr.) 30 mg.
Glutamic Acid 50 mg.
Thiamine HCL _...10 mg.
Dose: 1 tablet 3 times daily.
Available:
Bottles of 100, 500, 1,000.
ANDROID-X
Each orange tablet contains:
Methyl Testosterone 12.5 mg.
Thyroid Ext. (1 gr.) 64 mg.
Glutamic Acid 50 mg.
Thiamine HCL 10 mg.
Dose: 1 or 2 tablets daily.
Available: ,
Bottles of 60,500.
Write for literature and samples:
(bRcJJBOTHE BROWN PHARMACEUTICAL CO. 2500 W. 6th St., Los Angeles, Calif. 90057
ANDROID-PLUS
Each white tablet contains:
Methyl Testosterone 2.5 mg.
Thyroid Ext. (Vi gr.) 15 mg.
Thiamine HCL 25 mg.
Ascorbic Acid (Vit. 0 250 mg.
Glutamic Acid 100 mg.
Pyridoxine HCL 5 mg.
Niacinamide 75 mg.
Calcium Pantothenate 10 mg.
Vitamin B-12 2.5 meg.
Riboflavin 5 mg.
Dose: 1 tablet twice daily.
Available:
Bottles of 60, 500.
1244
The Ohio State Medical } ournal
Motorcycle Driver Risk Is Twice
That of Automobile Driver
The death rate for motorcycle accidents, in relation
to the number of motorcycles in this country, is twice
as high as the comparable rate for automobiles and
other motor vehicles.
This fact, along with other information about
motorcycle injuries, is contained in a new leaflet pub-
lished by the Public Health Service’s Division of Ac-
cident Prevention.
"Motorcycle registrations in the United States now
total more than iy2 million,’’ said Dr. Paul Joliet,
Chief of the Division. "By 1970, registrations are
expected to increase one million a year. This leaflet
explains, briefly, why motorcycle injuries are a serious
national health problem.’’
Information in the leaflet includes the following:
Many motorcyclists are often killed and injured be-
cause: (1) they lacked adequate training and experi-
ence in controlling their vehicles; (2) they failed to
wear safety helmets and goggles; (3) their motor-
cycles lacked such safety equipment as crash bars,
cowlings, and windshields; and (4) pedestrians and
operators of other motor vehicles sometimes create
potential accident situations by refusing to share the
roadway with motorcycle riders.
One study in this country found 20 per cent of the
injured persons were riding the motorcycle for the
first or second time, while 70 per cent had either
rented or borrowed the motorcycle.
Dr. Gregory G. Young, former chief of the De-
partment of Neuropsychiatry at Miami Valley Hos-
pital, Dayton, was principal speaker at the November
hospital breakfast for physicians and clergy. His
subject was "Care of the Psychiatric In-Patient and
the Role of the Psychiatrist, Referring Physician,
and Clergy.’’
Dr. Ralph C. Schwarz, Cincinnati, shared the rost-
rum with the Rev. Edward B. Brueggerman, chair-
man of the Theology Department at Xavier Univer-
sity, at a meeting sponsored by the Newman Forum
on the Miami University campus, Oxford. The
topic was "Abortion: A Medical and Theological
Discussion.’’
11:47 pm 11:53 pm 12:06 am
The meaningful pause. The energy
it gives. The bright little lift.
Coca-Cola with its never too sweet
taste, refreshes best. Helps people
meet the stress of the busy hours.
This is why we say
TRADEMARK®
things go
better,i
.-with
Coke
for Deceynber, 1966
1249
Carnation research and development laboratories
announce the first optimum-nutrition infant formula
(Dptimil
1250
The Ohio State Medical Journal
Establish and
maintain early,
more decisive
control of
blood pressure
DIUTENSEN:P
Cryptenamine 1.0 mg.* Methyclothiazide 2.5 mg. Reserpine 0.1 mg.
When blood pressure won’t stay down despite initial therapy—
when complaints of headache, fatigue or dizziness are often voiced—
it may be time for a change to Diutensen-R.
Diutensen-R is thiazide and reserpine plus cryptenamine— a rational,
comprehensive therapy to help establish and maintain early,
more decisive control of blood pressure.
The cryptenamine in Diutensen-R helps improve normal vasodilating
reflexes while the thiazide and reserpine components maintain
vasorelaxant, sedative, and saluretic benefits. Cryptenamine lowers
pressoreceptor reflex thresholds (which may be abnormally high in
hypertension) —“resets” pressoreceptors to function at more nearly
normotensive levels.
Early, more decisive control with Diutensen-R helps secure
continuing benefits — may reduce or even obviate the need for poorly
tolerated drugs later in therapy.
“. . .quite apart from the problem of vascular damage, there
arises a possibility of virtual ‘cure’ or remission of hypertension
when treatment is early, i.e., before too many other secondary
pressor systems have entered into the disequilibrium of pressor con-
trol, and when it is adequately suppressive.”
Corcoran, A. C.: The choice of drugs in the treatment of hypertension. In: Drugs
of Choice 1966-67, W. Modell, Ed., St. Louis, C. V. Mosby Company, 1966, p. 417.
Indications: Diutensen-R may be employed in all grades of essential hypertension.
Dosages: Usual dose is 1 tablet twice daily, at morning and evening meals.
However, adjustment of dosage to suit individual circumstances may be
required. Please refer to package insert for full particulars. Side effects and
precautions: The side effects observed with patients on Diutensen-R have
been of a mild and nonlimiting nature. These include occasional urinary frequency,
nocturia, nasal congestion, muscle cramps, skin rash, joint pains due to gout
symptoms and nausea and dizziness which have been reported for the individual
components. Most of these symptoms disappear while the drug is continued at
the same or lower dosage level. The concomitant use of digitalis and Diutensen-R
may increase the possibility of digitalis-like intoxication. If there is
evidence of myocardial irritability (extrasystoles, bigeminy or AV block), dosage
of Diutensen-R should be reduced or discontinued. Nocturia in patients
with marginal cardiac status and salt and fluid retention can be effectively
controlled by limiting the time of administration to early afternoon.
Diutensen-R should not be used in patients with a known intolerance to reserpine.
Package inserts furnish a complete summary of recommended cautions related to
each of the ingredients of Diutensen-R.
*As tannate salts equivalent to 130 Carotid Sinus Reflex Units.
NEISLER Hffa
NEISLER LABORATORIES, INC. • DECATUR, ILLINOIS
SUBSIDIARY OF UNION CARBIDE CORPORATION
The Historian’s Notebook
Health Officers of Cincinnati, Ohio
And the Problems of Their Day
1900 to 1960
KENNETH I. E. MACLEOD, M. D., M.P.H.*
PART VI
(Continued from November Issue )
MEDICAL EDUCATION: Regarding the Uni-
versity of Cincinnati’s Medical College, Dr.
■ W. H. Peters in 1920 writes:
The Medical College educates physicians and nurses for the
service of the people of Cincinnati. There are in Cincin-
nati at present, over 500 physicians who were educated in
this college. The staff of the college and hospital does all
of the work of the General Hospital. The supply of physi-
cians is running short in the country. The medical students
now number 224 from practically all the states and from six
foreign countries. Many more are applying, and with our
present magnificent equipment, buildings, and laboratories,
double this number could be educated here. But it will be
impossible to do this unless money is also provided . . .
Cincinnati General Hospital
And in a footnote on the General Hospital he
notes that it is,
One of the finest in the United States; probably as can be
found anywhere in the world. A rather striking feature is
presented in the fact that the indigent citizen is able to re-
ceive attention that the average taxpayer is unable to af-
ford in his home. Special pavilions are provided for com-
municable diseases. Also, the tuberculosis hospital is doing
valuable work in limiting the spread of the Great White
Plague. Under ideal conditions, tuberculosis can be treated
in the home. The trouble lies in the fact that these ideal
conditions are seldom found. Tuberculosis running through
families for several generations is the result of the environ-
ment and conditions in the homes of these families. A
wider knowledge of home sanitation will help . . .
And he notes an aphorism by the late Dr. Landis:
"No sanitary problem was ever solved by caring for
its victims . , .”
The continued development of "reasonable sanitary
codes” is illustrated by the "new” regulations to
govern the manufacture and sale of ice cream. (1920)
Mothers of Democracy and Other Matters
And "Hail to the 'Mothers of Democracy’ who
formed a rehabilitation society of about 500 women
to dedicate themselves to deeds of charity and benefi-
cence among the unfortunate ...”
*Dr. Macleod, Cincinnati, is Commissioner of Health, City of
Cincinnati.
Submitted March 16, 1966.
On the childhood diseases,
llowing toll in mortality:
Dr. Peters
notes the
1920
Cases
Deaths
Measles
. 4,156
.... 71
Diphtheria
258
.... 22
Scarlet Fever
. 1,404
.... 22
Typhoid Fever
19
5
Whooping Cough
287
... 11
Cerebrospinal Meningitis
1
1
Health Board Wins a Case
And on the Health Board Wins An Important
Decision: It transpired that a certain William P.
Devon, a wealthy tenement owner, refused "to abol-
ish toilets of the catch-basin type.” In his opinion,
Judge Stabley Mathews "upheld the sections of the
city ordinances, the right of the municipality to enact
the same, the power of the Board of Health to en-
force them, and he also held that catch-basin toilets
are a nuisance.”
Sex Education
A rather remarkable poster on "Health Woman-
hood” was published in the October issue of the
Bulletin, proposing to warn the public about the
dangers of VD. Truly the new frankness about
these social diseases was beginning to see the real
light of day . . . Sex education is discussed.
Compulsory Vaccination Upheld
The December issue of the Sanitary Bulletin
has as its frontispiece the seal sale’s stamp for 1920
— a happy child on the shoulders of a smiling
Santa. Its main article has the caption: "Compul-
sory Vaccination Upheld” and deals with an
opinion of the city solicitor on the subject in reply
to a question by the school superintendent, Mr. Ran-
dall J. Condon.
Prenatal Care
On prenatal care we are advised that
While Cincinnati occupies an excellent position in the Sta-
tistical Report of Infant Mortality, we feel more can be
done to reduce the number of deaths in children under one
1254
The Ohio State Medical Journal
Dairy Councils of Cleveland, Columbus &
Stark County District
1652 West Fifth Avenue Columbus, Ohio 43212
Our population's bursting at the seams.
It’s eat. Eat. Eat.
And then diet. Diet. Diet.
With the latest No-calorie.
No carbohydrate. No-vitamin. No exercise.
400-hour Kamikaze Plan!
When it's over, it’s eat, eat, eat again.
As a professional you can help wrest
some sense from this nonsense: first,
by cautioning against skipping meals, and
second by pointing the way to realistic weight
control through nourishing meals every day.
Day after day.
Naturally, balanced diets and
nourishing, palatable dairy foods go
together; they always have.
Project Weight Watch has been initiated
to assist you. Its scope
is nationwide, its purpose is to focus
professional attention on the problem.
To help you translate your concern to your
patients, a portfolio of materials is available.
Send for it. Help stamp out needless waist.
PROJECT I
WEIGHT
WATCH
)]
for December, 1966
1255
year. Last year 710 children died before they reached the
first milestone, giving us a rate of 88 per 1,000 births
recorded.
Crippled Children
A school for crippled children — a plan long in
conception —
began to crystallize and definitely shapen about five years
ago. In our own city it is proposed to increase the facilities
of the care of these children by the erection of suitable build-
ings on the grounds of General Hospital. [A school was
already in existence at the hospital.] The Board of Edu-
cation in Cincinnati is enabled to carry on the work of
educating the handicapped child by aid of a state subsidy.
In conservation of vision classes, we take occasion to re-
cord our grateful acknowledgment of Dr. Louis Sticker’s
report of the blind and conservation of vision classes in
our schools. The splendid results achieved in the careful
correction of optical defects, the methods by which conserva-
tion is consummated to a high degree, and the scientific
management of education and vocational training of the
totally blind, are worthy of our highest praise . . .
And on child health in general he quotes from
Herbert Hoover, President-Elect of the American
Child Hygiene Association: "If we could grapple
with the whole child situation for one generation,
our public health, our economic efficiency, the moral
character, sanity and stability of our people would
advance three generations . .
It is noted in 1921 that a survey of the "free” day
nurseries revealed that "most of the nurseries were
being conducted in a very practical and efficient
manner.”
"Doc” Behrer Appointed Lab Chief
On page 9, etc. of the Cincinnati Sanitary Bul-
letin for March, 1921, we find an extensive discus-
sion of the services of the Division of Laboratories
by our own inimitable "Doc” Otto Behrer, Chemist
and Bacteriologist in the Department for over 40
years. There were some 27,280 examinations made
at a unit cost of 22 cents per test that year.
12th Street Health Center and Lab
The 12th Street Health Center’s value is discussed
extensively in the issue for April and we are re-
minded that "the nucleus of our health center was
the tuberculosis dispensary, which was graciously
turned over to us just a little over a year ago by the
directors of the Anti-Tuberculosis League . . .”
Also, "the very notable decrease in the mortality from
tuberculosis in the year 1920 is noted. From 756
deaths in 1919 (a rate of 188 per 100,000 popula-
tion) to 619 deaths in 1920 (a rate of 154 per
100,000).” Today (1964) the rate is about 9 deaths
per 100,000.
Maternal Mortality
But in the same era — the early 1920’s — a higher
maternal mortality concerned the health authorities
throughout the nation. It is noted as "an unfavor-
able trend of mortality from the puerperal diseases
. . Dr. Peters notes, however, that
We may well be proud of our obstetric service in Cin-
cinnati, our supervision of midwifery and the modest
beginning which official and private health agencies have
made in providing prenatal service, but the hope of our
problem here lies in the extension of maternity nursing
work.
Sleeping Sickness
The national concern with the "sleeping sickness”
— encephalitis lethargica — is also a concern of Cin-
cinnati, with
the first case reported on January 9, 1921, although four
deaths were reported in December, 1920. From January
to April, 36 cases were reported — the distribution scat-
tered throughout the city. The disease attacked 24 males
of whom 6 died, and 12 females of whom 9 died. There
was a considerable number of complications in the sur-
vivors, mainly of a neurological nature. And as a result of
this the city got into a "fight against mosquitoes.” . . .
Occupational Diseases
The following "occupational diseases” were re-
ported during the period July, 1920 — May, 1921:
Cases
Aniline Dye Poisoning 20
Lead Poisoning 21
Zinc Poisoning 3
Occupational Neuroses 2
Chronic Dermatitis 1
Brass Poisoning 1
Total 48
Neighborhood Clinics
The concept of "neighborhood clinics” was obvi-
ously not new. In 1921 there were no less than nine
"health stations” for infant welfare.
Mental Hygiene Survey
Upon the invitation of the Public Health Federation in co-
operation with other agencies in Cincinnati, the National
Committee for Mental Hygiene has begun a survey of Cin-
cinnati and Hamilton County — a mental hygiene study of
the public school children included. A careful physical
and mental examination will be made on 10,000 children.
One of the largest problems facing a state is mental defect.
Immunizations Against Diphtheria
And on diphtheria immunization, Dr. Peters writes
in July, 1921:
After a year’s propaganda among the people conerning the
great value of permanent immunization against diphtheria by
toxin-antitoxin method, we started the work. We received
the cordial support and aid of the Pediatric Department of
the University.
Chiropraxis
And on chiropraxis, he writes :
In a masterly manner, Justice Wanamaker has handed down
his decision dissolving the temporary injunction obtained by
the chiropractors of the State of Ohio against the admin-
istration of the Platt-Ellis Law and Talley Law, which pre-
scribe the qualification for all who would treat the sick.
Public health is the very heart of public happiness. The
constitutional guarantees of life, liberty, and the pursuit of
happiness are of little avail unless there be clearly implied
therefrom the further guarantee of safeguarding the public
health ... (So said the judge among other things.)
( Continued in January Issue )
1256
The Ohio State Medical Journal
Dieting Results Shown in
Anti-Coronary Club
A substantial decrease in coronary heart disease
is reported among New York men who modified their
diet for five years as members of an Anti-Coronary
Club.
The report appeared in the November 7 Jour-
nal of the American Medical Association.
The incidence of "coronary events’’ among 814
volunteers, 40 to 59 years old, was only a third as
great as that among a control group of 463 men
of the same age.
Significant reductions in obesity and hypertension
also were noted among the study group. These
conditions remained unchanged in those who did not
use the special diet.
The study was designed to test the hypothesis that
reducing serum cholesterol in the diet will reduce
coronary heart disease. This was done by designing a
"prudent diet” that cut intake of saturated dietary
fats. The project has been conducted since 1957
by the Bureau of Nutrition of the New York City
Department of Health.
Much further study needs to be done, the investi-
gators point out, because the amount of new heart
disease among groups of this size is relatively
small. Follow-up studies also are needed on the men
who have experienced various kinds of heart mal-
functions.
Among men aged 40 to 49 who used the special
diet for five years, there was a heart-disease in-
cidence rate of 339 per 100,000 years, compared
to 642 per 100,000 among the non-dieters.
In the 50 to 59 age group, the rates were 379 per
100,000 among dieters and 1,331 per 100,000 in
the control group.
Controversies in General Surgery
Is Topic At Cleveland Clinic
The Cleveland Clinic Educational Foundation is
offering a postgraduate course entitled "Controversies
in General Surgery” on Wednesday and Thursday,
January 18 and 19.
Guest speakers will include the following:
Dr. Bentley P. Colcock, Department of Surgery,
Lahey Clinic Foundation, Boston;
Dr. Jerome A. Urban, associate clinical profes-
sor of surgery, Cornell University Medical College,
New York; and
Dr. Claude E. Welch, associate clinical professor
of surgery, Harvard Medical School, Boston.
A number of members of the clinic staff also will
participate in the program.
Registration may be made, or information obtained
from Walter J. Zeiter, M. D., Director of Education,
The Cleveland Clinic Educational Foundation, 2020
East 93rd Street, Cleveland, Ohio 44106. Regis-
tion fee is $40.
for December, 1966
1259
vignettes of angina pectoris —
no. 1 in a series:
angina and the surgeon
fohn Hunter—
British surgeon (1728-1793)
angina
of anger
“My life is in the hands of any
rascal who chooses to annoy and
tease me.”1 So said the great
British surgeon and anatomist,
John Hunter, realizing that he
could not control the anger which
precipitated frequent and severe
attacks of angina pectoris. Accord-
ing to Mettler: “His statement was
no exaggeration. On October 16,
1793, he attended a meeting of the
St. George’s hospital staff, and,
while defending the interests of
several students, he was contra-
dicted and thoroughly antagonized.
The pains of angina commenced,
he started toward another room,
gained it, and fell dying into the
arms of a physician.”2
Why Edward Jenner withheld
his paper on angina In 1777, at an
sarlier stage of the condition,
Hunter’s angina alarmed a favorite
pupil, Edward Jenner, who wrote
to Dr. Heberden that he feared his
teacher was “affected with symp-
toms of the Angina Pectoris.”3
So concerned was Jenner about his
rormer teacher’s emotion-related
:ondition that he deliberately can-
;elled publication of a paper on
ingina pectoris, fearing that
Hunter would read it, and have
“his fears excited by its truly
formidable nature.”4
Severity of angina described
Hunter’s brother-in-law, Dr.
Everard Home, who witnessed his
death and performed an autopsy,
gave this account of the later stages
of the condition:
“. . . the pain became excruciating
at the apex of the heart; the throat
was so sore as not to allow of an
attempt to swallow anything and
the left arm could not bear to
be touched....
“The affections above described
were, in the beginning, readily
brought on by exercise . . . but they
at last seized him when lying in
bed, and in his sleep. . . .”5
18th century ancestor of
the modern coronary candidate
Surgeon, anatomist, pathologist,
physiologist, geologist, and teacher.
Hunter had a passion for research
which led him to disregard his
practice, his health and even the
Mediatric
Designed for the “metabolically spent”
Nutritional reinforcement for those who can’t
- or won’t- eat properly. . . balanced amounts of
estrogen and androgen to counteract declining
gonadal hormone secretion and its sequelae of
premature degenerative changes... mild
antidepressant for a gentle “mood” uplift...
The estrogen component in MEDIATRIC is
PREMARIN® (conjugated estrogens — equine),
the natural estrogen most widely prescribed for its
superior physiologic and metabolic benefits.
MEDIATRIC also provides nutritional reinforce-
ment—blood-building factors and vitamin supple-
mentation. It contributes a gentle “mood” uplift
through methamphetamine HC1.
Three different dosage forms— Liquid, Tablets, and
Capsules— offer convenience and variety.
MEDIATRIC Liquid
Each 15 cc. (3 teaspoonfuls) contains:
^Conjugated estrogens — equine (Premarin®) 0.25 mg.
Methyltestosterone 2.5 mg.
Thiamine HC1 5.0 mg.
Cyanocobalamin 1.5 meg.
Methamphetamine HC1 1.0 mg.
Contains 15% alcohol
MEDIATRIC Tablets and Capsules
Each MEDIATRIC Tablet or Capsule contains:
•^Conjugated estrogens— equine (Premarin®) 0.25 mg.
Methyltestosterone 2.5 mg.
Ascorbic acid 100.0 mg.
Cyanocobalamin 2.5 meg.
Intrinsic factor concentrate 8.0 mg.
Thiamine mononitrate 10.0 mg.
Riboflavin 5.0 mg.
Niacinamide 50.0 mg.
Pyridoxine HC1 3.0 mg.
Calc, pantothenate 20.0 mg.
Ferrous sulfate exsic 30.0 mg.
Methamphetamine HC1 1.0 mg.
•^Orally active, water-soluble conjugated estrogens derived from
pregnant mares’ urine and standardized in terms of the weight
of active, water-soluble estrogen content.
MEDIATRIC helps keep the older patient alert and active;
helps relieve general malaise, easy fatigability, vague pains in
the bones and joints, loss of appetite, and lack of interest
usually associated with declining gonadal hormone secretion.
contraindication: Carcinoma of the prostate, due to methyl-
testosterone component.
warning: Some patients with pernicious anemia may not
respond to treatment with the Tablets or Capsules, nor is
cessation of response predictable. Periodic examinations and
laboratory studies of pernicious anemia patients are essential
and recommended.
side effects: In addition to withdrawal bleeding, breast ten-
derness or hirsutism may occur.
suggested dosages: Male and female: 3 teaspoonfuls of
Liquid, 1 Tablet, or 1 Capsule, daily or as required.
In the female: To avoid continuous stimulation of breast and
uterus, cyclic therapy is recommended (3 week regimen with
1 week rest period— Withdrawal bleeding may occur during
this 1 week rest period).
In the male: A careful check should be made on the status
of the prostate gland when therapy is given for protracted
intervals.
supplied: No. 910 — MEDIATRIC Liquid, in bottles of 16
fluidounces and 1 gallon. No. 752 — MEDIATRIC Tablets,
in bottles of 100 and 1,000. No. 252 — MEDIATRIC Cap-
sules, in bottles of 30, 100, and 1,000.
Mediatric
steroid-nutritional compound
AYERST LABORATORIES, NEW YORK, N. Y. 10017 • Montreal, Canada
6636
In Our Opinion
Comments on Current Economic, Social
And Professional Matters
THE IMPACT OF A PATRIARCH
ON AMERICAN MEDICINE
"The Impact of Herbert Morris Platter, M. D., on
American Medicine.’’ That is the title of a citation
issued in 1964 by the Executive Committee of the
Federation of State Medical Boards of the United
States. In part, the citation reads:
"He possesses the rare ability of always rendering
service in all of his many activities. He is well known
for his unyielding faith in his fellow man and a
firm belief in American Medicine and is one of the
nation’s outstanding physicians of all times. . . .
"The Executive Committee of the Federation of
State Medical Boards of the United States, as well
as many others, hold Doctor Platter in highest esteem,
respect him for his distinguished professional attain-
ments, admire him for his competence, his integrity,
his sterling honesty and his innate modesty; love him
for those other essential qualities of heart and mind
basic in the character of the true gentleman.”
This national salute is only one of numerous hon-
ors bestowed upon a man who literally dedicated his
life to furthering the public health by demanding
the highest standards of medical practice. Before
the turn of the century, he was fighting smallpox
and typhoid fever as a physician and public health
officer. Prior to World War I, he was laying the
foundation for health codes for the public schools
and for the state as a whole. For years he passed
on his store of wisdom to medical students at Ohio
State University.
But the crowning peak of his impact on medicine
in Ohio and beyond was in his 48 years as the
keystone of the State Medical Board of Ohio.
His exacting demands of those who sought to
practice the healing arts in Ohio was proverbial.
His knack of sifting out the unqualified was based on
long, objective study. His talent for cutting through
red tape to weed out the incompetent was unique.
Perhaps not as well known, but nevertheless tre-
mendous, was this humanitarian’s contribution to
medical organizations.
In early November, physicians joined their fel-
low citizens of Ohio and of the Nation to pay
homage to Dr. Platter at his last rites. From one
point of view, this event marked the end of an era.
But in a broader sense, Dr. Platter lived to usher
in a new era in medicine.
He was a thorough believer in the principle that
physicians are Number One in the guardianship of
the public’s health. The practice of medicine has
changed. The horse-and-buggy doctor is a thing of
the past; the little black bag has taken on more
sophisticated airs; the kitchen table has given way
to the operating room. The artist’s concept of The
Doctor in the new era of medicine will be different,
but it will still picture the doctor beside the bedside
of his patient. That phase of medicine will not
change. The doctors of Ohio will see to it. The
impact of Dr. Platter on medicine will continue long
after his passing.
HEALTH AND SAFETY TIPS
INCLUDE HOME FIRE DRILL
With the warning that more than 2,000 children
die every year in home fires, an article in Today’s
Health recommends that parents set up their own fire
drills. Fire drills in schools are a must, the article
points out, yet the chances are 200 times greater
that a child will be trapped in a fire at home.
This article is typical of the common sense infor-
mation and advice that goes to readers each month
through Today’s Health, the American Medical Asso-
ciation magazine for lay people. This is only one ex-
ample of how the AMA is helping to protect the
public’s health, and in our opinion, a good incentive
for very physician to support the AMA.
Dr. Rex H. Wilson, medical director of the B.
F. Goodrich Company, Akron, discussed preventive
medicine programs as they related to occupational
medicine, at a seminar in Ojai, California, sponsored
by the Chemical Industry Council of Southern Cali-
fornia.
1264
The Ohio State Medical Journal
Dream work 1966
A Symposium*
An Overview of Current Research
Into Sleep and Dreams
Roy M. Whitman, M. D.
In the early 1950’s Aserinsky and Kleitman1 made
the initial observations that rapid eye movements are
coexistent with the process of dreaming. This has re-
sulted in an enormous amount of research7 into the
psychophysiology of this rapid eye movement (REM)
stage of sleep.19-20 Apparently this stage of sleep
is sufficiently distinctive to be called "a third state of
existence.”
In addition to calling it the REM, or third state,
other phrases characterizing this phase of sleep are:
D-state, emergent stage- 1, stage 1-REM, activated
sleep, rapid sleep, light sleep, deep sleep, rhomben-
cephalic sleep, and the paradoxical phase of sleep.14
This descriptive array contains the essentials of this
phase of sleep. It is characterized by rapid eye move-
ments and the occurrence of dreaming as the subject
goes from deep sleep to light sleep (hence "emer-
gent”). There is diffuse activation of the small
musculature of the body, accompanied by fast rhythm
on the electroencephalograph (EEG), and the
neurophysiologic locus of this phase of sleep is in the
rhombencephalon.15 Some of the inconsistencies in
this phase are due to the fact that the person is in a
"light” phase of sleep according to EEG criteria but he
is relatively impervious to external waking stimuli, a
strikingly paradoxical combination.
Every mammal thus far studied has these charac-
*The four papers in this Symposium were presented before the
joint meeting of the Ohio Psychiatric Association and Ohio Psy-
chologic Association, February 16, 1966, Cincinnati, Ohio.
teristic rapid eye movements including the cat, rat,
opossum, mouse, monkey, chimpanzee, pig, sheep and
goat.20 It thus appears that the neurophysiologic sub-
strate is present in higher forms of the animal king-
dom and provides the mechanism upon which the
psychologic process of dreaming is grafted. This
mechanism appears in newborn infants as a major
percentage of sleeping time and dream percentage
time gradually decreases to 20 to 25 per cent of the
night’s sleep in the adult human. If we sleep one
third of our lives and dream one quarter of that, then
one twelfth of our lives is spent dreaming. In a
normal life span this comes to six years of dreaming,
making it a significant part of life from a time view-
point alone.
In a number of experiments, investigators have
established that dreams are not instantaneous and
that if the subject is pushed may report that prob-
ably 80 per cent are in color.16 In addition, the
eye movements are consistent with the action ob-
served.3 Physiologic accompaniments consist of in-
creased but irregular respiration, blood pressure and
pulse. Finger pulse volume is decreased. There is
a suppression of the skin response and, of course,
an increased arousal threshold. In addition, though
previously reported as an incidental observation,18
Fisher has established the existence of partial or full
erections as accompanying this phase of sleep.8
The impetus of this discovery has sparked more
precise neurophysiologic investigations localizing the
source of REM and the source of inhibition of major
motor movements. Jouvet14 has implicated the nucleus
locus caemleus as inhibiting skeletal-motor outflow,
thus protecting the dreamer from actually acting out
his dream. Further, he has identified the cortical
1271
pontile nucleus of the pontile reticular formation as
being essential for the occurrence of REMs. Cats
with this nucleus destroyed have no more REMs, die
in toxic coma, and seem to hallucinate before death.
Other significant neurophysiologic research has been
done by Evarts4 by an ingenious micro-electrode tech-
nique. He has established the fact that firing of
these individual motor neurons is as high a level or
higher than in the waking state5 during the REM
phase of sleep. In addition, there is a high degree of
spontaneous activity in the neurons of the visual
pathways and visual cortex. Only the small neurons
in the cerebrum seem to become quiescent.6
Dream Deprivation
Dement, one of the early and most vigorous in-
vestigators of dreaming and sleep, has become particu-
larly interested in the phenomenon of "dream depri-
vation.’’22 His most recent and striking findings
have unearthed the rather impressive observation that
during recovery REM time is proportional to the
amount of deprivation. Thus, 25 per cent REM dep-
rivation for 20 days is "made up’’ in ensuing nights
just as much as 100 per cent deprivation for five days.
Dement feels, therefore, that this is a built-in phe-
nomenon in which there is an accumulation of a
metabolite, and other investigators have speculated as
to whether this is serotonin or gamma-amino butyric
acid.
The phenomenon of dream deprivation for from
2 to 15 days consecutively has led to the observation
in some subjects of increased appetite, an increase in
anxiety and irritability, a decrease in concentration
ability, and an increase in impulsivity. Three subjects
deprived for two weeks consistently showed changes
in the Rorschach in the direction of increased move-
ment and creativity.13
Cats that are dream deprived frequently show hy-
perphagia and hypersexuality.7 The decrease in REM
seems to lead to a general hyperexcitability and a
potentiation toward drive-oriented behavior. Psycho-
physiologically, it would seem that there is a cluster
of functions in the limbic midbrain centers that are
involved in sexual, oral and aggressive behavior.7
From a completely different point of view there has
been a great deal of psychoanalytic theory-making
concerning the orality of dreaming.
Lewin’s hypotheses of the dream screen, the Isa-
kower phenomenon, as well as Spitz’s work on the oral
cavity,21 all point to the initial libidinal period of
orality as basic and combining with the psychophysi-
ology of dreaming.23 Despite Fisher’s fascinating
observations of the accompaniment of erections with
REMs,8 these seem to be non-genital and rather
diffuse libidinal phenomena.18 They seem very simi-
lar to Freud’s recounting the observation in "Three
Contributions to the Theory of Sexuality”11 concern-
ing the concurrence of erection and thumb sucking.
The question repeatedly arises as to the function
of REM sleep. It is clearly not a restitutive phe-
nomenon since Evarts5 has shown that activity during
REM sleep of individual neurons continues at levels
equal to waking life. The sleep protecting function
of dreaming must be modified to say that this para-
doxical phase may protect awakening during REM
sleep but definitely not during non-REM sleep.
Dreams are not brought about by awakening the
person during NREM sleep unless the dream cycle is
about to begin anyway.
REM vs. NREM Sleep
The difference between REM and NREM sleep17
is highly significant for the theory of sleep and
dreams. In NREM sleep when mentation is recov-
ered,9 it usually consists of reports of abstract thoughts
and uninvolved visual imagery. These thoughts are
closer to waking life, often even replicas of waking
life, and less bizarre and, for want of a better word,
less "dreamlike.”
Apparently there is an ongoing stream of mentation
throughout the night which at approximately 90-
minute intervals is aroused to hallucinatory intensity
by the firing of centers in the pons which produces
the characteristic dreams usually examined during
psychoanalysis and psychotherapy. These REM
dreams utilize the classic mechanism of displacement,
substitution, condensation, symbolization and sec-
ondary elaboration. The unraveling of these dreams
produces the most fruitful material for a psychologic
investigation of the personality22 since not only are
the libidinal drives unearthed but also the ego’s char-
acteristic mode and style of dealing with these drives.
An interesting theoretic possibility is that NREM
dreams as reported by Rechtschaffen, et al17 and
Foulkes9 do not utilize these mechanisms and there-
fore do not have a latent content in the classic psy-
choanalytic sense that Freud formulated.10
References
1. Aserinsky, E., and Kleitman, N.: A Motility Cycle in Sleep-
ing Infants as Manifested by Ocular and Gross Bodily Activity.
/. Appl. Physiol., 8:11-18, 1955.
2. Dement, W., and Fisher, C.: The Effect of Dream Depriva-
tion. Science, 131:1705-1707, June, 10, I960; abstracted, Bull.
Phila. Assn. Psychoanal., 10:30, I960.
3. Dement, W., and Kleitman, N.: The Relation of Eye Move-
ments During Sleep to Dream Activity: an Objective Method for the
Study of Dreaming. /. Exp. Psychol., 53:339-346, 1957.
4. Evarts, E.: Activity of Neurons in Visual Cortex of the Cat
During Sleep with Low Voltage Fast EEG Activity. /. Neurophysiol.,
25:812-815, 1962.
5. Evarts, E.: Effects of Sleep and Waking on Spontaneous and
Evoked Discharge of Single Units in Visual Cortex. Fed. Proc.,
19:828-837, 1960.
6. Evarts, E.: "Relation of Cell Size to Effects of Sleep in
Pyramidal Tract Neurons,’’ in Akert, K.; Bally, C., and Schade,
J. P. ( eds. ) : Progress in Brain Research (Sleep Mechanisms),
Amsterdam, London, New York: Elsevier Pub. Co., 1965, vol. 18,
pp. 81-91.
7. Fisher, C. : Psychoanalytic Implications of Recent Research on
Sleep and Dreaming. Part I: Empirical Findings; Part II: Implica-
tions for Psychoanalytic Theory, ]. Amer. Psychoanal. Assn., 13:
(2 ) 197-303 (April) 1965.
8. Fisher, C.; Gross, J., and Zuch, J.: A Cycle of Penile Erec-
tion Synchronous with Dreaming (REM) Sleep: Preliminary Report.
Arch. Gen. Psychiat., 12:29-45, 1965.
9. Foulkes, W. D.: Dream Reports from Different Stages of
Sleep. J. Abnorm. Soc. Psychol., 65:14-25, 1962.
10. Freud, S.: The Interpretation of Dreams (1900), stand, ed.
4, London: Hogarth Press, 1953.
11. Freud, S.: Three Essays on the Theory of Sexuality (1905),
stand, ed. 7, London: Hogarth Press, 1953.
1272
The Ohio State Medical Journal
The Participants
• Dr. Whitman, Cincinnati, is Associate Profes-
sor of Psychiatry, Department of Psychiatry, The
University of Cincinnati College of Medicine.
• Mr. Baldridge, Cincinnati, is Instructor in Psy-
chology, Department of Psychiatry, The University
of Cincinnati College of Medicine, and Consulting
Psychologist, Veterans Administration Hospital,
Cincinnati, Ohio.
• Dr. Ornstein, Cincinnati, is Assistant Professor
of Psychiatry, Department of Psychiatry, The Univer-
sity of Cincinnati College of Medicine.
• Dr. Kramer, Cincinnati, is Assistant Professor
of Psychiatry, The University of Cincinnati Col-
lege of Medicine, and Assistant Chief, Psychiatric
Service, Veterans Administration Hospital, Cin-
cinnati, Ohio.
12. Hoedemaker, F.; Kales, A.; Jacobson, A., and Lichtenstein,
E.: Dream Deprivation: an Experimental Appraisal. APSS*, 1963.
13. Holt. R. R. : Gauging Primary and Secondary Processes in
Rorschach Responses. /. Proj. Tech., 20:14, 1956.
14. Jouvet, M. : "Paradoxical Sleep — A Study of Its Nature
and Mechanisms,” in Akert, K.; Bally, C., and Schade, J. P. (eds.):
Progress in Brain Research (Sleep Mechanisms) , Amsterdam, Lon-
don, New York: Elsevier Pub. Co., 1965, vol. 18, pp. 20-62.
15. Jouvet, M. : "Telencephalic and Rhombencephalic Sleep in the
Cat. in Wolstenholme, G. E. W., and O’Connor, M. (eds.): The
Nature of Sleep, Boston: Little, Brown, I960.
16. Kahn, E.; Dement, W.; Fisher, C., and Barmack, J. L.: The
Incidence of Color in Immediately Recalled Dreams. Science, 137:
1054, 1962.
17. Monroe, L. J. ; Rechtschaffen, A.: Foulkes, D., and Jensen,
J. : The Discriminability of REM and NREM Reports. J. Pers. Soc.
Psychol. (In press.)
18. Ohlmeyer, P., and Brilmayer, H.: Periodische Vorgange im
Schlaf. Pfliig. Arch. ges. Physiol., 2:249-2 50, 1947.
19. Oswald, I.: Sleeping and Waking, Amsterdam, New York:
Elsevier Pub. Co., 1962.
20. Snyder, F.: The New Biology of Dreaming. Arch. Gen.
Psychiat., 8:381, 1963.
21. Spitz, R. A.: "The Primal Cavity,” in The Psychoanalytic
Study of the Child, New York: International Universities Press, 1955,
vol. 10, pp. 215-240.
22. Trosman, H.: Dream Research and the Psychoanalytic Theory
of Dreams. Arch. Gen. Psychiat., 9:9-18, 1963.
23. Whitman. R. M. : Remembering and Forgetting Dreams in
Psychoanalysis. J. Amer. Psychoanal. Assn., 11:752-774, 1963.
ifi %
Physical Concomitants of Dreaming
And the Effect of Stimulation
On Dreams
Bill J. Baldridge, B. A.
Historically there have been two conflicting
thoughts concerning dreams and their influence on
or by the physical forces which may prevail during
dreaming. Dreaming has been viewed both as an
attempted continuation of the previous waking activity
and as a purely psychologic phenomena with little
relation to the physical world of the dreamer. Sup-
port for either of these points of view has been read-
ily producible. One could cite the dramatic incorpor-
ation of physical events in dreams, on the one hand,
and the obvious insensitivity of the sleeper to stimu-
lation on the other. Instances of sleep talking, sleep
walking, enuresis and other nocturnal activity tended
to be seen as activated dreaming while the near mo-
tionless state which accompanied most dreams added
to the confusion.
Still another facet of dreaming proved difficult to
resolve. This was the belief by some that dreams
occurred instantaneously. The possibility that events
of minutes, hours, or days might be compressed into
a fraction of a second was an intriguing one and
found support in both popular opinion and among
scientific observers. A classic example is the "Guil-
lotine” dream of Maury reported by Freud in The
Interpretation of Dreams A1 Such an instantaneous
occurrence of dreams would hardly permit correspon-
ing changes in one’s physiological state, nor produce,
or be affected by physical forces except perhaps in the
role of a triggering mechanism.
The discover)' by Aserinsky and Kleitman, of an
objective method for determining when dreaming
* APSS is the abbreviation for the Association for the Psycho-
physiological Study of Sleep.
occurs, provided the tool for a systematic investiga-
tion of the many questions related to these concepts.1
Information subsequently gathered by Aserinsky and
Kleitman, and Dement and Kleitman did much to
establish a firm basis from which to pursue these
studies.2'8 I would now like to present some of the
findings which have been made at the University of
Cincinnati using the method of Aserinsky and Kleit-
man and to indicate their relevance for understanding
the dream process and its relation to physical and phy-
siologic forces where possible.
Dreaming: Occurrence or Development
In one of the early studies of dreaming, Dement
and Kleitman obtained dream reports from 80 per
cent of the awakenings made during periods of rapid
conjugate eye movements. Less than 10 per cent of
the awakenings from the non-rapid eye movement
periods produced a dream report with little or no
recall reported when the awakenings followed the
rapid eye movements by more than eight minutes.7
This suggested that dreaming did not occur out-
side the rapid eye movement periods and that
when dreaming was reported outside of these pe-
riods it represented some fragmentary memory of
the preceding dream. More recently others, nota-
bly, Foulkes, Rechtschaffen, Goodenough and Kam-
iya have obtained a substantially higher per cent of
dream reports from the non-rapid eye movement
periods.10’12’14’16
We have completed a study, at the University of
Cincinnati, in which a number of variables affecting
dream reports were investigated by awakening sub-
jects on a predetermined random time schedule.6
The subject’s report was then referred to the recorded
eye movement activity in order to relate these two on
a continuous time basis.
for December, 1966
1273
In this study the per cent of dream reports ob-
tained, as a function of the length of the eye move-
ment period which preceded the awakening, rose
from 10 per cent with activity of less than one minute
to approximately 80 per cent after three to seven
minutes of eye movement activity. The probability
of obtaining a dream report remained near 60 to 70
per cent for all longer periods of eye movement
activity. The average number of words per dream
tended to increase with increased duration of eye
movements.
Since the awakenings were random, many awaken-
ings were made outside the eye movement periods. The
effect was a sharp drop in dream recall for those awak-
enings which were made within a few minutes after the
eye movements ceased. A minimum of dream reporting
was obtained after an interval of 7 to 15 minutes
without eye movements. This was followed, how-
ever, by a gradual increase in the frequency of dreams
reported until nearly 80 per cent was again reached,
after 31 to 63 minutes of non-rapid eye movement
sleep. This interval corresponds approximately to
the well established dream cycle time and suggests a
developmental aspect of dreaming with an increasing
probability of occurrence.
Activity and Dreams
For the most part, eye movements have been record-
ed by means of the electrical retinal potential using
standard electroencephalograph (EEG) instru-
mentation.1-2’7-8 Several difficulties have been en-
countered with this method, including interference
by EEG activity and the bulk and expense of the
instrument. A method of mechanically recording the
movements of the eyes by means of a strain gauge
was developed in our laboratory which circumvents
some of these difficulties.3 With the strain gauge
method, smaller eye movements may be detected
without interference from the electrical activity of the
brain. The use of this method of recording eye move-
ments, which does not depend on the electrical poten-
tial from the retina, made possible the recent demon-
stration, by Gross, of rapid eye movements during
dreaming in the congenitally blind.13 Previous studies
of dreaming in the congenitally blind had produced
little or no rapid eye movements indicating their occur-
rence during dreaming to be a learned phenomenon.
Initially Aserinsky and Kleitman reported that
dreaming with eye movements occurred during peri-
ods when other muscle movements were at an ex-
tremely low level or nonexistent.1 Dement and Kleit-
man, however, speculated that other fine muscle
movements should in fact occur.8 Our own observa-
tions led us to believe that such fine muscle move-
ments, not only should but did occur along with the
movement of the eyes. A subsequent study demon-
strated that these observations were correct.4 In this
study, ten subjects slept undisturbed overnight while
recordings of movements were made by means of
strain gauges attached to their eyelid, throat, wrist
and ankle. From these records it was seen that when
eye movements began, all channels became active and
when the eye movement activity ceased, activity from
the other channels also ceased. Correlations between eye
movement activity and the average of the activity
from the other three channels were greater than .75
for 7 of the 10 subjects in the study.
Influencing Dream Content
An early study by Dement and Wolpert reported
only moderate success in their attempt to affect dream
content by means of external stimulation.9 Of the
three stimulus modes used by these investigators, only
a spray of water on the skin of the subject was re-
ported to be effective in producing a change in the
dream. We have undertaken a series of studies to
systematically investigate the effect of a variety of
external physical stimuli on dream content.5 The
first to be completed was one to determine the effect
of movement induced by raising and lowering the
upper part of a hospital type bed. Results indicate
those dreams which occurred with movement can be
distinguished from those obtained from control
awakenings without movement. In addition to a
number of specific movement activities in these
dreams, such as falling, flying or riding a motor-
scooter, dreams from the awakenings following move-
ment are generally distinguishable on the basis of in-
creased activity on the part of the dreamer.
Other forms of stimulation being studied include
temperate changes produced by flowing water of dif-
ferent temperature through rubber tubing imbedded
in a pad on which the subject is sleeping. Here,
stimulation with cold may result in a reference to
getting food from a refrigerator, while stimulation
with a warm temperature may result in reference to
a warm day.
The effects of internal physiologic states are also
being studied by depriving the subjects of food for a
period of 24 hours. The dreams obtained are then
compared to the dreams reported by a subject under
normal conditions. The effect produced with some
seems to be an obsessive reference to food in their
dreams while others are more likely to respond with
anger. A sufficient amount of data has not yet been
collected from which to draw any firm conclusion.
Investigation of Dream Process
And Related Mechanisms
It seems reasonably certain now that many forms
of physical stimulation and internal physiologic states
may produce changes in the contents of the reported
dream. A great many more studies will need to be
completed before we will be able to specify the exact
nature of these effects. The use of different forms of
stimulation and of different manners of presentation
should be employed to answer questions, such as the
1274
The Ohio State Medical Journal
effects which may be produced by a stimulus which
begins prior to the onset of a dream and one which
is initiated after the dream has started. The repeated
use of the same stimuli during different periods of
the night may provide information concerning the
variety of symbolization and the various techniques
of defense employed by the dreamer. It should also
provide some measure of the qualitative differences
which appear in dreams as a result of the purely phy-
sical and physiologic forces which are known to be
present.
The variety of muscle activity during dreaming is
now known to be extensive. Some more general
understanding of its significance is beginning to take
place. Kuntz has emphasized the importance of
the developing musculature in the course of the phy-
logenetic development of the central nervous sys-
tem.15 With this view in mind, a closer analysis of
movement during dreaming may indicate something
of the organization of the neural mechanisms involved.
References
1. Aserinsky, E., and Kleitman, N. : Regularly Occurring Periods
of Eye Motility, and Concomitant Phenomena, During Sleep. Science,
118:273-274, 1953.
2. Aserinsky, E., and Kleitman, N. : Two Types of Ocular Motil-
ity Occurring in Sleep. J. Appl. Physiol., 8:1-10, 1955.
3. Baldridge, B. J.; Whitman, R., and Kramer, M.: A Simpli-
fied Method for Detecting Eye Movements During Dreaming. Psy-
chosom. Med., 25:78-82, 1963.
4. Baldridge, B. J.; Whitman, R. M., and Kramer, M.: The
Concurrence of Fine Muscle Activity and REMs During Sleep.
Psychosom. Med., 27:19-26, 1965.
5. Baldridge, B. J.; Whitman, R. M., and Kramer, M.: The
Effect of External Physical Stimuli on Dream Content. APSS, 1964,
Washington, D. C.
6. Baldridge, B. J.; Whitman, R. M., and Kramer, M.: Dream
Development and Recall. Midwestern Psychological Association,
Chicago, 1965.
7. Dement. W., and Kleitman, N.: The Relation of Eye Move-
ments During Sleep to Dream Activity: an Objective Method for the
Study of Dreaming. J. Exp. Psychol., 53:339-346, 1957.
8. Dement, W., and Kleitman, N.: Cyclic Variations in EEG
During Sleep and Their Relation to Eye Movements, Body Motility,
and Dreaming. Electroenceph. Clin. Neurophysiol., 9:673-690, 1957.
9. Dement, W., and Wolpert, E.: The Relation of Eye Move-
ments, Body Motility, and External Stimuli to Dream Content. J.
Exp. Psychol., 55:543-553, 1958.
10. Foulkes, W. D.: Dream Reports from Different Stages of
Sleep. J. Ahn. Soc. Psychol., 65:14-25, 1962.
11. Freud, S.: The Interpretation of Dreams (1900), Stand. Ed.,
4, London: Hogarth Press, 1953.
12. Goodenough, D. R.; Shapiro, A.; Holden, M., and Stein-
schriber, L.: A Comparison of Dreamers and Nondreamers: Eye
Movements, Electroencephalograms and the Recall of Dreams. /.
Ahn. Soc. Psychol., 59:295, 1959.
13. Gross, J.; Byrne, J., and Fisher, C.: Eye Movements During
Emergent Stage 1 EEG in Subjects with Lifelong Blindness. /. Nerv.
Ment. Dis., 141:365-370, 1965.
14. Kamiya, J.: "Behavioral, Subjective, and Physiological As-
ects of Drowsiness and Sleep,” in F unctions of Varied Experience,
iske, D. W., and Maddi, S. R., (eds) : Homewood, 111.: Dorsey
Press, 1961.
15. Kuntz, A.: A Text-hook of Neuro-Anatomy, ed 5, Philadel-
phia: Lea and Febiger, 1950.
16. Rechtschaffen, A.; Verdone, P., and Wheaton, G.: Reports
of Mental Activity During Sleep. Canad. Psychiat. Assn. J., 8:409,
1963.
sjs sjl i*C
Dreams and Conflicts
Paul H. Ornstein, M. D.
This brief report describes an experimental design
in which structural conflicts are hypnotically im-
planted in volunteer subjects and then the derivatives
of these conflicts are traced in the free-associative in-
terview material, the hypnotically induced dreams and
in the dreams of the night.
The combined use of hypnotically implanted con-
flicts and the modified Kleitman technique for the
collection of dreams is eminently suited for studying
the impact of these implanted conflicts upon dreams,
feelings and verbal behavior.
Method
In this study undergraduate students of the Uni-
versity of Cincinnati served as experimental subjects.
They were recruited by the U. C. Employment Bureau
and were paid for their participation. The screening
of those sent to us was done by a brief clinical inter-
view, a questionnaire and the use of two Thermatic
Apperception Test cards to determine hypnotizability.
After one or two training sessions, each lasting for
about one hour to achieve quick induction and post-
hypnotic amnesia, a date was set for an experiment.
On the experimental day, at 9:15 A. M., the subject
is hypnotized. Once he is in deep hypnosis and
ready for the implantation of a "structural conflict,”
the experimenter selects the conflict randomly from
15 cards. Each of these cards contains the typewrit-
ten text of one of the 15 conflicts used in these ex-
periments. (See Table 1.)
Table 1. "Structural Conflicts” for Hypnotic Implantation
DISTURBING MOTIVES
versus
REACTIVE MOTIVES
1. Hostile wishes
a.
Fear of physical injury
b.
Fear of loss of love
c.
Fear of feeling ashamed
a.
Fear of feeling guilty
e.
Fear of losing control
2. Sexual wishes
a.
Fear of physical injury
b.
Fear of loss of love
c.
Fear of feeling ashamed
d.
Fear of feeling guilty
e.
Fear of losing control
3. Dependent wishes
a.
Fear of physical injury
b.
Fear of loss of love
c.
Fear of feeling ashamed
d.
Fear of feeling guilty
e.
Fear of losing control
After the conflict is implanted, the subject is told
that his intense conflict will create a dream. In-
struction is given that after the dream ends, while
still under hypnosis, the subject is to tell his dream.
Subsequently, amnesia is suggested for the entire
experience — with a random variation that the hyp-
notic dream is at times allowed to be remembered
after awakening.
The implantation procedure usually takes 30 to 45
minutes. At 10:00 A. M., the subject is aroused,
tested for amnesia and sent to another office where
he is interviewed by a psychiatrist, mostly in the
presence of another observing psychiatrist, for about
20 to 30 minutes, with the technique of associative
anamnesis.
At the beginning of this interview, the subject is
again tested for posthypnotic amnesia. The interviewer
also asks for early memories. The entire procedure is
tape-recorded and subsequently transcribed.
for December, 1966
1275
That evening the subject sleeps in the Dream
Laboratory of the Department of Psychiatry at the
Cincinnati General Hospital, and his dreams are col-
lected by a modification of the Kleitman technique.
These dreams are recorded and transcribed along with
associations to the dreams which are asked for when
the subject is awakened.
The Use of Our Data
The data are then used as follows: the interviewer
and observer independently make an immediate for-
mulation after the interview as to the most likely
conflict of the 15 possibilities. They also give a
second and third choice, and record these.
Subsequently, members of the entire team receive
a transcript of the interview (with or without the
hypnotic dream, depending on whether it is recalled
or not) and of the night dreams. The transcript of
the implantation is withheld. Then in a joint session
the team works with the interview, the hypnotic
dream when available, and the night dreams. They
use all of this material to arrive at separate formula-
tions of the focal conflict.
Once the formulations are recorded, the implanted
conflict is revealed and the data are reexamined in
the light of this new information. The interview
and the dream material are then combed carefully
for evidence which supports or refutes the hypothesis
that there has been a "take” of the implanted conflict.
Another, recently introduced, method of working
this material over is the independent, clinical-intui-
tive interpretation of the data by two members of our
team in a stepwise fashion.
1. A formulation of the focal conflict based on
the interview alone;
2. A similar formulation based on the early mem-
ory alone;
3. A formulation on the basis of the hypnotic
dream, if available;
4. A formulation based on the night dreams;
5. A formulation based on integrating all of the
available information.
Two other members of the team work on the same
material, in the same sequence, using a scoring tech-
nique, rather than the clinical approach.
Areas of Study
It is immediately evident that this method pro-
vides an opportunity for experimental studies in many
important areas of clinical practice:
• 1. The consensus regarding the validity of psy-
chodynamic formulations;
• 2. Steps in the process of clinical inference;
• 3. Teaching focal conflict formulation in a
fashion similar to the clinicopathological conference
in medicine;
• 4. A comparative study of hypnotic dreams
and night dreams;
• 5. The influence of implanted conflicts on early
memories; and finally,
• 6. The interrelationship of the artificially in-
duced conflicts with the subject’s own naturally oc-
curring conflicts.
You may rightly argue at this point that before
we can state with certainty that our method and our
data are really suitable for the studies I just enu-
merated, we have to be able to demonstrate that the
conflicts we implant actually become implanted and
visibly affect the subject’s behavior, verbalizations,
hypnotic and night dreams.
I cannot hope to be convincing in such a brief re-
port, but perhaps you may get a glimpse at what is
involved if you follow me in a bit of clinical exercise:
I will give you a highly condensed version of an
interview with one of our subjects, a hypnotic dream
and one of her three night dreams. I invite you to
think along with me and attempt to guess which of
the three major disturbing motives and which of the
five reactive motives were implanted in this particular
experimental situation.
The three disturbing motives we use in our experi-
ments are: (1) Hostile Wishes; (2) Sexual Wishes;
(3) Dependent Wishes. These may each provoke
one of five reactive motives: (a) Fear of Physical
Injury; (b) Fear of Loss of Love; (c) Fear of
Feeling Ashamed; (d) Fear of Feeling Guilty; (e)
Fear of Losing Control. We therefore have 15 pos-
sibilities to choose from. However, if you succeed in
choosing the correct disturbing motive, one of only
three, you will have done very well with this sample.
A Sample of Our Data
The subject was an 18 year old girl, student at
U. C., who said essentially the following in a free as-
sociative interview:
She wanted to be a nurse when her little sister was
born until she was a high school senior. From then
on she no longer wanted to be a white slave. She
runs the family, her father is dead, because mother is
not as good at it and she is the first one to arrive
home every day - — - mother and older sister work and
younger sister is in school. The summer after she
graduated from high school she asked mother to let
her run the house completely. She did the shopping,
planned the meals, spent the money.
Then she recalled a dream she had under hypnosis :
I pictured myself doing laundry by hand, like sort of with
the long skirts like a pioneer — but it wasn’t quite pioneers
— there was an electric bulb in the background, the bare
wire type, like poverty — when you are struggling.
In her associations she seemed to present a Cin-
derella picture of herself at first. When the inter-
viewer asked her about it, she denied being or feel-
ing like a Cinderella and said that no one tells her
what to do; she volunteers. The picture in the dream
reminded her of a Salvation Army girl who is out
with the drums trying to save people.
The interviewer wanted to know if the Salvation
Army image meant to her that she was straight-laced.
1276
The Ohio State Medical Journal
She responded by saying that she was reserved and
shy, but went on to talk about her boy friend, who
was very aggressive and whom she admired in spite
of seeing some of his faults.
One of her night dreams in the Dream Laboratory
was as follows:
I was going to tell one of my roommates about sleeping
here and the advantages of this. Then there was an article
in the paper about some high school students who just spent
two and a half months living in a lavish apartment and tak-
ing care of themselves . . .
The Interpretation of Our Sample
Unless some of you want to reveal your guesses,
I will go on to tell you what the research group
thought of this material. At this point Dr. B. Clem-
ente of the audience suggested that the implanted
conflict was: ’ Dependency’ vs. Fear of Loss of Love.”
Three out of four in our research group chose
"Dependency7 Wishes versus Fear of Loss of Love.”
The conflict that was actually implanted was "De-
pendency7 Wishes versus Fear of Feeling Ashamed.”
It is to be acknowledged that the differentiation of
these two reactive motives is extremely difficult.
In tracing this conflict in the material, I can only
mention a few of the obvious ones:
In the interview, the first thing she revealed was
that she wanted to be a nurse: A frequent solution
for dependency7 conflicts. The rest of the interview
shows the solution to the conflicts: excessive need to
be independent (which in this instance was a sug-
gested solution).
In the hypnotic dream the assertion of independ-
ence suggests a reaction against underlying depend-
ence. Shame seems to appear in the form of the
long dress that covers up what should not be seen;
then the revealing electric light bulb also suggests
exposure in contrast to what is implied by the Salva-
tion Army girl association.
In the night dream the dependenq7 wish comes
through in the idea of being given to (she was paid
for sleeping here). The shame is handled by spread-
ing it around to a number of people and the implica-
tion of her working for the care she receives.
This condensed sample may sufficiently illustrate
the kind of symbolization, disguise, displacement
which is utilized by our experimental subjects to
elaborate the implanted conflicts and express them,
unbeknown to themselves consciously in the inter-
view and dreams.
Flow do we know that we are dealing with the
implanted and not with the natural conflicts of our
subjects? The answer to that is relatively simple.
We implant a number of different conflicts in the
same subject and often the same conflict more than
once. This provides us with an opportunity7 to study
the differences in the material as they relate to the
different conflicts implanted.
Because of these discernible differences, this type
of material is well-suited for teaching purposes. It
is possible for those engaged in this diagnostic
"game” to retrace their steps in the inferential process
once the implanted conflicts are revealed and to recog-
nize where they were led astray in their formulation.
The implanted conflict senes as radioactive sub-
stances do in medicine and surgery, and the clinician's
empathoscilloscope has to be sensitive enough to pick
up the different, disguised and symbolic transforma-
tions.
References
1. Whitman, R. M.; Ornstein, Paul H., and Baldridge. Bill: An
Experimental Approach to the Psychoanalytic Theory of Dreams and
Conflicts. Comprehensive Psychiatry, 5:349-363 (Dec.) 1964.
% %
Drugs, Depression, and
Dream Sequences
An Exploration of Dream Content Changes Induced by
Medication, by Psychopat hologic Conditions, and by Varia-
tions in the Ego’s Adaptability.
Milton Kramer, M. D.
The primary focus of our dream research group
here at the University of Cincinnati has been on the
study of the content of dreams rather than on the
physiologic process of dreaming. Certainly our ther-
apeutic orientation has considerably influenced and
guided our work in this direction. As poetry will
never be completely understood in electrophysical
terms, dreams cannot be explained solely from a
description of eye movements and activated Stage I
electroencephalograms. Even granting the phvsi-
ologic and biologic primacy of rapid eye movement
(REM) sleep, we are still left with the problem of
the function of the concomitant psychic activity7 of
dreaming, which cannot simply be reduced to the
underlying somatic and physiochemical processes.
What Kety said about memory, that we may some-
times have a biochemistry of memory but never of
memories, holds true for dreaming and dreams9 as
well.
Our initial interest was to use the dream, now that
the vagaries of dream recall could be substantially
bypassed, to examine the psychologic shifts which
accompany the taking of tranquilizing drugs. As
clinicians, we view the dream as representing the
most significant, condensed, psychologic product of
the organism.27 The dream is ever}7 man’s personal
projective occurring three to five times a night, ever}7
night. That tranquilizers were known to affect the
hallucinations of the dream3-618'23’23 and of psy-
chosis and that the site of action of the drugs and the
center for dream initiation were both subcortical15
intrigued us all the more.
Drug Studies
Our intent was to psychoassay the newer drugs by
examining their effects on dream content. To this
end we have undertaken studies of the influence on
dream content of various types of psychoactive drugs.
The drugs we have studied are Compazine®, a major
for December, 1966
1277
tranquilizer; imipramine, an antidepressant; mepro-
bamate, a minor tranquilizer, and phenobarbital, a
sedative.29’ 30
Our approach has been to obtain baseline nights
of dreaming, then to start the subject on medication,
and finally to obtain additional dreams from the
subject after he has been on the medication for at
least several days. The subjects sleep in our labora-
tory at either the General Hospital or the V. A.
Hospital in Cincinnati. Dreaming is determined by
eye-movement indicators.4 Subjects are awakened to
report dreams after five minutes of dreaming to keep
the dream reports somewhat comparable.14 We have
the subject report his dream into a tape recorder from
which typed scripts are prepared. These typed dream
reports are then rated along seven dimensions using
rating scales we have devised.30 The dimensions
along which the dreams are rated include hostility,
dependency, heterosexuality, homosexuality, anxiety,
intimacy, and motility.
The psychoassay of tranquilizing drugs has yielded
a number of interesting results. Our most striking
finding is the tendency of imipramine to stimulate
the expression of hostility in dreams.30 We specu-
lated that this increase of hostility discharge in
dreams could result in a reduction of aggressive in-
stinctual pressure. If this were the case, then the
discharge of hostility in the fantasy of the dream
might be linked to the antidepressant effects of
imipramine, the idea being that the blocked self-
directed aggression so common in the depressed was
finding some release in the hostility expressed in
dreams. Our work on enuresis, in which enuretic
episodes were found to substitute for dream periods,
supports this notion of the dream having a discharge
function.22
The major specific effect on dream content that we
found for meprobamate could also be seen as an ex-
ample of the discharge function of the dream. Scores
on the motility scale were found to be significantly
elevated over the baseline in a subject taking mepro-
bamate. We conceptualized this change as perhaps
reflecting a compensatory discharge of motility in
the dream resulting from the alledged muscle relaxant
properties of meprobamate blocking motoric discharge
via peripheral motor channels.29
Both imipramine and meprobamate led to a de-
crease in the number of dreams reported per night.
This may relate to the suppression of REM time
described for most tranquilizing medication.8’10’11
Phenobarbital and Compazine tended to cause
elevated scores on the sexual scales, the former on
the homosexual scale and the latter on the heterosex-
ual scale.30 These rises were trends which did not
reach statistical significance. However, we wondered
if phenobarbital might have fostered a passive state
because of its relaxant qualities which was reflected in
expressions of homosexuality in the dream. This
does not fit our thesis of the discharge quality of
the dream which we have described above. The
tendency for Compazine to elevate heterosexual scores
remains unexplained.
We noted a series of changes in several of the
other scales which occurred with all of the drugs that
were studied.29, 30 These changes were probably
related less to the pharmacologic effect of the medica-
tion and more to the experimental setting and the
doctor-patient type relationship engendered by the
giving of drugs. The changes we observed with all
of the drugs were a rise in scores on the anxiety
and dependency scales and a decrease on the intimacy
scale. The experimental setting tends to be anxiety
provoking and stimulates many concerns which are
inevitably reflected in the dreams of the subjects.31
The distancing implied by a decrease in intimacy
scores could well be seen as the defensive maneuver
of an anxious patient. That being given a pill would
foster an increase in dependency is to be expected as
it often raises hopes of further care from the giver.
The introduction of medication into the doctor-patient
relationship could tend to decrease the intimacy of the
relationship.
We feel encouraged that by utilizing the dream,
the most central intrapsychic product of the organism,
we can, by quantifying the psychologic forces in the
dream along traditional psychologic vectors, begin
to evaluate the psychologic effects of the tranquilizing
drugs in a meaningful way.
Depression Study
Our interest in the dreams of various diagnostic
entities such as schizophrenia, traumatic neuroses, and
depression lead us, in view of our having found such
a striking effect of imipramine on the dreams of
normal subjects, to study first the dreams of the de-
pressed.17 We obtained two nights of dreaming
from ten depressed patients while they were on an
imipramine placebo. They were then switched to
the active medication and had their dreams collected
one night a week for three additional weeks. At the
end of the fourth week when the last dreams were
collected, all of the patients had improved.
Our purpose in studying the effects of imipramine
on the dreams of the depressed was in searching for
possible shifts in various kinds of dream content as
well as to observe any change in dream frequency
or dream recall. We were also interested, as part of
our curiosity about the dream characteristics of vari-
ous diagnostic entities, in noting whether the dreams
of the depressed were different from those of the
non-depressed.
What we found was that the depressed recalled
dreams less often than the non-depressed, 51 per cent
recall as compared to 85 per cent; but that the
frequency of dream episodes per night was essen-
tially the same, 3.7 as compared to 3.4.
We noted that the depressive themes described by
Beck5 as characterizing the verbalizations of depressed
patients at times of depression, namely: low self-
regard, deprivation, self-criticism and self-blame,
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The Ohio State Medical Journal
overwhelming problems and duties, self-commands
and injunctions, and escape and suicide did indeed
occur more frequently in the dreams of the depressed
than the non-depressed. Interestingly, 49 per cent
of the depressive themes in the dreams of the de-
pressed were themes of escape while only 12 per cent
of the depressive themes in the non-depressed were
in this category. No single theme predominated in the
non-depressed as escape themes did in the depressed.
When the dreams of the depressed were examined
for reflections of feelings of helplessness or hopeless-
ness as defined by Engle7 and Schmale,24 the dreams
of the depressed were found to contain such feelings
in 33 per cent of cases while such themes were present
in only 7 per cent of the dreams of the non-depressed.
We were unable to demonstrate any shift in the
frequency of dream recall or in any of the dream
theme parameters concurrent with clinical improve-
ment in the depressed patients when we compared the
first night of observation to the last. We have not
as yet examined these dreams to explore for possible
shifts in hostility expression concomitant with clinical
improvement.
A number of speculations about the dreams of
the depressed occurred to us as result of our observa-
tions. Even recognizing the dream suppressant ef-
fect of imipramine, we felt the most likely explana-
tion for the decrease in dream recall in depressed
patients is to see this as part of the repressive defen-
sive process exemplified in the decreased productivity
of the depressed state and related to the interpersonal
technique of not reporting dreams to preserve rela-
tionships28 and to avoid the pain which, for the
depressed, accompanies thinking.2 A physiological
explanation of reduced dream time appears unten-
able to us to account for the decreased dream recall
in the depressed.
It is clear from our observations of the dreams of
depressed patients, as reflected in dream recall per-
centages and various dream themes, that their dreams
do not mirror their waking clinical state. Apparently
the dream lags qualitatively behind the clinical state
in indicating change. If the intrapsychic indicators
do ultimately change, one might consider that the
lag reflects the still precarious adaptation of the de-
pressed patient. If this is so, decisions about recov-
ery and readiness for discharge from the hospital
should take this fact into account.
Dream Sequences
One of the points of view about dreams that I
stated above was that for us the dream was the most
significant, intrapsychic product of the organism and
that it was truly each man’s personal projective.
With the availability of a larger number of dreams
from a single night, we became interested in what
this nightly projective might tell us about subjects
and in a sequential analysis of these data, i.e., how
do the various dreams of a single night interrelate.
Most pre-REM observers of the multiple dreams of
a single night deal with pairs of dreams rather than
dream series, by which we mean three or more
dreams. These observers noted that dreams of a
single night form part of a single whole,13 that
often they have a condition-consequent relationship
one to the other,12 and that they may differentially
disguise object and impulse.1
It was a group at the University of Chicago21’26
who first studied the multiple dreams of a single night
collected by awakening the subject at night when
physiologic indicators of dreaming appeared. They
were able to show that all the dreams of a single
night do deal with the same or a limited number of
conflicts. Further they noted that the organization
of a particular dream depends at least in part on the
consequences of the attempted solution in the pre-
vious dream. And finally, that the dreams within a
single night seemed to reflect a cycle of tension ac-
cumulation, discharge, and regression or quiescence
which may be related to a psychologic sequence of
alternating ascendancy of disturbing and reactive
motives in the sense that Thomas French uses these
concepts.
In view of the paucity of data in the clinical litera-
ture on the multiple dreams of a single night, we
were curious as to the incidence of such multiple
dreams in psychotherapeutic situations. We examined
the case records of eight analytic cases : they contained
a total of 2744 therapy hours. A dream was reported
in 1584 of these hours, or 58 per cent of the time.
Multiple dreams, i.e., three or more dreams from a
single night, were reported in 201 hours, or in 13
per cent of those hours which contained a dream —
or in 7 per cent of all the therapy hours examined.16
Multiple dreams of a single night in therapy are
a relatively rare occurrence and this might account for
the paucity of discussions of such situations in the
clinical literature.
We continued our inquiry into the interrelation-
ship of the multiple dreams of a single night16 by
examining the dream sequences of two subjects, who
had been part of another study.28 We were able to
discern from their experimentally collected dreams,
as well as from clinical data, the previously described
sequential pattern in which progression occurs and in
which each dream acts as a "night residue” for the
next dream. This pattern accounted for about 50
per cent of our experimental data.
I would like to illustrate this sequential pattern
by the following series of dreams from a female
subject:
FEMALE SUBJECT — Dream Night No. 6
(6-1): "This little girl was asleep. She was being real
cute, prolonging things for money or to stay in the hospital
longer.”
(6-2): "I passed Frank’s wife in a car. She saw me
come . . . she pulled away. I got kind of mad. I decided
it didn’t make any difference . . .”
(6-3): "I was playing tennis. I hit it back real hard.
We won the game.”
(6-4): "A patient didn’t need the doctor after all. She
for December, 1966
1279
started out thinking she needed a doctor but she didn't.
She had a big bandage on her stomach.”
(6-5): "Doctor was not able to treat patient because
he was not properly licensed. Patient is planning to use
surgery against the doctor.”
The sequential pattern in this series expressed a
dependent sexual longing toward the experimenter/
doctor which led to a feared but expected rejection
by the wife/mother in the second dream. The con-
flict was mastered in the third dream by an aggressive
victory with her own partner. The fourth dream re-
vealed a rejection of the previously felt need though
evidence remains that the need still exists. In the
last dream, a more intense rejection in the form of an
attack on the doctor serves to deny any need.
We found another pattern of dream interrelation-
ship in examining our data which had not been pre-
viously described. This was repetitive in type rather
than sequential. This repetitive pattern accounted
for about 32 per cent of our experimental data. In
contrast to the flexibility of the sequential pattern,
this pattern suggests a traumatic-like state in which
the conflict is re-stated with little progression or
mastery occurring.
Let me illustrate this repetitive pattern, again from
the dreams of our female subject.
(3-1): "Somebody was lost. It was a dog and they
were trying to find out where it lived. A little kid or
somebody couldn’t tell where he lived. It wasn’t my dog,
though. I wasn’t lost. This person who was lost was al-
ways fumbling around leading everybody else around
because he didn’t know what he was doing. Some boy, I
think. Somehow we had telephone numbers, trying to
find the right one. It was supposed to be that little boy
that was lost.”
(3-2): "They filled up the car. There wasn’t enough
room, unless I went back with the people we went back
with before. I could go back with someone else. The
place we were going was an orphanage someplace, some
house, a place like that.”
(3-3): "I was dreaming about visiting, I think it was
some EEG laboratory, or something like that where the
mothers could leave their children, and they could go
shopping. I doubt whether they could, there wouldn’t be
enough room for all these people.”
In all the dreams of the night, the subject dealt
with her fear of being abandoned and her method
of recontacting her family — calling on the phone,
riding in a car, and being picked up.
We wondered if dream patterns of a sequential
and repetitive type might be two ends of a continuum
with one reflecting a flexible-adaptive coping state of
the ego and the other an ego whose solutional cap-
acity is currently constricted. We were able to de-
scribe one night of dreaming on which an inter-
mediate pattern occurred. In this case, progression
developed and then restatement occurred.
As I indicated at the beginning of my remarks, the
primary interest in our group is in the dream more
than in dreaming. We cannot accept Nelson’s com-
ment*,19 made in 1888, which seems echoed in the
flurry of studies on dream time with little or no in-
terest in dream content, that it’s not what you dream
*Nelson, J.: Amer. J. Psychol., 1888.
that matters but only how much. I would like to
conclude with a bit of verse20 by a graduate student
that may explain our romantic commitment to the
richness of dream content rather than the sterility of
dream time. It goes like this :
One mystery alone remains
Of my beloved’s sleep:
We’ve solved the movement of her eyes
And why they do repeat;
We know what brings her breath in sighs;
We’ve tracked her EEG;
The haunting doubt that still remains
Is does she dream of me?
What better reason could one have for an interest in
dream content?
References
1. Alexander, F.: Dreams in Pairs and Series. Ini. J. Psycho-
anal., 6:446-452, 1925.
2. Arieti, S.: "Manic-Depressive Psychosis," in American Hand-
book of Psychiatry, New York: Basic Books, Inc., Chap. 22, 1959,
p. 419.
3. Azima, H.: The Possible Dream Inducing Capacity of the
Whole Root of Rauwolfia Serpentina. Canad. Psychiat. Ass. J.,
3:47-51, 1958.
4. Baldridge, B. J., Whitman, R. M., and Kramer, M.: A
Simplified Method for Detecting Eye Movements During Dreaming.
Psychosom. Med., 25:78-82, 1963.
5. Beck. A. T.: Thinking and Depression. I. Idiosyncratic Con-
tent and Cognitive Distortions. Arch. Gen. Psychiat., 9:324-333
(Oct.) 1963.
6. Cohen, I.: Complications of Chlorpromazine Therapy. Amer.
I. Psychiat., 113:115-121, 1956.
7. Engel, G. L.: Anxiety and Depression-Withdrawal : The Pri-
mary Affects of Unpleasure, lnt. J. Psychoan. , 43:89-97, 1962.
8. Feinberg, I.; Koresko, R. L.; Gottlieb, F., and Wender, P.
H.: Sleep Electroencephalographic and Eye Movement Patterns in
Schizophrenic Patients. Comp. Psychiat., 5:44-53, 1964.
9- Fisher, C. : Psychoanalytic Implications of Recent Research
on Sleep and Dreaming. I. Empirical Findings. II. Implications
for Psychoanalytic Theory. J. Amer. Psychoan. Assoc., 13:197-303,
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10. Fisher, C., and Dement, W. : Studies on the Psychopathology
of Sleep and Dreams. Amer. J. Psychiat., 119:1160-1168, 1963.
11. Freeman, F., Agnew H., Jr., and Williams, R.: An Electro-
encephalographic Study of the Effects of Meprobamate on Human
Sleep. Clin. Pharmacol. Ther., 6:172-176, 1965.
12. Freud, S.: New Introductory Lectures on Psychoanalysis, New
York: Norton, 1933, p. 41.
13. Freud, S.: The Interpretation of Dreams, New York: Basic
Books, 1958, pp. 333-334.
14. Gottschalk, L. A.; Gleser, G. C.; Springer, K. J.; Kaplan,
S. M.; Shanon, J., and Ross, W. D: Effects of Perphenazine on
Verbal Behavior Patterns. Arch. Gen. Psychiat., 2:632-639, I960.
15. Jouvet, M.: "Telencephalic and Rhombencephalic Sleep in
the Cat," in Wolstenholme, G. E. W., and O’Connor, M. (eds) :
The Nature of Sleep, Boston: Little, Brown, I960.
16. Kramer, M.: Whitman, R. M.; Baldridge, B. J., and
Lansky, L. M.: Patterns of Dreaming: The Interrelationship of the
Dieams of a Night. J. Nerv. Ment. Dis., 139:426-439, 1964.
17. Kramer, M.; Whitman, R. M.; Baldridge, B. J., and Lansky,
L. M.: Depression: Dreams and Defenses. Amer. J. Psychiat., 122:
411-419, 1965.
18. Lesse, S.: Experimental Studies on the Relationship Between
Anxiety, Dreams and Dream-Like States. Amer. J. Psychother.,
13:440-455, 1959.
19. MacKenzie, N. : Dreams and Dreaming, New York: The
Vanguard Press, Inc., 1965, pp. 280-317.
20. Miller, M. H.: "On Building Bridges," in Greenfield,
N. S., and Lewis, W. C. (eds): Psychoanalysis and Current
Biological Thought, Madison and Milwaukee: University of Wiscon-
sin Press, Chap. 1, 1965, pp. 3-9.
21. Offenkrantz, W., and Rechtschaffen, A.: Clinical Studies of
Sequential Dreams. Arch. Gen. Psychiat., 8:497-508, 1963.
22. Pierce, C. M.; Whitman, R. M.; Maas, J. W., and Gay,
M. L.: Enuresis and Dreaming. Experimental Study. Arch. Gen.
Psychiat., 4:166-170, 1961.
23. Prigot, A.; Barnes, A. L., and Barnard, R. D.: Meprobamate
Therapy. Harlem Hosp. Bull., 10:63-77, 1957.
24. Schmale, A. H., Jr.: Relationship of Separation and Depres-
sion to Disease. Psychosom. Med., 22:259-277, 1958.
25. Selling, L. S.: A Clinical Study of a New Tranquilizing
Drug. JAMA, 157:1594-159 6, 1955.
26. Trosman, H.; Rechtschaffen, A.; Offenkrantz, W., and Wol-
pert, E.: Studies in Psychophysiology of Dreams. Arch. Gen. Psy-
chiat., 3:602-607, I960.
27. Whitman, R. M.: Drugs, Dreams and the Experimental
Subject. Canad. Psychiat. Assoc. J.. 8:395-399, 1963.
28. Whitman, R. M.; Kramer, M., and Baldridge, B.: Which
Dream Does the Patient Tell? A:ch. Gen. Psychiat., 8:277-282,
1963.
29. Whitman, R. M.: Pierce, C. M., and Maas, J.: "Drugs and
Dreams," in Uhr, L., and Miller, J. (eds): Drugs and Behavior,
New York: John Wiley & Sons, Chap. 49, I960, pp. 591-595.
30. Whitman, R. M.; Pierce, C. M.; Maas, J. W., and Bald-
ridge, B.: Drugs and Dreams. II: Imipramine and Prochlorperazine.
C.ompr. Psychiat.. 2:219-226, 1961.
31. Whitman, R. M.; Pierce, C.: Maas, J., and Baldridge. B.:
The Dreams of the Experimental Subject. J. Nerv. Ment. Dis.,
134:431-439, 1962.
1280
The Ohio State Medical Journal
Introduction to Widowhood
The Role of the Family Physician
GEORGE D. CLOUSE, M. D.
The Author
• Dr. Clouse, Columbus, is a member of the
staffs of Mt. Carmel, Riverside, Grant, and Chil-
dren’s Hospitals.
THE family physician is often in the unique and
unenviable position of introducing a woman to
widowhood. Here, as in marriage counseling, he
becomes an important member of the medical team
upon which almost everything else turns. His words
and actions are often discussed by the family and
relatives for days afterwards, and his management
can guide the family through troubled times ahead.
The task is never easy. For a physician it is doubly
difficult because it symbolizes his defeat in the con-
stant struggle against death. Physicians who do not
know the family well may brusquely offer some words
of comfort and condolence, then hurry away quickly
before their emotions show. The family doctor is
expected to do more than this, and, in fact, is negli-
gent if he does not. He may not even feel he can
say the right words, but that is not as important as
is his presence. He probably would not have to say
much so long as he was there and remained there
while sorrowing ones lean on him for support until
their emotions come somewhat under control. This
is one time when he must convey the absolute impres-
sion of not being in a hurry. The last thing a be-
reaved widow can tolerate is being left alone at such
a time. Compassion and helpfulness are demonstrated
best by being close at hand. The greatest reassurance
comes from not feeling abandoned.
Trivial points? Unnecessary? Not at all, be-
cause the family practice of medicine is based on
treating people as human beings ! These are the little
things that are so important and the stuff that lives
are built upon. These are the things that make
people respect and love their physicians even though
they might owe them money. People might possibly
be persuaded to permit the scientific part of medicine
to be socialized, but they will never permit it for
the human and compassionate side.
The Immediate Situation
An illustrative case history will serve to bring out
how some of the problems relating to widowhood
may be managed. The suggestions given here rep-
resent one approach only; and, undoubtedly every
physician will have his own approach.
Submitted May 4, 1966.
Reprint requests to 185 E. State St., Columbus, Ohio 43215.
A 42 year old man on a hot July afternoon walked
into his house from washing his car. He told his
wife he "couldn’t breathe” and collapsed on the
kitchen floor. Her voice was laden with emotion
when she called me. "He’s awfully bad. Can you
come right away?”
I told her to summon the Emergency Squad and I
would be right over (in spite of an office full of
patients). The squad beat me there and was ad-
ministering oxygen when I arrived. A stethoscope
was immediately applied to the chest, at the same
time I felt for the carotid pulse. No heart activity
was present, and one of the squad murmured there
had been no breathing. An injection of epinephrine
was given into the area of the heart. The wife was
constrained in an adjoining room by a neighbor wom-
an who had come running when she heard a cry
for help. I wanted the wife nearby but not actually
in the room, although she inquired every ten seconds
about her husband. I asked her to call her minister
to see if he could come over.
External cardiac massage was begun even with the
futile realization that the patient was already dead.
The 15 year old son kept yelling, "How’s my
Dad?” When told to shut off a radio that was still
playing, he went over and smashed it (right in the
middle of a commercial). The wife asked if I could
cut the chest open and massage the heart. I made
no reply but stood up and shook my head slowly.
The widow then became completely hysterical and the
son threw himself on the floor beside his dead
father and beat the floor with his fists.
I gave a hypo of morphine gr. to the widow
with no protest although she was abnormally afraid
of "shots.” The son was given morphine gr. I/4. It
is my opinion that there is no better drug for seda-
tion in such instances because of the sense of well-
being that it imparts. The relatively high dosage
for December, 1966
1281
in children seems to be well tolerated because of
their intense emotional level.
"He’s gone isn’t he?” cried the wife. I nodded
slowly in answer. I believed first of all, she should be
told the truth. I suggested the squad continue giving
oxygen for a while longer, then led her into an-
other room and questioned her regarding her hus-
band’s recent health. She described the symptoms
of angina which he had developed several days prior
to death. This, plus knowledge of the man’s
hectic living habits and the history of his father
having had a cardiac death at a similar age, made
a diagnosis of coronary occlusion most likely. Never-
theless I stated that although I was reasonably certain
as to the cause of death I could ask the Coroner to
review all facts and make the final diagnosis. Al-
though she didn’t think this was necessary, I felt
the choice should be hers so that there would be
no unanswered questions later.
I then dismissed the Emergency Squad and reas-
sured the police officer that I would sign the death
certificate. I asked the neighbor to get a sheet
and cover the body, but first to close the eyelids.
The wife asked if pennies could be put on the eye-
lids and this I did. I believe it is important to go
along with certain rites and procedures at this time
to fulfill the family’s feeling that everything was done
properly.
The man’s mother and the woman’s father, being
the only elder relatives still living, were then notified.
In the meantime the woman was reminded gently
that, had he been in the best hospital in New York
City with the best of medical attention, his death
could not have been prevented. When relatives ar-
rived and the first gush of hysteria had subsided, the
minister arrived and administered last rites. Then
the family was brought together and told they must
select a funeral director. A small difference of
opinion was resolved by picking one the deceased
himself would have chosen. Not until then did I
leave the house.
Realization of Widowhood
Later that evening I made another visit to the home.
The widow was given two capsules of pentobarbital,
150 mg. each, which she laid aside until I personally
administered them with a glass of water. Her relatives
had volunteered to stay with her, so a small number
of meprobamate tablets were given to a responsible
looking brother-in-law to administer to the widow
during the next several strenuous days. He was
warned that she must not have access to them
to swallow during an overwhelming feeling of
despondency.
Then I sat down and invited the widow and the
family to ask any questions. Nearly always the
widow has a gnawing guilt feeling and some mem-
bers of the family are prone to blame the person’s
death on various circumstances. Such feelings are
often expressed: "If only ... he might be alive
today.” These feelings were thoroughly aired and
described as perfectly normal reactions. The tension
in the room was considerably lessened when everyone
seemed satisfied that everything had been done that
could be done.
It was also pointed out that it was normal to
have mixed feelings, and everyone should be allowed
to express any hostility or bitterness; even some
irrationality.
Then the son was taken aside and told he could
help his mother by giving her encouragement, by
staying closer around the house and by being more
confidential in talking to his mother about his own
personal feelings and problems.
At this point one of the relatives was determined
to make several large pots of coffee. She was advised
not to prepare the coffee, because by the time of the
funeral, the relatives tend to become more irritable
and emotionally depleted without additional stimuli.
Under such conditions remarks may be made which
should not be expressed while feelings are "raw.”
Instead the busy relative was asked to supervise
the feeding of other members of the family and
organize food contributions from neighbors. The
bereaved wife was advised to eat small amounts of
high energy food at frequent intervals, even if she
had to force it down.
Two days later I stopped at the funeral home
during visiting hours, comforting the bereaved wife
that her husband had lived a useful life and that he
had left a legacy of love and respect with his com-
munity, his associates, friends, and relatives. Seeing
that her emotions were under control she was given
a limited number of pentobarbital capsules for sleep
to use "as long as you need them.” This was
obviously offering trust at a time when she did not
especially feel trustworthy, namely, the beginning of a
long and concerted effort of adjustment. Knowing
the completely hopeless feeling she had and the
many difficult problems ahead, I scheduled an office
visit for her several days after the funeral. I told
her I would like to have her make weekly visits to
the office for several weeks and then at less frequent
intervals as her self-confidence returned.
I reminded several members of the family to al-
low her to cry if she wanted to, and to be left alone
if she wanted to, but not for too long a time. I
obtained assurance from the brother-in-law that in-
surance details, financial arrangements and legal prob-
lems would be given attention.
Office Visits Helpful
The subsequent office visits became counseling pe-
riods on helping her meet the problems she faced,
helping her regain her self-confidence, and helping
her begin to look ahead instead of backwards. In
all the discussions the word widoiv was never men-
tioned because it seems to be a repugnant word to
those misfortunate women to whom it applies. In
our discussions it was necessary to demonstrate sym-
1282
The Ohio State Medical Journal
pathy and compassion without at any time becom-
ing sentimental or allowing over- dependency.
I urged her first to cry without restraint if she
felt like it, and to spend some time alone re-living
some of the pleasant memories she had shared with
her husband. She said she felt that God took him
because his work on earth was finished, but that
He left her here for a purpose. I suggested that
her husband was always near and she could speak
to him in her thoughts, or even aloud if she felt
like it.
Later I drew her away from thoughts of self-pity
and reminded her not to indulge excessively in re-
morse, that there was a job to be done. It was
suggested that at first she need face only a few hours
at a time — not even a day. It was pointed out
that one of her first duties would be the painful task
of writing her "thank you” notes and she was urged
not to postpone this but to get it out of the way.
She was urged to seek the advice of her male relatives
about financial planning which often becomes the
most important concern to face. She was reminded
that her decisions should be tested by applying the
question of how she would feel about them ten years
hence. No problem could be compared to the edu-
cation and rearing of her son. Later on she would
never remember little mistakes she would inevitably
make, so long as she could know she had done her
best as a mother.
I discussed the many financial worries with her
and the tremendous responsibility that must be shoul-
dered as she became the sole head of the household
instead of a dependent wife. Again she was re-
minded to feel free to seek help and not try to carry7
her burden alone.
Feelings Often Overlooked
She seemed quite relieved to hear that other wom-
en had similar feelings about some of the unspoken
things, such as: The bed not feeling "weighted-
down” properly; the loud noises she heard at night
that she never heard before; the letdown after the
first week or two when friends and relatives had ex-
hausted their time and sympathy and there was much
time to be alone; the dreaded long week-ends of
too much quiet; and the things that got lost some-
how even though she could no longer blame her
husband for misplacing them. She wondered to
whom would she tell about that amusing thing she
saw at the super market; or how in the wrorld could
she ever get someone in to fix the leaky7 faucet; who
would be interested in hearing about her awful lone-
liness, inadequacy, and despair; and who would
really care if she just ended it all?
She remarked about how her meal planning had
been considerably altered. She discovered that she
over-bought at the super market, and had lots of
uneaten food with no one to praise her cooking.
She mentioned that as the same day of the week
and the same day of the month of her husband’s
death approached, she would develop an anniver-
sary type of anxiety. Just knowing she was not
alone in these feelings seemed to give considerable
consolation.
Gradually, in the course of our discussions, she
began to learn that living with these feelings meant
not only gritting her teeth or shrugging them off,
but rather a re-focusing of her thoughts from in-
ward to outward.
Turning Toward the Future
It was emphasized that she must think about
other people and help others overcome personal
anguish. She was urged to consult with her min-
ister about how she could start to live creatively and
give comfort to others who were lonely or sick.
In time she made many new friends simply by
being sincerely interested in them. As she became
fairly active in her church and PTA activities, her
self-confidence returned and she made her own de-
cisions more courageously. She remarked that her
husband was probably looking down on her quite
proudly.
She said that she had been whistled at on the
street, and it helped her morale tremendously be-
cause it was very important to her that she was still
desirable as a woman. This was a cue for a brief
comment that she was dressed attractively.
Mild sedation was prescribed sparingly, but after
several months she indicated she thought she needed
more. I realized that the numbness following her
loss was beginning to wear off and that she was
becoming more aware of her physical needs, coupled
with depression. This was considerably relieved first,
by prescribing Etrafon® with its antidepressant effect,
later followed by Pertofrane®, both given once or
twice a day.
Once again she seemed relieved as we discussed
the subject and spoke openly of the problem. I
agreed that prayer would help as it had always done
and that hard physical work would do her good.
She was told that washing walls was a good way to
work off emotion, and that there was nothing like
spading up a garden. Besides, helping things to
grow was another creative activity. Also, she was
urged to step up the pace of her social activities.
After a long interval she saw me again, and I
sensed a certain vague restlessness. After talking
awhile in generalities I suggested she begin to think
entirely of the future and start by getting rid of her
husband’s old pipes. It was suggested she might
even consider the possibility of re-marriage. She
said she would give this some thought, although it
was obvious she already had.
Summary
In summarizing the main problems to be considered
in the foregoing case history, the family doctor plays
for December, 1966
1283
a key role in a difficult and complex human situation.
The following points are worthy of re-emphasis.
1. Be present in the time of need and never act
hurried.
2. Pay particular attention to religious rites and
amenities.
3. Sedation: Morphine first followed by judicious
use of tranquilizers or antidepressants.
4. Discuss with the family to relieve feelings of
guilt and blame.
5. Have constructive discussions with the widow’s
children and responsible relatives.
6. Schedule a definite series of office consultations
with the widow, while anticipating her feelings,
building her morale, helping her to live creatively
and outwardly, giving confidence and encouragement.
7. Avoid using the word widow.
* * *
Comment*: Dr. Clouse’s article presents a "how to do
it” discussion in an area about which we have had far too
few specific instructions. He has tackled a subject that
most physicians meet many times but have found little in
their professional education or reading to prepare them to
handle.
In treating his patient, Dr. Clouse used well accepted
psychiatric techniques and, I am glad to say, did not
disguise these techniques with multisyllable verbiage and
esoteric language. He used supportive psychotherapy and
chemotherapy early and when needed. J do not necessarily
agree with the use of morphine as a sedative or tranquilizing
drug, but I do believe that every physican should use
those drugs he knows best and feels most comfortable in
using. While continuing the supportive therapy, he grad-
ually introduced directive psychotherapy when his patient
was ready for it and could accept it. This timing is, I
believe, of the greatest importance and Dr. Clouse’s percep-
tiveness in determining the patient’s readiness for this step
in therapy indicates, in my opinion, the great value of the
physician’s knowing his own patients. I feel there is a
point at which directive therapy becomes the treatment
of choice and that only the good clinician can recognize
this point. We should remember that our very title of
Doctor is derived from the Latin meaning "to teach.”
To me, preventive Psychiatry is the most sophisticated
form of medical treatment. I can easily envison Dr. Clouse’s
patient having become a chronic psychoneurotic with con-
versions in various areas accompanied by chronic depres-
sion, if she had not had the benefit of preventive care.
In the prevention of invalidism and the prevention of un-
necessary surgery which frequently prolongs and helps
solidify the psychoneurosis, Dr. Clouse has done his pa-
tient a great service.
May we see more "how to do it” articles permitting more
prevention, and with less invalidism. — Wendell A. But-
cher, M. D.
* These comments by Dr. Wendell A. Butcher were solicited by The
Editor. Dr. Butcher is Chairman of the OSMA Committee on Men-
tal Health.
WIDOWHOOD. — There are 8,815,000 widows in the United States.
Metropolitan Life Insurance Company statisticians report that one out of
every eight American women 14 years or older is a widow . . . and almost two
of every three maintain a household, many of these with children. The figures
based on the March 1965 estimates of the Bureau of Census, show that this
country’s widowed population has increased by nearly 870,000 in the past five
years. There are now four times as many widows as widowers. A breakdown
of the statistics on American widows shows that most of them are past midlife;
one fifth of all women at ages 55 to 64 are widows; over two fifths between
65 and 74, and 70 per cent past 75.
At every period of life, it was noted, widowhood brings serious burdens. For
instance, the burden is particularly heavy for women under 45 when three fourths
of them with their own household have at least one young child in their care.
And many widows past midlife have children under 18 in their home. Altogether,
in I960 about 900,000 widows faced this responsibility.
Over half the widows under 35 were reported employed or seeking work
in I960. The proportion was even higher — close to two thirds — at ages 35-54.
Past midlife the proportion diminished. Even so, one seventh of the widows at
ages 65-74 years were employed, many in part-time jobs.
Most widows still have many years ahead of them due to the favorable
prospects of longevity among women. An American woman at age 50 can expect
to live 20 years longer. The same number of years remain for nine tenths of
those under 40. Almost three fifths of our women who are 65 can expect to
live for 15 years and about one third for 20 years. — Metropolitan Life Insurance
Company, News Release, July 26, 1966.
1284
The Ohio State Medical Journal
Hypersensitivity Diseases
Of the Lung
A Review (Concluded)
JON P. TIPTON, M. D.
IN PART ONE of this review, asthma, the pul-
monary infiltration with eosinophilia syndromes,
Wegener’s granulomatosis, and vasculitis involv-
ing the lung were discussed. Part Two will deal with
pulmonary hypersensitivity associated with the inhala-
tion of organic dusts, will include a discussion of
sarcoidosis, tuberculosis and fungus infections, and
will review the pulmonary manifestations of the
major collagen diseases.
Farmer’s Lung
This syndrome is characterized by the development
of a granulomatous interstitial pneumonitis following
exposure to moldy hay, grain, fodder, or tobacco. The
patients develop chills, fever, cough, and shortness
of breath minutes to hours after exposure. Dyspnea
may be extremely alarming and cyanosis may occur.
Physical findings range from minimal change to res-
piratory distress with many crepitant rales and
wheezes. The illness tends to run a course of seven
to ten days with a gradual fall in fever and loss of
symptoms. If it becomes chronic, following repeated
exposure, interstitial fibrosis may develop.
Chest x-rays may show no changes or there may
be extensive, diffuse, interstitial alteration with con-
glomeration of some areas to form patchy, pneumonic
densities.
This disease is held to be caused by antigens in
moldy hay which are produced by the action of the
fungi on heated hay. Thermophilic actinomycetes
are thought to be the important agents which appear
in hay as it becomes heated in the course of molding.
Of these actinomycetes, Pepys identifies polyspora as
the most important. The antigenic stimulus pro-
duced by the action of these actinomycetes on the
hay is so strong that 80 per cent of the affected
patients develop precipitating antibodies in their
sera. These precipitins are present against both the
fungi present in good hay (i.e., Aspergillus, Clado-
sporium, Penicillium, Mucor, various Actinomycetes),
bacteria in the hay, and the all-important antigens
derived from the moldy hay. Contact with the vari-
ous fungi or with good hay will not cause this syn-
From the Department of Medicine and Divisions of Pulmonary
Diseases and Allergy, The Ohio State University Hospitals, Colum-
bus, Ohio.
Submitted April 18. 1966.
The Author
• Dr. Tipton, Fellow, Division of Allergy and
Pulmonary Diseases, Duke University Medical
Center, Durham, North Carolina; formerly (1964-
1966), Resident in Medicine, Ohio State University
Hospital, Columbus.
drome to develop. Inhibition tests showed that the
reactions to moldy hay extracts of the farmer’s lung
sera could only be inhibited by extracts of moldy hay
and not by extracts of the fungi or of good hay.
Other Pulmonary Syndromes Associated with
Organic Dust Inhalation
Bagassosis is a respiratory disease associated with
the inhalation of dust from dried sugar cane fiber or
bagasse. As the bagasse is usually baled and trans-
ported to industrial plants for a variety of purposes,
including the production of paper and various types
of building material, the number of workmen ex-
posed is increasing. Thus, the disease is no longer
limited to the sugar cane growing areas.
Patients suffering from this disease usually develop
shortness of breath, a productive cough, chest pain,
weakness, chills and fever, anorexia, weight loss,
and frequently have night sweats. Histologically,
they are found to develop a round cell infiltration of
the interstitial tissue of the lung with thickening of
the alveolar walls. There results a reduction in all
components of lung volume and a degree of alveolar-
capillary block. It is postulated that antigenic sub-
stances are formed in the bagasse by the action of
fungi under appropriate conditions. Very old moldy
bagasse has produced the most antigenically potent
extracts. It is suspected that thermophilic actino-
mycetes probably serve as an important source of
antigen in bagassosis, as they do in farmer’s lung.
Chronic bronchitis and fibrosis may develop if ex-
posure is not curtailed.
Byssinosis is a syndrome found in textile workers
and is related to exposure to cotton dust (pericarps
and bracts). This disease process is interesting in
that the patients are most symptomatic when exposed
for December, 1966
1285
on Monday mornings after being away from the anti-
genic stimulation during the weekend. Major symp-
toms include fever, dyspnea, cough and wheezing.
Chronic bronchitis and emphysema have been se-
quelae in some patients.
Maple-Bark disease is a disorder that affects both
trees and man. Cryptostroma Corticale can be death-
dealing to the sycamore tree. The hypersensitivity
reaction in man to its spores causes a syndrome similar
to farmer’s lung. The disease has been found among
workers engaged in peeling bark from maple and
sycamore logs. Histologic studies have demonstrated
numerous zones of cellular infiltration of the alveolar
walls and disruption of the bronchiole walls. Exten-
sive alveolar wall fibrosis, numerous granulomas and
areas of focal histiocytosis with foreign body giant
cells have been observed. As the spores do not grow
at body temperature, this syndrome does not represent
a true infection in man. High levels of precipitating
antibodies have been found directed against anti-
genic extracts of the spores of C. corticale. This syn-
drome seems to involve both immediate and delayed
types of hypersensitivity.
Sarcoidosis
This is a non-caseating granulomatous disease in-
volving various organ systems. It is frequently called
a disease of anergy. Sarcoidosis may be subacute,
having a rather sudden onset in patients less than 30
years of age. In this type, one usually finds bilateral
hilar adenopathy and associated erythema nodosum.
These patients frequently have spontaneous remissions
after three or four weeks. The chronic form is more
insidious, occurring in both young and middle-aged
patients. This type eventually involves more systems.
These patients typically lose their delayed sensitivity
(become anergic) but retain circulating antibody
capability. The Kveim test is almost always positive.
By x-ray, one may find hilar nodes, soft patchy
infiltrates, or diffuse fibronodular lesions with linear
markings radiating from both hilar areas. Lesions
may become confluent, assuming a snowball configura-
tion. Healing fibrosis frequently develops in the
lungs.
The exact etiology of this process is not yet defi-
nitely established. Studies by Buckley, Nagaya and
Sieker revealed evidence of immunologic alterations
other than impaired delayed hypersensitivity. Tran-
sient impairment of the response of lymphocytes cul-
tured from patients with sarcoidosis to phytohemag-
glutinin stimulation was found to parallel the clinical
severity of the disease process. A disproportionate
increase in serum IgA was found and the hemolytic
activity of serum complement was increased. They
concluded that an altered immune response may be
important in the pathogenesis of sarcoidosis.
As to etiology, the following hypothesis was for-
mulated and postulated. It held that an infectious
agent (i.e., mycobacteria) and altered immunity are
both important in this process. Normally, susceptible
individuals infected with phage-infested mycobacteria
respond immunologically to both mycobacterial and
phage antigens. The production of phage neutraliz-
ing antibodies impairs the effectiveness of the phage
and permits infection with acid-fast bacilli. In such
a case, typical tuberculosis results. If the patient
lacks the capability to muster an effective immunologic
response to the phage, typical tubercle bacilli do not
develop. An altered phage-resistant mycobacterium
analogous to a pleuropneumonia-like organism form
develops. Areas of chronic inflammation develop as
a result, which like the early phases of tuberculosis
infections, are free of caseating necrosis and are not
associated with tuberculin hypersensitivity. Clinically,
typical sarcoidosis results.
They noted that the continued production of anti-
bodies to mycobacteria by patients with sarcoidosis
and the excretion of phage suggests that some form
of symbiosis between the altered bacillus and the
phage within the host cell must be achieved in which
both persisting antigenic stimulation and phage repli-
cation are possible.
Background for this theory was derived from the
work of Mankiewicz and van Walbeek, who demon-
strated that patients with sarcoidosis and tuberculosis
excrete large quantities of phage lytic for virulent
mycobacteria in their stool. They noted that the pa-
tients with tuberculosis have high titers of neutraliz-
ing antibodies for lytic phage in their sera while those
with sarcoidosis have little or none.
For many years, the literature has been preoccupied
with the pro’s and con’s of loblolly pine pollen as a
possible factor in the etiology of sarcoidosis. These
theories have been based on the apparent direct rela-
tionship of sarcoidosis incidence and the density of
the loblolly pine forests. In addition, laboratory
workers have been able to produce granulomata in
mice and guinea pigs following intranasal instillation
of suspensions of loblolly pine pollen. Other studies
have reported a significant proportion of the popula-
tion residing in so-called pine belts exhibited delayed
skin reactions to a purified protein preparation of
pine pollen, while sarcoidosis patients revealed a
decreased index of skin reactivity consistent with the
depression of delayed hypersensitivity. Patients with
sarcoidosis are held to have an abnormally efficient
production of circulating antibody in the face of im-
paired delayed hypersensitivity. Ten to 13 per cent
of these patients have hypercalcuria in addition to the
increased gamma globulin levels. Antinuclear anti-
bodies have not been demonstrated.
Systemic Lupus Erythematosus
This collagen disease involves most organs and
results in the homogenization and eosinophilic stain-
ing of the ground substance with thickening and
straightening of the connective tissue fibers. Serous
membranes are affected with fibrous deposition and
fibrosis. Pulmonary involvement is frequent but its
pathology is not characteristic.
1286
The Ohio State Medical Journal
Common pulmonary findings are interstitial in-
flammatory lesions with associated atelectasis. The
interstitial pneumonia consists of alveolar wall ex-
udate and swelling of the septa. This process is
said to occur diffusely in 44 per cent of the patients
and focally in 9 per cent. Mucinous edema occurs in
about 10 per cent of the patients and is characterized
by a basophilic appearance (H & E) of the connective
tissue of the peribronchiolar, perivascular, or intersti-
tial tissue.
More commonly, terminal bronchopneumonia,
hemorrhages or pleural effusions occur. Some esti-
mate that fibrinous pleuritis occurs in 50 to 75 per
cent of the cases. Thoracentesis is rarely necessary.
Lupus infiltrates may persist for months without
change. X-ray findings including multiple plate-like
areas of atelectasis at the bases, elevation of the dia-
phragm and pleuritis are frequently seen in SLE. Ar-
teritis of pulmonary vessels may result in hemoptysis,
cavity formation, or lung abscesses if secondary in-
fection occurs.
The peripheral leukocyte count is usually normal
or depressed. About 15 per cent of the patients
with SLE show biologic false positive tests for syph-
ilis, frequently years before a diagnosis of SLE can
be made by any other criterion. This, plus the pres-
ence of high titers of antibodies in all three main
immunoglobulin classes at the onset of clinical SLE,
implies that antigenic stimulation precedes the overt
disease by a prolonged period.
Positive LE preparations are found in approxi-
mately 80 per cent of these patients. The antinuclear
factor has been detected in IgG, IgM, and IgA im-
munoglobulin classes. Immunofluorescent studies
have been done endeavoring to show specific antibody
to nucleoprotein, to deoxyribonucleic acid (DNA),
and to a phosphate-extractable protein of the nucleus.
These studies have been inconclusive. Substances with
nuclear antigenicity are not limited to tissue nuclei, but
may be demonstrated in the blood stream as well. It
is thought that antinuclear antibodies may play a
role in the progression of the already established dis-
ease state if they interact with their respective anti-
gens in the hosts’ tissues.
Progressive Systemic Sclerosis
This is a systemic disorder of connective tissue
characterized by inflammatory7, fibrotic, and degen-
erative changes in the skin, synovium, and certain
internal organs, notably the heart, gastrointestinal
tract, lung and kidney. The fundamental nature of
its etiology remains obscure. Women are affected
twice as often as men. This process generally first
presents between the ages of 30 and 50. There has
been a high incidence in workers exposed to silica
dust.
Pulmonary7 involvement in this disease is of im-
portance. The elastic tissue of the alveolar walls is
replaced by collagen fibers, as is that of the interstitial
areas. Endarteritis, medial hypertrophy, and intimal
proliferation have been described. The pulmonary7
fibrosis results in a decrease in the size of the lungs.
The involved lobes are referred to as being leathery*.
Small subpleural cysts are encountered with some fre-
quency. Extensive fibrous pleurisy may be present,
especially in the lower portion of the lungs. Bron-
chial involvement consists of fibrous replacement of
the muscular coats of some of the smaller bronchi
with resultant bronchiolar dilatation.
It is believed that hyaline changes occur first, fol-
lowed by diffuse parenchymal fibrosis. Obliteration
of the capillaries by interstitial fibrosis leads to degen-
eration of alveolar walls and cystic areas in relation
to the bronchioles. Alveolo-capillary block often
results from the interstitial proliferation and the
alveolar wall changes. The lung fibrosis plus fibrosis
and induration of the thoracic skin combine to pro-
duce a restrictive pulmonary function pattern. To
compensate for the increased oxygen gradient, these
patients tend to hyperventilate and may be mildly
alkalotic due to the ready diffusibility of carbon
dioxide.
There is variable sclerosis of the smaller pulmonary7
vessels. Chest roentgenograms may show diffuse or
localized fibrosis or nodulation, or subpleural cystic
changes. Occasionally, calcification is seen within
the lung.
Approximately half of the patients with P. S. S.
have hypergammaglobulinemia. Studies of the sera
reveal antinuclear globulins in a high percentage of
the cases. Beck reported this finding in 78 per cent
of cases studied. Some of these patients have positive
LE preparations without evidence of that disease.
Over half seem to have positive hemagglutination
and latex agglutination reactions. Complement levels
have been reported as normal although some postu-
late that the sera of certain patients exert an inhibitory
effect on complement fixation reactions. A familial
basis is rare.
Rheumatoid Arthritis
This collagen disease occurs in 2 per cent of our
population. Pulmonary involvement is rare and
nonspecific. However, it is becoming apparent that
interstitial disease of the lung has more than a co-
incidental relationship with rheumatoid arthritis.
In this condition, the lungs may be decreased in
size, depending on the degree of interstitial fibrosis.
One may find dense, pleural adhesions, fibrinous
pleuritis and pericarditis. Nodulation and diffuse
fibrotic scarring may be present. Occasionally, one
finds a typical rheumatoid nodule. Vascular lesions
are infrequent.
Clinically, fever, cough, dyspnea and occasionally
cyanosis exacerbate with bouts of arthralgia. The
syndrome may resemble primary* atypical pneumonia.
Pleural effusions may develop.
Sullivan found pulmonary fibrotic lesions in six
of 100 autopsies of patients with rheumatoid arthritis.
In comparison, only 16 of 16,000 random autospied
for December, 1966
1287
patients had this finding. Some postulate that these
patients are hypersensitive and over-react to coal dust,
silica and other irritants with resultant connective
tissue changes. This disease process combines hu-
moral hypersensitivity of the arthus and cytotoxic
types.
Other Pulmonary Diseases Involving
Hypersensitivity
Pulmonary tuberculosis, although too large a subject
for adequate discussion in this article, represents the
infection type of cellular hypersensitivity. This proc-
ess is produced by Mycobacterium tuberculosis. It
has been discovered that, in addition to delayed hy-
persensitivity, humoral antibodies develop in response
to the same antigenic stimulus. A third immunologic
factor involves the production of a degree of acquired
resistance which is implied from the ability of in-
fected subjects to contain or localize the process.
On re-infection, this enables the patients to localize
the infection to the area in which it begins without
lymphatic involvement.
The cells generally considered to be the alternatives
for antibodies as instruments of acquired immunity
in tuberculosis are the macrophages. These cells
possess the ability to engulf the mycobacteria (with-
out inevitable death to the macrophage) .
The cells directly implicated in delayed hypersen-
sitivity by most workers are the lymphocytes. Some
believe there are developmental relationships between
the lymphocytes and the macrophages. An impor-
tant aspect of the pathogenesis of tuberculosis is the
pronounced tendency of the cellular lesion at the time
of appearance of the immunological responses (about
three to four weeks from the time of infection) to
undergo necrosis. During this phase, the number of
bacteria in the lesion is likely to decrease consider-
ably. Tissue enzymes usually do not attack the dead
tissue. Thus, it retains a relatively solid consistency,
being described as caseous. These lesions most often
heal with fibrosis and deposition of calcium. Even-
tually, they contract to a scar. This granulomatous
lesion plus pulmonary lymphatic and hilar node in-
volvement form the classical Ghon complex of pri-
mary tuberculosis.
Humoral antibodies can be identified by comple-
ment fixation, agar gel diffusion and hemagglutina-
tion tests. The antibodies are elaborated against
proteins and polysaccharides and, perhaps, against
certain lipids of the mycobacteria. Kochan describes
a tuberculostatic factor in the serum of healthy hu-
mans. Inorganic phosphate and citrate, which are
present in "tuberculous” media were found to be
antagonistic for the tuberculostatic activity of the
factor. Also, the tuberculostatic factor could be re-
moved from the sera by repeated adsorptions with
heavy suspensions of tubercle bacilli. This factor is
present in the sera of both tuberculin negative and
tuberculin positive patients and is thought to be native
and not acquired. It is doubtful if humoral factors
are related to acquired immunity against the disease.
Delayed or cellular hypersensitivity is classically
passively transferred only via mononuclear cells (i.e.,
lymphocytes) and not in the serum or plasma. Re-
cent investigations have demonstrated a "transfer
factor” which may be released from the cells into a
cell-free substrate if the hypersensitive lymphocytes
are physically disrupted. A release or liberation of
the same kind of specific material from the hyper-
sensitive lymphocytes has been demonstrated in vitro
following exposure to specific antigen. The involved
lymphocytes appear to become desensitized.
Other pulmonary disorders with hypersensitivity
factors include fungus infestations which, for the
most part, involve both humoral and delayed hyper-
sensitivity mechanisms.
Conclusion
The major pulmonary disorders with a hypersen-
sitivity basis or component are reviewed. Humoral,
cellular and combined forms of hypersensitivity have
been described as the immunologic basis for the vary-
ing disorders. The most current theories concerning
the immunologic mechanisms are presented.
Acknowledgment: Appreciation to Robert J. Atwell,
M. D., Professor of Medicine, The Ohio State University
College of Medicine, for reviewing the manuscript.
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CHRONIC LYMPHOCYTIC LEUKEMIA. — The cooperation of physicians
is requested in a continuing study of chronic lymphocytic leukemia, includ-
ing therapy in patients with this disorder, being conducted by the Medicine and
Radiation Branches of the National Cancer Institute at the Clinical Center, Na-
tional Institutes of Health, Bethesda, Maryland. Referrals of selected patients,
particularly those with high circulating lymphocyte counts, are needed.
Physicians interested in having their patients considered for the study may
write or telephone: Ralph E. Johnson, M. D., Clinical Center, Room BlB-4lB,
National Institutes of Health, Bethesda, Maryland 20014; Telephone: 656-4000,
Ext. 65457. — Announcement, Clinical Center, NIH, September 1966.
❖ * Hs
MALIGNANT LYMPHOMA. — The cooperation of physicians is re-
quested in a study of lymphosarcoma and reticulum cell sarcoma in chil-
dren and young adults. This study is being conducted by the Medicine Branch of
the National Cancer Institute at the Clinical Center, National Institutes of Health,
Bethesda, Maryland.
All clinical stages of biopsy-proven disease are acceptable, and untreated pa-
tients are preferred. Slides of pathologic material must be submitted for review
before patients can be accepted.
Of particular interest are those patients with clinical and histologic features
similar to the malignant lymphoma of African children (Burkitt tumor). These
patients generally present with jaw, ovarian, or abdominal masses. The purpose
of this study is to conduct immunologic, virologic, pathologic, and chemother-
apeutic studies.
Suitable patients will be admitted to the Clinical Center in Bethesda, Mary-
land, or to one of the participating medical centers. Physicians who wish to
have their patients considered for the study may write or telephone: John L.
Ziegler, M. D., Clinical Center, National Institutes of Health, Building 10 Room
12-N-226, Bethesda, Maryland 20014; Telephone: 656-4000, Ext. 64251, (Area
code 301). — Announcement, Clinical Center, NIH, October 1966.
for December, 1966
1289
A Clinicopathological Conference
From The Ohio State University Hospital, Columbus, Ohio
Edited Under the Auspices of the Ohio Society of Pathologists
J. B. McMILLAN, M. B., Ch. B., President
PRESENTATION OF CASE
THIS white male truck driver, aged 28, was ad-
mitted in shock to University Hospital. While
playing baseball two days prior to admission
the patient experienced the sudden onset of se-
vere pain in the throat and neck, followed shortly
by radiation of pain down the back into the legs. He
was taken to his local hospital and was found to have
a blood pressure of 210/90. Later the same day he
developed severe cramping abdominal pain followed
by several large bloody stools and vomiting. He con-
tinued to complain of intermittent cramping abdomi-
nal pain, became febrile, developed tachycardia, and
his blood pressure fell to 80/50, requiring pressors.
The patient became progressively shocky and con-
fused. He was treated with oxygen, intravenous
fluids, penicillin, and streptomycin. Because of his
rapid deterioration he was transferred to University
Hospital for further evaluation and therapy.
Prior to this acute episode the patient had been
in moderately good health. Five months prior to
admission he was found to be hypertensive with his
blood pressure recorded at 190/120. He was started
on antihypertensive therapy but never returned for
follow-up care. He had also had mild epigastric
pain and pyrosis for several years, relieved by Rol-
aids®. Otherwise the past history and the review of
systems were not contributory.
Physical Examination
The patient was moderately obese, acutely ill, con-
fused, cyanotic, and in obvious shock, with a pulse
rate of 140 per minute, a systolic blood pressure of
60, and a temperature of 105. 6°F. His skin was cool
and clammy. Examination of the head, eyes, ears,
nose and throat revealed no abnormalities. Fundu-
scopic examination was not recorded. The neck was
supple; no venous distention was noted; carotid pul-
sations were present; no bruit were noted. The thyroid
was not enlarged. The lungs were clear to percus-
sion and auscultation. The heart had a regular tachy-
cardia and no murmurs or cardiomegaly were found.
The abdomen was obese, rigid, and diffusely tender
with rebound tenderness; no bowel sounds were
Submitted September 17, 1966.
Presented by
• Richard M. Goodman, M. D., Columbus, and
• Emmerich von Haam, M. D., Columbus;
Edited by Dr. von Haam.
heard; no organomegaly was noted. Rectal examina-
tion revealed grossly bloody stool. The extremities
were cool on touch and there was mottling of both
legs. No pulses were palpable below the femoral
arteries. The neurological examination was note-
worthy only for the disoriented, confused mental
status of the patient.
Laboratory Data
On admission, the hematocrit was 53 per cent, the
hemoglobin 18.2 Gm., the white blood cell count
26.000 with 33 per cent nonsegmented and 63 per
cent segmented polymorphonuclear leukocytes and 4
per cent lymphocytes. Serum chemistries on admis-
sion revealed a C02 combining power of 33 mEq.,
sodium of 142 mEq., potassium 4.6 mEq., and chlo-
rides of 92 mEq. per liter; amylase 132 units; direct
bilirubin 2.2 mg. and total bilirubin 3.3 mg. per
100 ml. The blood urea nitrogen was 60 mg. per
100 ml. The prothrombin time was 46.2 per cent of
normal. An electrocardiogram revealed a right in-
terventricular conduction defect, sinus tachycardia,
and broad P- waves.
An anteroposterior recumbent x-ray film of the
chest revealed possible cardiomegaly and normal
lungs. The abdominal films were compatible with
an adynamic type of ileus.
Hospital Course
On admission the patient was acutely ill with
sepsis and shock. His abdomen was tapped and the
fluid obtained revealed 19,500 red blood cells and
47.000 white blood cells with 90 per cent neutro-
phils. Gram stain of the abdominal fluid revealed
numerous bacteria, both cocci and rods. Amylase on
the abdominal fluid was 1600 units. The patient
was started immediately on intravenous replacement
therapy and antibiotics. Four hours after admission
1290
The Ohio State Medical journal
his temperature was 99.6, the pulse 116, and his
blood pressure 140/70. The urine output was 15
ml. per hour; the specific gravity of the urine was
1.025. During this period he had received 7 liters
of fluid including 2,800 ml. of Albumisol® and
12.5 Gm. of mannitol. He also received large doses
of Chloromycetin® intravenously and was treated
with Solu-Cortef®, 100 mg. intravenously every six
hours.
After the initial period of fluid replacement his
condition seemed somewhat stable, and eight hours
after admission an abdominal exploration was per-
formed. Following surgery he continued on a down-
hill course. His urinary output continued to decline
and he became anuric 12 hours after surgery. He
was again taken to surgery and femoral catheters were
inserted for hemodialysis. Postoperatively, he con-
tinued to have rectal bleeding and bloody drainage
from the Levin tube. While being prepared for
hemodialysis 48 hours after admission the patient had
a precipitous fall in his blood pressure with respira-
tory-cardiac arrest. Resuscitative efforts were to no
avail.
CLINICAL DISCUSSION
Dr. Goodman: I think at first that we ought to
summarize a few essential points. This was a 28
year old truck driver who had an acute and severe
pain in his throat and neck which radiated to his
back and into both legs. He was known to be
hypertensive. He became febrile, developed tachy-
cardia, went into a shock-like state, and was referred
to our hospital. He had been in relatively good health
until five months ago, when he was found to be hy-
pertensive and gave a history of having mid-epigastric
pain and pyrosis. He was admitted to the hospital in
obvious shock with a rapid pulse, a low blood pres-
sure, and fever. His abdomen was obese, rigid, and
there was certainly evidence of peritonitis. He also
had grossly bloody stool. His legs felt cool, and
no pulses were felt below the femorals. The labo-
ratory data are not too revealing for his state at that
time. His electrocardiograms suggested left ventricu-
lar hypertrophy and a possible conduction defect.
Discussion of X-Rays
Before we continue I think we ought to take a look
at his x-rays.
Dr. Dunbar: I do think that his heart is large
and that his left ventricle is bigger than it should be.
I also feel that his aorta is wide for a 28 year old
man, and I would be happy with the diagnosis of
some type of cardiovascular disease. The abdomen
shows small bowel distention with fairly thick walls.
Dr. Goodman: What’s the significance of the
thickness of the bowel wall?
Dr. Dunbar: Boggy, edematous small bowels
are quite common in either venous or arterial throm-
bosis and mesenteric infarction. It could also be just
peritoneal fluid between the loops.
Dr. Goodman : Is there any evidence on the
chest film of coarctation or dissection of the aorta?
Dr. Dunbar: No, I see no rib notching and no
evidence of the fuzziness which we get with mediasti-
nal hematoma.
Dr. Goodman: Do you think there is widen-
ing of the arch of the aorta or anything that would
suggest aneurysmal dilatation?
Dr. Dunbar: The aortic arch is wider. If he
were a 50 year old man I could not say that this was
abnormal, but for a 28 year old man I don’t think
the aortic shadow should be as wide as this is.
Dr. Goodman : This man was acutely ill. They
were able to stabilize him with fluids and albumin,
and once he was stable the surgeons felt they should
operate. So they explored the patient. He didn’t
do well. Hemodialysis was attempted. He became
anuric and died.
An Obese First Baseman
I would now like some information regarding the
body size of this man. Was he tall and thin, short
and fat, or what do we know about his stature?
Dr. Thompson : There is no mention on the
chart other than that the patient was moderately
obese.
Dr. Goodman : I would like to take you through
my thought processes as I first read this protocol. The
first thought that entered my mind : Here was a young
fellow with an acute onset of pain, and in any young
individual with a pain in his neck radiating down
his back to his legs one must certainly be concerned
with an acute vascular accident, and the first diagnosis
that entered my mind was that perhaps we are deal-
ing with a ruptured aneurysm in a hypertensive
individual.
If we assume a ruptured aneurysm, we are forced
to ask the questions, Why? and What type of an-
eurysm did he have? It could have been congenital,
syphilitic, arteriosclerotic, mycotic, traumatic, or em-
bolic. You can rule out a number of these by his
history, etc., but you certainly can’t rule out the pos-
sibility that he had a congenital aneurysm or an ar-
teriosclerotic aneurysm, or perhaps even an aneurysm
that was precipitated by his playing baseball. Did
he experience any trauma to his abdomen or chest
at the time he was playing baseball?
Dr. Thompson: Apparently this came on during
a baseball game and he didn’t experience any trauma.
He was playing first base when this happened.
Dr. Goodman: Let us assume for the present
that this man did have a ruptured aneurysm and make
the further assumption that we may be dealing with
an arteriosclerotic aneurysm. The most common site
of such an aneurysm is at the iliac bifurcation. It is
usually below the renals and this would certainly ac-
count for the findings of decreased pulsations below
for December, 1966
1291
the femoral pulses and could account for his symp-
toms of pain in the neck with radiation down. He
could have had dissection with subsequent rupture.
Now we must ask ourselves, Could this man have had
Marfan’s syndrome? Sudden death in a young indi-
vidual with a possible vascular accident as the factor
always suggests Marfan’s syndrome.
I really wasn’t so pleased with my first impres-
sion because I became concerned with his abdomen,
and here we find that he did have evidence of a peri-
tonitis with blood in his stools, and we could explain
this on the basis of an aneurysm which had ruptured
into the gastrointestinal tract. I think it is rare, but
it has been reported. So we could lump everything
together and explain it in this way.
Mesenteric Vessel Disease?
The next thing that we have to consider is that
something went wrong with the mesenteric artery
— either a thrombosis or an embolism — and per-
haps one might even be intrigued with the idea that
this man had mesenteric artery insufficiency, because
of the symptoms he gave earlier of pyrosis and mid-
epigastric pain, though at the same time perhaps
these symptoms could have been due to a peptic
ulcer. When we speak of mesenteric artery disease
we must be aware that this occurs in all ages, but it
is much more common in older individuals and much
more common in men. It need not be the mesenteric
artery; it could be the mesenteric vein. But by and
large, when you are dealing with thrombosis of a
mesenteric vein you are very much concerned with
infections in the neighboring organs, such as the
appendix, colon, and the pelvic organs. When you
think in terms of a thrombosis affecting the mesen-
teric artery you are much more concerned with ar-
teriosclerosis, endocarditis, polyarteritis, and even
thromboangiitis obliterans.
As long as we think about the mesenteric artery
we must ask ourselves, Was this an acute or chronic
affair? There is some indication, if we want to put
emphasis on the earlier symptoms, that he could have
had a chronic mesenteric artery insufficiency, but I
would like to consider this more as an acute episode.
The symptoms of acute mesenteric artery thrombosis
could be identical to what he had — pain in the ab-
domen, increased temperature, increasing white count.
His entire course of shock, increase in hematocrit,
diminished blood volume, and the anuric state he
went into could be due to a mesenteric artery disease.
But once again we have to raise other questions.
What else could simulate an acute vascular accident
involving the abdomen? Similar symptoms are found
in acute pancreatitis, in traumatic pancreatitis, or in a
perforated viscus. As far as perforation of a viscus
is concerned, we have no evidence on x-ray that he
had any free air under his diaphragm though we do
have a history of a possible peptic ulcer. If he had
a pancreatitis the chances are that the serum amylase
would have been elevated, and it was not in this case.
He did have an increase in the amylase in his peri-
toneal fluid and we certainly can find this in mesen-
teric artery disease.
Hypertension
Let’s now try to answer the most basic problem
of this case: Why was this man hypertensive? The
protocol says, "A funduscopic examination was not
recorded.” I can assume that it wasn’t done. If one
had looked at his eyegrounds one could have come to
some conclusion as to the duration and severity of his
hypertension and maybe as to its cause. Certainly
whenever you have a hypertensive individual you
should examine his eyegrounds. Let’s discuss a few
possibilities of his hypertension. One intriguing pos-
sibility is that perhaps this man had a coarctation of
his aorta and that his femoral pulses were diminished
all along. But we have no evidence of this and I
consider this possibility as very remote. Perhaps he
had a pheochromocytoma with sudden onset of hy-
pertension. He could also have had any type of renal
disease, or just essential hypertension which went
into the malignant phase.
Well, I am about to commit myself now. I think
we are dealing here with a man who had an acute
vascular accident. This accident certainly involved
his gastrointestinal tract. I think that perhaps one
of the most likely would be rupture of an aneurysm
and I pick this because he had pains radiating into
his neck, down his back, and into his legs. If we are
just dealing here with an isolated mesenteric artery
thrombosis, I would be very surprised to find these
symptoms. So I would think that we are dealing
here with a man who had a dissection and rupture of
an aortic aneurysm and that this aneurysm may very
well have subsequently involved the mesenteric artery
with occlusion or have ruptured into the gastroin-
testinal tract producing the symptoms of blood in the
G. I. tract and subsequent peritonitis.
Why he had hypertension I don’t know, and I
really don’t think it does any good to speculate
more about it. I suppose I could say perhaps the
sudden onset may mean that he had a pheochromocy-
toma, but we really have very little to speculate on.
And behind it all lies the possibility that perhaps we
are dealing with a Marfan’s syndrome with dilatation
of the arch of the aorta and rupture. I would call
your attention to the fact that not all Marfan indi-
viduals are tall and thin; they can be obese, but this is
rare.
General Clinical Discussion
Dr. Perkins: I have seen a few reports of
silent dissection of the aorta and I wondered if it
could have happened some time in the past in this
man, resulting in hypertension, and a delayed rup-
ture caused his acute episode.
Dr. Goodman: I think that’s a good possibility.
Dr. Harris: You say "aneurysm.” Couldn’t you
be a little more specific about that?
1292
The Ohio State Medical Journal
Dr. Goodman: I would think probably that this
was a dissecting type of aneurysm and that he dis-
sected earlier and that he didn’t really rupture a true
aneurysm.
Dr. Harris: Could you suggest any particular
site in the aorta for the rupture? Why did he die
so suddenly?
Dr. Goodman: This dissection could well have
started in the arch of his aorta or in the ascending
portion, dissected all the way down and ruptured into
his abdomen. If you take the group of people with
dissecting aneurysm below the age of 40, 20 per cent
of them will have Marfan’s syndrome and only about
9 or 10 per cent will suffer from coarctation of the
aorta. By the way, we should mention that a very
common cause of dissecting aneurysms in women is
pregnancy, and this is why women ought to be ex-
cluded from any statistics.
Student: I would just like to take advantage of
one fact Dr. Thompson gave us a few moments ago
and that’s that the man was playing first base. This
would suggest a person with a long reach. I would
like to ask Dr. Goodman what Marfan’s syndrome is.
Dr. Goodman : It is really a collection of sev-
eral manifestations occurring in individuals suffering
from an inherited defect of connective tissue de-
velopment. It particularly affects the aortic arch with
weakening of the media of the aorta leading to dis-
secting aneurysm or aortic regurgitation, and it also
produces ectopia of the lens, all probably due to
weakness of the connective tissue. An individual
with the Marfan’s syndrome may have one or all
of these manifestations.
CLINICAL DIAGNOSIS
1. Dissecting aneurysm of the aorta.
2. Mesenteric artery disease with thrombosis and
hemorrhage.
3. Generalized peritonitis.
PATHOLOGICAL DIAGNOSIS
1. Medionecrosis of the aorta with ruptured
dissecting aneurysm.
2. Compression of the inferior mesenteric artery
with thrombosis, and infarction of the small
intestine.
3. Acute peritonitis.
DISCUSSION OF PATHOLOGY
Dr. von Haam: First we would like to find out
from Dr. Thompson what surgical procedures were
performed.
Dr. Thompson: Since the patient presented an
acute surgical abdomen they felt that it had to be ex-
plored. When they opened the abdomen they did
discover diffuse peritonitis. They also found numer-
ous loops of small bowel which appeared dark and
showed questionable viability. They removed two
small areas of necrotic bowel. The stomach was filled
with blood clots and a small bleeding ulcer was found
at the cardio-esophageal junction.
Dr. von Haam: At the autopsy we found a
rather tall man measuring 6 ft. 4 in., weighing about
300 lbs. There was no specific disproportion of the
length of the extremities, nor were there other gross
characteristics present commonly associated with Mar-
fan’s syndrome. The heart weighed 450 Gm. and
showed left ventricular hypertrophy. The aorta had
dissected through a slit 5 mm. above the valve. A
minimal amount of seepage had occurred into the
pericardial cavity (70 cc.). A seepage of 200 cc.
had occurred into each pleural cavity, and about 500
cc. of blood had infiltrated the retroperitoneal space.
The dissection of the aorta had progressed to the
femoral arteries, causing stenosis and thrombosis of
both vessels. The renal arteries were free of dissec-
tion. The mesenteric artery showed a severe compres-
sion of the lumen by the dissecting aneurysm with
recent and complete thrombosis.
Microscopic sections showed necrosis and severe
mucoid degeneration of the media of the aorta with
splitting of the media and recent dissection. The
bleeding ulcers in the stomach were of the type com-
monly found in acute stress with superficial necrosis
of the mucosa and seeping hemorrhage. Much of the
remaining bowel showed recent necrosis due to com-
plete ischemia. No pheochromocytoma was present,
but a small cortical adenoma was found in one ad-
renal gland. The kidneys showed no evidence of
advanced vascular disease but did show ischemia of
the glomeruli compatible with shock.
So in summary, we have an individual who had
some but not all the constitutional characteristics of
Marfan’s syndrome with medionecrosis of the aorta
and extensive dissection. I think the dissection prob-
ably had been going on for some time and we esti-
mated its duration at four to six days. The patient
died from acute intestinal infarction due to mesenteric
artery thrombosis with diffuse peritonitis.
IN 168 COAL MINERS, peptic ulcer was observed in 18.5 per cent. There
was no difference in the occurrence of peptic ulcer in patients with or without
pulmonary disease in chest x-ray and pulmonary function tests. - — Edward M.
Schneider, M. D., Clinical Medicine, 73:69-71, March 1966.
I or December, 1966
1293
Maternal Health in Ohio
Maternal
Deaths Involving
suicide
By the OSMA COMMITTEE ON MATERNAL HEALTH
With Comment of Consulting Psychiatrist
T
^HE files of the Committee on Maternal Health,
Ohio State Medical Association, contain ap-
proximately 1,025 cases for nine years, 1955 to
1963, inclusive. In ten of the cases the cause of death
is related to suicide associated with the pregnant state.
Eight of the ten have been voted nonmaternal deaths
(no connection with pregnancy) while only two were
considered maternal deaths. Herewith the Committee
presents three cases, two of which are maternal deaths;
the third was classified a nonmaternal death.
Case No. 533
The patient was an 18 year old, white, Para II, who died
from asphyxia ten days postpartum. Her general past history
was not remarkable, neither was the specific history concern-
ing emotional or psychiatric disturbances. However, in her
sixteenth year the patient had delivered a pregnancy at
term without any obstetric complication; she was married
during the second gestation. The family physician with
whom she registered in the seventh month, in retrospect
concluded that the patient might have developed a "guilt
complex’’ originating in circumstances surrounding either
or both of the two pregnancies.
Prenatal care for the second pregnancy revealed no abnor-
malities; serologic test for syphilis was negative, and her
blood was Rh positive. On November 27 (42 weeks gesta-
tion) labor began spontaneously and the patient was ad-
mitted. Premedication consisted of Demerol® and scopol-
amine. Membranes ruptured spontaneously and after a six
and one-half hour labor the patient delivered a living term
fetus (weight not stated) under a general anesthesia, admin-
istered by a registered nurse. No lacerations were incurred;
blood loss was estimated at 200 cc., and the third stage was
normal.
The following day she was discharged to her mother’s
home at her own request. Her physician made two routine
visits (November 30 and December 4) reporting her puer-
peral course to be uneventful. Later the patient’s mother
revealed that the daughter seemed slightly vague on or about
December 5 (8 days postpartum) stating that she "must go
home” (to her abode, approximately two miles away).
Further, that the patient insisted on getting all the work
done before she would leave. On December 5 or 6 the
patient’s mother considered advising the physician of the
unusual behavior, but neglected to do so. Later, on Decem-
ber 6 and 7, the family missed the patient; further search
*A continuous state-wide Maternal Mortality Study is being con-
ducted by the Committee on Maternal Health of the Ohio State
Medical Association, in cooperation with the Ohio Department of
Health and representatives of the various County Medical Societies.
Summaries of some of the cases studied by the Committee, based on
anonymous data submitted, are published here from time to time,
interspersed with statistical summaries.
revealed she had trudged through ice and snow to her
mobile-home. Her body was found (fully clothed) sub-
merged in a nearby creek.
Cause of Death (Coroners Autopsy): Asphyxia by drown-
ing.
Comment
The case was studied at great length by the Com-
mittee. All available facts were discussed in detail.
It was assumed that the patient had developed a
postpartum psychosis, based upon predisposing factors
presented in the history. After prolonged delibera-
tion, by a narrow vote, members voted the case a
nonpreventable maternal death. Nearly a majority
believed the mother might have secured valuable as-
sistance from the physician had she advised him
promptly of her daughter’s behavior.
Case No. 595
This patient was a 26 year old, white, gravida II, Para I,
who died undelivered of carbon monoxide poisoning, in
the thirty-sixth week of gestation. Little information is
available concerning her past history; however, from various
sources it was elicited that she had episodes of emotional
disturbances in the past. The previous pregnancy was de-
livered in 1958, at term without any known obstetric com-
plications. Her child’s pediatrician states she made regu-
lar visits with the baby who developed a succession of
complicated illnesses. This physician, who also attended
neighbors of the deceased, stated that they regarded her as
"seriously upset” over prospects of bearing another child.
She had no prenatal care during the last pregnancy.
On February 16 (about eight months gestation) the pa-
tient’s husband awoke to discover her dead in the front
seat of the family car. Allegedly she had attached a garden
hose to the exhaust, led the other end into the car, and
started the motor.
Cause of Death (Coroner’s Autopsy): Carbon monoxide
poisoning; suicide.
Comment
Realizing that only meager facts were available in
the case, the Committee studied the data with great
interest. Emotional features possibly precipitated by
the ill-health of her first-born child were discussed at
great length; the vague facts concerning previous
anxiety states were considered carefully. Members
felt that these potential factors, together with certain
physiologic changes associated with pregnancy, formed
1294
The Ohio State Medical Journal
the basis for a diagnosis of psychosis of pregnancy.
By a majority vote the case was voted a nonprevent-
able maternal death.
Case No. 891
The patient was a 22 year old, white, gravida I, who
died undelivered, 28 weeks gestation, from a self-inflicted
bullet wound of the heart. Her past history is noncon-
tributory. She registered with her family physician in the
third month of pregnancy, and made nine prenatal visits.
Blood type was O positive, serologic test for syphilis was nega-
tive; the physical examination was grossly normal. Her
prenatal course was uneventful until the fifth month when
she displayed signs of tension and emotional disturbance,
withholding all information regarding the cause. Frequent
visits to her pfq-sician (six or more) were then made at in-
tervals in futile attempts to investigate and treat the basis
of the patient’s distress. The last such visit was made at
twenty-eight weeks gestation (January 3) when the physi-
cian recorded "she appeared much improved and reported
subjective improvement”; the next appointment was sched-
uled in two weeks.
On arriving home one night, the husband discovered the
body of his wife.
Cause of Death ( Col-otter’s Autopsy) : Bullet wound of
the heart; hemopericardium 200 cc.; bullet wound of the
left lung; hemothorax 1800 cc.; bullet wound of left thorax;
gravid uterus, seven month fetus; suicide.
Comment
Members of the Committee studied available infor-
mation surrounding the tragedy, and analyzed details
supplied by the physician of the patient. After due
deliberation it was felt that the pregnancy was not
related to the death either directly or indirectly. The
case was voted a nonmaternal death.
Comment of Consultant
The following comment of a consultant, who is a
specialist in Psychiatry, was given at the request of
the Committee;
"Suicide is a subject few physicians like to con-
sider. Death represents an individual failure to us,
and when there is added the realization that one of
our own patients has decided to kill herself and has
carried out her decision, most of us avoid considering
it with all the emotional rationalization at our com-
mand. For this and other reasons, such as the pos-
sible abrogation of insurance payments, fear of the
effect such knowledge might have on surviving rela-
tives and friends, and religious considerations, many
suicides are glossed over as natural deaths, and I feel
that any group of statistics involving suicide rates are
inconclusive. They cannot, therefore, be used as we
ordinarily use statistics in the practice of medicine.
Even so, suicide is known to be one of the ten most
frequent causes of death in the United States today.
"Prevention of death, whether it be due to an un-
controllable postpartum hemorrhage or to an uncon-
trolled postpartum depression, is the ultimate concern
of every physician. The three foregoing case histories
make the point that the obstetrician should be fully
aware of the signs and symptoms of depression and
their implications. He should also know the avail-
able weapons in our therapeutic armamentarium.
"However, it is imperative that relatives, friends
and persons with whom the patient associates, be
alerted to notice early signs, or symptoms of unusual
behavior and report them to the patient’s physician
or other proper source. Tensions, demonstrable as
nervous or emotional disturbances, as well as pecu-
liarities in behavior or habits are among the important
signs to be noted.
"No pregnant woman is without some depression,
which can be intensified by environmental factors or
by emotional immaturity. Endocrinologically, the
postpartum period resembles the menopause. The
cornerstone of obstetrical psychotherapy is a strong,
supportive doctor-patient relationship. This entire
journal could be devoted to the discussion of the three
cases in their relationship to these principles, and to
the art and science of the recognition of the signs
of depression and their implications. The space al-
lotted does, however, permit the plea that every pri-
mary-care physician avail himself of whatever training
he can obtain, be it through reading, through semi-
nars, or, preferably, through postgraduate training of a
clinical nature. I feel that depression is probably the
most common disease encountered by the physician.’’
ABORTION AND THE PSYCHIATRIST. — A study of 213 patients with
puerperal psychosis showed that the condition carries a good prognosis and
is virtually unpredictable. Instability in pregnancy does not contribute materially
to the incidence of puerperal psychosis. Suicide is less of a risk in pregnant women
than in nonpregnant women. Unmarried mothers are relatively immune from
puerperal psychosis. Abortion, even if therapeutic, may in itself produce a
psychosis.
There are no psychiatric grounds for the termination of pregnancy. Pressure
may be brought to bear on the psychiatrist to recommend termination. He may be
told the patient is threatening suicide or be regaled with the dreadful social con-
sequences. The answer is still not to recommend termination, which may indeed
be harmful, but to nurse the patient through her unstable phase. — Myre Sim,
M. D., Birmingham, England: British Medical Jottrttal, p. 145, July 20, 1963.
for December, 1966
1295
NEWS
n AN° c?
Proceedings of The Council . . .
Statements of Policy Regarding Utilization Review Committees,
And Assignment Under Medicare Are Drafted in Special Session
T
^HE COUNCIL of the Ohio State Medical As-
sociation met at the Fort Hayes Hotel, Colum-
bus, Ohio, 8:30 A. M., October 23, 1966. Those
present were: Drs. Lawrence C. Meredith, Elyria,
President; Robert E. Howard, Cincinnati, President-
Elect; Henry A. Crawford, Cleveland, Past President;
Philip B. Hardymon, Columbus, Treasurer; Paul N.
Ivins, Hamilton; Theodore L. Light, Dayton; Robert
N. Smith, Toledo; P. John Robechek, Cleveland; Ed-
win R. Westbrook, Warren; Sanford Press, Steuben-
ville; Robert C. Beardsley, Zanesville; Oscar W.
Clarke, Gallipolis; Richard L. Fulton, Columbus;
and William R. Schultz, Wooster. Others attending
the meeting were: Drs. John H. Budd, Cleveland,
and Robert E. Tschantz, Canton; Mr. Wayne E.
Stichter, Toledo, OSMA Legal Counsel; Mr. James
Kline, Offices of the General Counsel, Toledo; and
Messrs. Page, Edgar, Campbell and Moore of the
OSMA staff.
The Council developed statements, concerning the
method of billing patients under Titles XVIII and
XIX of Public Law 89-97, and with regard to Utiliz-
ation Review Committees of Hospitals and Extended
Care Facilities.
The Council then recessed for a discussion pro-
gram with the Presidents, Secretaries, and Hospital
Relation Committee Chairmen of county medical so-
cieties, members of the OSMA Committee on Gov-
ernment Medical Care Programs and the Committee
on Hospital Relations, and Executive Secretaries of
certain county medical societies.
Subsequently, the Councilors met with the mem-
bers of each district and the policy statements were
reviewed and many suggestions were volunteered for
incorporation in the finished statements.
Council then recessed until 1:30 P. M., October 26,
1966. It met in the Board Room of the Huntington
National Bank Building, 17 S. High Street, Colum-
bus. Those present were: Drs. Meredith, Howard,
Crawford, Hardymon, Ivins, Light, Westbrook,
Beardsley, and Fulton. Also present were: Mr.
Wayne E. Stichter and Messrs. Page, Gillen, Trap-
hagan and Moore.
Billing Methods Under Title XVIII
and Title XIX
By official action, the following policy was adopted
as a "Statement of Position of The Council of the
Ohio State Medical Association Regarding the Method
of Billing Patients Under Titles XVIII and XIX of
Public Law 89-97”:
STATEMENT OF POSITION OF THE COUN-
CIL OF THE OHIO STATE MEDICAL ASSO-
CIATION REGARDING THE METHOD OF
BILLING PATIENTS UNDER TITLES XVIII
AND XIX OF PUBLIC LAW 89-97
The Council of the Ohio State Medical Association
has been advised by the Ohio Department of Public
Welfare that physicians may not employ direct bill-
ing of patients who are recipients under the Ohio De-
partment of Public Welfare Aid For the Aged pro-
gram but must employ the assignment method of bill-
ing for such patients. The Council has received from
the Ohio Department of Public Welfare a copy of its
letter dated October 21, 1966 addressed to the physi-
cians of Ohio on the subject of "Billing Procedures
— - Charges for Services Provided On Hand After
July 1, 1966 to Recipients 65 Years of Age and
Over,” a copy of which letter is attached hereto.
In enacting Public Law 89-97 Congress specifically
1296
The Ohio State Medical Journal
provided that physicians may employ either of two
methods of billing:
(a) directly billing the patient; or
(b) billing by means of an assignment executed
by the patient and accepted by the physician.
Congress also specifically provided in Public Law
89-97 that every patient shall have and enjoy the right
of free choice of physician and Congress specifically
disclaimed any supervision or control over the practice
of medicine or the manner in which medical services
are provided or over the administration or operation
of any institution, agency or person providing health
sendees.
It is the official policy' of this association, as already
established by The Council and endorsed by the House
of Delegates of this association that all physicians
should be encouraged to bill directly all their patients
for all medical sendees rendered to them, regardless
of what third parties may be involved.
This association takes strong issue with the follow-
ing statement in the Department of Public Welfare’s
letter of October 21, 1966:
"A claim on Form 1490 may only be filed on the
basis of a receipted bill or through the acceptance
of an assignment by a physician. Since the public
assistance recipients may not be given money
for the purpose of paying medical bills directly
and can not be reimbursed from welfare
funds if they make a payment to the physician,
the assignment method appears to be the only prac-
tical way for handling bills for sendees rendered to
welfare recipients.”
In this connection attention is called to Ohio Re-
vised Code Section 5105.12 in which it is expressly
recited that:
"warrants for the payment of medical, dental,
optometrical, nursing, or hospital care, shall be, at
the option of the department (Ohio Department of
Public Welfare), made payable to, and delivered
directly to, either the recipient or persons or agen-
cies furnishing such care.”
It is abundantly clear that this Ohio statute permits
payment to be made either directly to the welfare
recipient or directly to the physician and without the
necessity of an assignment in either case.
Ever)’ member of this association is urged to bill
welfare recipients directly (as is specifically permitted
under Public Law 89-97 and under Section 5105.12
of the Ohio Revised Code) and to bill all patients
directly in accordance with the established policy of
this association. Members of the profession are re-
minded that any dictation or control by any lay part)'
or organization over the practice of medicine inevi-
tably leads to the deterioration of quality medical care
and to the injur)’ of the public. Ever)’ member of the
profession is accordingly advised to guard zealously
his professional freedom, to resist strongly any and all
efforts to interfere with or exercise control over his
right and duty to practice medicine in accordance
with his best medical judgment, to oppose vigorously
any attempt to interfere with the personal and con-
fidential relationship of physician and patient or to
impair in the least the valuable right of the patient
to a free choice of physician. Only by so doing can
the profession assure to patients a continuation of the
high quality medical care which they now enjoy.
Council Instructions
It was the instruction of The Council that the state-
ment of position dealing with the Ohio Department
of Welfare be issued to all members of the Ohio
State Medical Association (Medicare Newsletter
No. 6) and to county societies, specialty societies,
American Medical Association and to other state
medical associations.
The Council requested that the statement of posi-
tion be accompanied by a letter from the President
of the Association, explaining the necessity for this
action.
The Council further requested that a special letter
from the President of the Association be sent to all
attending the officers meeting of October 23, 1966,
thanking them for their enthusiastic participation in
developing the policy of the Association with regard
to the matters at hand and explaining recent develop-
ments which have required an alteration, so that the
statement regarding billing methods is directed to-
ward the Ohio Department of Welfare rather than
the U. S. Department of Health, Education, and Wel-
fare. It was requested that a copy of the Ohio De-
partment of Welfare letter, dated October 21, 1966,
be attached thereto.
Utilization Review Committees
The Council then adopted the following statement
with regard to Utilization Review Committees:
STATEMENT OF POLICY OF THE COUNCIL
OF THE OHIO STATE MEDICAL ASSOCIA-
TION REGARDING UTILIZATION REVIEW
COMMITTEES OF HOSPITALS AND EX-
TENDED CARE FACILITIES
The U. S. Department of Health, Education, and
Welfare, through its Division of Medical Care Ad-
ministration, has expressed a specific interest in
engaging contracts "to plan for, establish and sup-
port the initial operation of community-based utiliza-
tion review plans for hospitals and extended care
facilities.”
It is the official policy of this Association that:
(1) The function of a utilization review com-
mittee is a purely medical function.
(2) The responsibility and obligation of such
committees are medical only.
(3) Ever)’ utilization review committee shall be
composed solely of practicing physicians.
(4) When such a committee enters into an
for Deceviber, 1966
1297
agreement or contract with any third party, the ful-
fillment of its medical responsibility and obliga-
tion is seriously jeopardized.
(5) When a utilization review committee or its
individual members accept remuneration for carry-
ing out the medical responsibilities of the com-
mittee, an employer-employee relationship is
established, which leads to lay influence and control
over matters which are strictly medical.
(6) Since the function of a utilization review
committee is exclusively medical in nature and pur-
pose, its findings and recommendations should be
limited to medical decisions and should not in-
clude recommendations with respect to third-party
benefits to the patient.
(7) This Association recommends to each com-
ponent County Medical Society that it point out to
the utilization review committees in its county the
proper function of such committees and the limits
of their responsibilities and obligations.
(8) Each County Medical Society is urged to
establish, or cause to be established, a utilization
review committee. In event a County Medical
Society does not have sufficient professional per-
sonnel available to establish an effective Utilization
Review Committee, such County Society is urged
to seek the aid of this Association in establishing
an area Utilization Review Committee which would
function in two or more counties.
The Council instructed the Executive Secretary to
notify Dr. James L. Elenry of the acceptance of his
statement for information and future consideration,
and to convey the thanks of The Council for his
assistance.
Additional Actions
A motion to continue with additional docket items
was officially adopted.
Direct Billing — AMA Resolution
The following resolution on direct billing (shown
here in its final form) was adopted as OSMA policy
and approved for submission to the AMA House of
Delegates:
WHEREAS, the Principles of Medical Ethics forbid
the rendition of a physician’s services under terms
and conditions which tend to interfere with or
impair the free and complete exercise of his medi-
cal judgment and skill or tend to cause a deteriora-
tion of the quality of medical care, forbid both the
payment and the receipt of a commission for the
referral of patients, and forbid the solicitation of
patients; and
WHEREAS, the American Medical Association has
repeatedly denounced as unethical any professional-
lay relationship or arrangement which results: (1)
in the denial of, or interference with, the free choice
of a physician; or (2) in the deterioration of the
physician-patient relationship; or (3) in the split-
ting of fees with a lay organization; or (4) in the
accrual to lay employers of a direct profit from the
fees paid for professional sendees; or (5) in the
exploitation of the services of the physician for the
financial profit or benefit of a lay agency or organ-
ization; and
WHEREAS, it is evident that the ethical questions
arising from any such relationships or arrangements
can be greatly minimized or entirely eliminated
through the regular use by every physician of the
procedure of direct billing; and
WHEREAS, the House of Delegates of the American
Medical Association on October 3, 1965, adopted
the following resolution:
"Hospital-based medical specialists are engaged
in the practice of medicine. The fees for the serv-
ices of such specialists should not be merged
with hospital charges. The charges for the
services of such specialists should be established,
billed, and collected by the medical specialist in
the same manner as are the fees of other physi-
cians. The American Medical Association intends
to continue vigorously its efforts to prevent inclu-
sion in the future of the professional services of
any practicing physician in the hospital service
portion of any health care legislation.”
NOW, THEREFORE, BE IT RESOLVED, that the
actions of the American Medical Association in
denouncing as unethical any professional- lay rela-
tionship or arrangement which results: (1) in the
denial of, or interference with, the free choice of a
physician; or (2) in the deterioration of the physi-
cian-patient relationship; or (3) in the splitting of
fees with a lay organization; or (4) in the accrual
to lay employers of a direct profit from the fees
paid for professional services; or (5) in the ex-
ploitation of the services of the physician for the
financial profit or benefit of a lay agency or organ-
ization, be and the same hereby are, approved,
confirmed and ratified; and
RESOLVED FURTHER, that the foregoing October
3, 1965 resolution of the House of Delegates be,
and it hereby is, reaffirmed and reapproved; and
RESOLVED FURTHER, that the American Medical
Association implement the October 3, 1965 resolu-
tion by calling to the attention of all physicians,
and particularly hospital-based physicians, the de-
sirability of the adoption and use of the direct
billing procedure and urging them to employ such
procedure in all cases; and
RESOLVED FURTHER, that the term "direct bill-
ing” means and is hereby defined as the prepara-
tion of a separate bill for professional services on
the physician’s own letterhead (or billhead), ad-
dressed to the patient (or the member of the pa-
1298
The Ohio State Medical Journal
tient’s family legally responsible for payment of
such services), and mailed or delivered to the
patient, without any notice to, or understanding
with, either the hospital in which the professional
sendees were rendered or the patient that:
(1) the patient has no responsibility for the
payment of such bill and may ignore it, or
(2) the patient may relieve himself of his re-
sponsibility to the physician for payment by (a)
transmitting such bill to the hospital in which the
professional sendees were rendered or (b) trans-
mitting such bill to an organization or carrier which
provides coverage to such hospital for hospital
sendees as distinguished from professional sendees,
and
RESOLVED FURTHER, that the foregoing pro-
nouncements concerning unethical professional-lay
arrangements and concerning direct billing by
hospital-based medical specialists shall apply to
ever)' professional-lay arrangement with a hospital,
corporation or other lay agency regardless of
whether such hospital, corporation or other lay
agency is organized and operated as an organiza-
tion for profit or as a nonprofit organization.
Third Party Problems
Dr. Meredith briefly discussed hospital medical staff
disciplinary’ procedures. It was the consensus that
additional attention should be given this matter in a
future Medicare Newsletter, and the proper source of
information would be the booklet, "Statements of
Policy’ — Third-Party Medical Care Plans."
Direct Billing Information Program
On a motion by Dr. Light, seconded by Dr. Ivins
and passed, the staff was authorized to develop a direct
billing promotion program along the lines of that
being implemented by the Louisiana State Medical
Scciety.
Travel Insurance
By official action, The Council adopted that section
of the minutes of the OSMA Insurance Committee
session of October 9, which dealt with Travel Ac-
cident Insurance. Council voted to accept the three-
year policy’ outlined by the Committee, subject to the
consideration and the approval of the general counsel.
There being no further business, The Council
adjourned.
ATTEST: Hart F. Page
Executive Secretary
Minutes of Special Conference of
The Council on November 1
A telephone conference of The Council of the Ohio
State Medical Association was held at 3 p. m., Nov-
ember 1, 1966. The following members of The
Council participated: President Meredith, President-
Elect Howard, Past President Crawford and Coun-
cilors Ivins, Light, Merchant, Smith, Robechek, West-
brook, Press, Beardsley, Clarke, Fulton and Schultz.
Also in the conference was Mr. Hart F. Page, OSMA
Executive Secretary’.
The purpose of the conference call was the con-
sideration of the following paragraph for addition to
the OSMA policy’ on direct billing which was adopted
October 26, 1966:
"RESOLVED FURTHER, that the foregoing pro-
nouncements concerning unethical professional-lay ar-
rangements and concerning direct billing by hospital-
based medical specialists shall apply to every’ profes-
sional-lay arrangement with a hospital, corporation, or
other lay agency’ regardless of whether such hospital,
corporation, or other lay agency’ is organized and op-
erated as an organization for profit or as a nonprofit
organization.’’
The Council voted to accept the above paragraph
for inclusion in the official policy’. (See entire res-
olution, including this paragraph, on this and pre-
ceding pages.
Adjourned.
ATTEST: Hart F. Page,
Executive Secretary
Keep Narcotic Drugs Safeguarded.
Treasury Department ^ arns
Thefts of narcotic drugs are alarmingly high, ac-
cording to an announcement by the Treasury’ Depart-
ment’s Bureau of Narcotics, and all persons registered
under the federal narcotics law are warned to take
extra precautions in safeguarding their stocks.
During the 12-month period ending December 31,
1965, there were 2,503 thefts of narcotic drugs from
persons registered under the narcotics law. This is
the largest number of thefts ever reported in a single
year, and accounted for a loss of some 292 pounds
of drugs.
Section 151.471 of Regulations No. 5 requires that
"Narcotic drugs and preparations shall at all times be
properly safeguarded and securely kept ..." Henry’
L. Giordano, commissioner of narcotics, states that
appropriate security measures must be taken depend-
ing on the kind and size of stock, the immediate
surroundings, and the general circumstances.
Standards for safeguarding narcotics of the vari-
ous classes are set out in the Bureau of Narcotics
Order No. 213, which is available on request. Physi-
cians and other persons registered under the nar-
cotics law are invited to consult the narcotics district
supervisors for respective areas when in doubt re-
garding safeguards or when moving narcotic stocks
to new locations.
Dr. John G. Boutselis, Columbus, was speaker
for a Religion in Life lecture at the University of
Dayton. He discussed family planning, using as his
title, "Rhythm, — Past, Present, and Future.”
for December, 1966
1299
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1300
The Ohio State Medical Journal
Moves to Combat Athletic Injuries . . .
Joint Committee Lays Plans for Summer Institute. Regional
Conferences; Subject Discussed in News Media Interview
THE Joint Committee on Athletic Injuries of
the Ohio State Medical Association and the
Ohio High School Athletic Association has
taken additional positive action toward reducing in-
juries among participants in high school sports events.
Following a meeting on November 2, the commit-
tee announced plans for the Fourth Postgraduate
Institute on Athletic Injuries, and set the date for
August 16-17, 1967. Dr. Robert J. Murphy, Colum-
bus physician and team doctor for Ohio State Uni-
versity, was appointed chairman of the program
committee. The announced place for the conference
is the Fort Hayes Hotel in Columbus.
The following possible program topics were sug-
gested: Rehabilitation exercises, physical facilities,
drugs, enzymes, ultra-sound, and other much modal-
ities, athletic injuries in elementary school children,
and a consideration of desirable athletic competition
for elementary school children.
Additional actions of the committee included rec-
ommendations for regional conferences for coaches
to be held in the Spring of 1967, and for cooperat-
ing in a survey of football injuries sustained by Ohio
scholastic football players during the 1967 season.
Each year for several years the Joint Committee has
been issuing statements for coaches, players, and par-
ents regarding dangers of heat stroke during the early
parts of the football season. This action will be
taken again for the coming season.
Recently the committee sponsored a news confer-
ence in the headquarters office of the Ohio State
Medical Association, at which news media personnel
interviewed representatives of the Joint Committee
on problems arising out of environmental heat and
athletic injuries.
Principals in this interview, all members of the
Joint Committee, were Robert J. Murphy, M. D., Co-
lumbus, team physician for the Ohio State Univer-
sity; Thomas E. Shaffer, M. D., Columbus, professor
of pediatric medicine at Ohio State, and associated
with the Center for Adolescents at Children’s Hospi-
tal in Columbus; Paul Fandis, high school athletic
commissioner with the Ohio High School Athletic
Association; and Harold Meyer, assistant commis-
sioner with OHSAA.
The interview was set up by the staff of the Ohio
State Medical Association at the request of the Joint
Committee to better inform the public in this field.
In the insert are Harold Meyer, left, assistant commis-
sioner, and Thomas E. Shaffer, M. D., two other prin-
cipals in the interviews. The news media interviews were
held at the OSMA Headquarters.
This interview on athletic injuries by news media person-
nel shows Robert J. Murphy, M. D., left, and Paul Landis,
Ohio High School Athletic Commissioner, in front of the
camera.
for December, 1966
1307
Institute on Areawide Planning . . .
OSMA Joins With Other Groups Interested in Hospitals
And Related Health Facilities for January 15 Program
THE Ohio State Medical Association is one of the
sponsors of "An Institute on Areawide Planning
for Hospitals and Related Health Facilities,” to
be held in Columbus on Sunday, January 15. Persons
invited to attend are medical staff representatives and
administrators of hospitals and related health facilities;
members of County Medical Societies and members of
Academies of Osteopathic Medicine; trustees, com-
mittee members and staff members of areawide health
facility planning agencies, hospital membership asso-
ciations; personnel of Blue Cross, health insurance com-
panies, health and welfare councils; and officials of
governmental agencies involved in hospital planning.
Sponsors, in addition to the Ohio State Medical As-
sociation, are the Ohio Hospital Association, and the
Ohio Osteopathic Association of Physicians and Sur-
geons.
Purposes of the Institute are to review planning by
individual hospitals and related health facilities in
response to changing community health needs, spe-
cialized service requirements, advances in medical
education and research; also to further promote work-
ing relationships with voluntary areawide health fac-
ility planning agencies.
Meeting place is the Sheraton-Columbus Motor
Hotel in downtown Columbus. Time is 9:30 A. M.
to 3:30 P. M.
The program has been announced as follows :
Morning Session
Presiding: Wilson L. Benfer, chairman, OHA Co-
ordinating Committee for Health Facility Planning.
Responding to Changing Community Health
Needs — Robert Craig, M. D., chairman, Commit-
tee on Hospital Relations, OSMA.
Responding to New Demands for Specialized
Services and Facilities: — Extended Care Serv-
ices — - Mrs. Helen D. McQuire, director, Division
of Fong Term Care, American Hospital Association.
Community Mental Health Programs: "Changing
Concepts in Treatment of Mental Health” —
Wendell A. Butcher, M. D., chairman of the Com-
mittee on Mental Health of OSMA; "Develop-
ment of Community Mental Health Centers” —
George T. Harding, Jr., M. D., legislative chair-
man, Ohio Psychiatric Association.
Professional Health Personnel Requirements —
William G. Pace, M. D., assistant dean, Ohio State
University College of Medicine.
Afternoon Session
Presiding: William R. Schultz, M. D., vice-chairman,
OHA Coordinating Committee for Health Facility
Planning.
Responding to Advances in Medical Research and
Education — Clifford G. Grulee, Jr., M. D., dean,
University of Cincinnati College of Medicine.
Meeting Planning R e s p o n si b i 1 i t i e s — Hospital
Planning Association of Greater Toledo.
PROGRAM: Institute on Areawide Planning for Hospitals and Related Health Facilities
PLACE: Sheraton-Columbus Motor Hotel, Third and Gay Streets, Columbus
TIME: 9:30 A. M. — 3:30 p. M. — January 15, 1967
FEE: $6.00 per person (Includes Lunch)
Registrant’s Name
Title
(If more than one person, please list other)
Address
Mail to:
Ohio Hospital Association
Room 501, 40 South Third St.
Columbus, Ohio 43215
Make Checks payable to the Ohio Hospital Association
Receipt of your application will be acknowledged, and a blank sent to you, should you desire to
make hotel reservations. The telephone number at the Sheraton-Columbus Hotel is 228-6060.
J
1308
The Ohio State Medical Journal
AD ASTRA
H. M. Platter, OSMA Past President,
Medical Board Secretary, Dies
Herbert Morris Platter, M. D., Past President of
the Ohio State Medical Association, venerable secre-
tary of the State Medical Board of Ohio, and a former
practicing physician in Columbus, died at the age
of 97 on November 4.
Numerous honors had been bestowed upon Dr.
Platter on the local, state, and national levels for his
untiring efforts in behalf of medicine and the public
health. At the 1966 OSMA Annual Meeting in
Cleveland, the entire program was dedicated in his
honor. In memorializing Dr. Platter on this oc-
casion, the OSMA House of Delegates resolved in
part "That the Ohio State Medical Association and the
physicians of Ohio hereby express their admiration
and gratitude to Dr. Platter for his outstanding lead-
ership, guidance, and counsel.”
On this same occasion, Lieutenant Governor John
W. Brown paid tribute to Dr. Platter for his years
of sendee with the State Medical Board and brought
a message of commendation from Governor Rhodes.
In 1964 Dr. Platter was guest of honor at the
Annual Convention of the American Medical As-
sociation in San Francisco, and was presented a Cer-
tificate of Merit for his pioneering service to the
AM A. The honor referred back to 1899 and the
AMA Convention in Columbus, on which occasion
Dr. Platter was instrumental in initiating the first
scientific exhibit ever shown at an AMA meeting.
It was in 1964 also that the Executive Commit-
tee of the Federation of State Medical Boards pre-
sented a citation entitled "The Impact of Herbert
Morris Platter, M. D., on American Medicine.”
Dr. Platter was born at Lockbourne on June 18,
1869. He attended Ohio Wesleyan University, and
received his medical degree from Starling Medical
College, Columbus, in 1892. His early interest
in medical organization work is shown in the fact
that from 1883 to 1899 he was secretary of the Co-
lumbus Academy of Medicine. In the latter year
he became assistant secretary of the Ohio State Medi-
cal Society.
From 1899 to 1908 he was associated with the Co-
lumbus Board of Health, in charge of work in con-
tagious diseases in addition to his private practice.
From 1908 to 1911 he was epidemiologist for the
State Department of Health. It was in 1911 that
he went to Europe to study dermatology in Berlin and
in Vienna. From that time until 1954 his part-
time practice was in the field of dermatology.
From 1912 to 1917 he was chief of the Division
of School Health for the Columbus Board of Educa-
tion, and helped to write the first Columbus public
school health code. In 1917 Dr. Platter became secre-
tary of the State Medical Board, a position he held
until his retirement on December 31, 1965.
A past president of the Columbus Academy of
Medicine, he was treasurer of the Ohio State Medi-
Dr. Platter is shown here as he appeared
before the AA1A House of Delegates at the
1964 Annual Convention in San Francisco.
cal Association from 1918 to 1931 when he was
named President-Elect of the State Association. In
1932 he was installed as President of the Associa-
tion and served in that office for the term 1932-1933.
Dr. Platter was a Past President of the Federation
of Licensing Board of the U. S.; a member of the
National Board of Medical Examiners and in 1954
completed two terms of six years each as represen-
tative.
Teaching was another field for Dr. Platter. From
1929 to 1942 he was on the faculty of the Ohio State
University College of Medicine where he lectured
in dermatology and medical law.
Dr. Platter was a member of the Presbyterian
Church and several Masonic bodies. He is survived
by a son, Harold O. Platter of Columbus and Rey-
noldsburg, by a son-in-law and by a grandchild and
great grandchildren.
Eben Leon Brady, M. D., Texas City, Texas; Ohio
Medical University, Columbus, 1903; aged 86; died
for December , 1966
1309
September 24; member of the Ohio State Medical
Association and the American Medical Association.
A physician of long standing in Marion, Dr. Brady
specialized in the EENT field. He was a past presi-
dent of the Marion County Medical Society, and a
past president and former treasurer of the North-
western Ohio Medical Association. Honored with
the United Community Service Award, he was active
in numerous local organizations; he was past presi-
dent of the Rotary Club, a member of the YMCA
board, the Aero Medical Association, the Chamber
of Commerce, Catholic Church, Knights of Co-
lumbus, Salvation Army board, Moose, Elks, and
Eagles Lodges. Survivors include a son and a daughter.
Basil Butheway Brim, M. D., Bradenton, Florida;
University of Maryland School of Medicine, 1902;
aged 86; died October 18; member of the Ohio State
Medical Association and the American Medical As-
sociation. A practitioner of long standing in the
West Toledo area, Dr. Brim retired several years
ago and was making his permanent home in Florida.
A veteran of World War I, he was a member of the
American Legion. Other affiliations included mem-
berships in the Masonic Lodge and the Elks Lodge.
Two daughters and a sister survive.
John Edwin Brown, Sr., M. D., Columbus; Medi-
cal College of Ohio, Cincinnati, 1887; aged 102;
died November 2; member of the Ohio State Medical
Association, the American Medical Association, Amer-
ican Academy of Ophthalmology and Otolaryngo-
logy, and the American Laryngology, Rhinology and
Otology Society; diplomate of the American Board of
Ophthalmology and the American Board of Otolar-
yngology.
Widely recognized for his activity in medical or-
ganization work and for his contributions in his
specialty field over a practice span of some 55 years,
Dr. Brown was honored in absentia at the dinner
meeting of the OSMA Section on Otorhinolaryn-
gology in 1964. A plaque was presented in behalf of
the Centurion Club of the Deafness Research Founda-
tion. Feature articles on Dr. Brown appeared in
several newspapers at the time, especially the Colum-
bus Dispatch and the Columbus Citizen-Journal.
Also in 1964 on the occasion of Dr. Brown’s 100th
birthday, the Academy of Medicine of Columbus and
Franklin County paid special tribute to him and
dedicated an issue of its Bulletin in his honor.
Dr. Brown actively practiced medicine from 1888
when he first opened his office in Columbus to
1944. He was the fifth president of the Columbus
Academy of Medicine, holding that office in 1896.
From 1894 to 1927, he was on the teaching staff of
Ohio Medical University and its successors, Starling-
Ohio and Ohio State University.
He became president of the American Academy
of Ophthalmology and Otolaryngology in 19 16.
Among his numerous other affiliations, he was presi-
dent of the Board of Trustees of Ohio Wesleyan
University, his Alma Mater.
Dr. Brown is survived by grandchildren. His son,
Dr. John Edwin Brown, Jr., was a practicing physi-
cian in Columbus before his death in 1958.
Fritz Paul Bucher, M. D., Dayton; University of
Cincinnati College of Medicine, 1930; aged 66; died
October 9; member of the Ohio State Medical As-
sociation and the American Medical Association. Dr.
Bucher was a general practitioner in the Dayton area
for some 35 years. Among affiliations, he was a
member of the Fraternal Order of Police in Oakwood
and was a member of the Catholic Church. He is
survived by his widow, a daughter, two sons, and
three brothers.
Salvador M. Capote, M. D., Columbus and White-
hall; graduate of the Faculty of Medicine of the
University of Havana; aged 64; died October 22. A
former practicing physician in Cuba, Dr. Capote
fled that country in 1962 and was making his home
with a daughter in Whitehall, while on the staff
of the Alum Crest Hospital in Columbus. Other
survivors are a son in Cuba, a brother and six
sisters.
Ferdinand Donath, M. D., Cincinnati; University
of Vienna Faculty of Medicine, 1921; aged 71; died
October 4; member of the Ohio State Medical As-
sociation, the American Medical Association, Ameri-
can Psychosomatic Society, and the American College
of Cardiology. A former practitioner in Austria
before he came to this country, Dr. Donath had been
in Cincinnati since 1939. His specialty was cardi-
ology and he was associate clinical professor in the
University of Cincinnati College of Medicine. Sur-
vivors include his widow, a daughter, and a son,
Dr. Rudolf Donath, Cincinnati; also a sister, Dr.
Hedwig Lang, of Columbus, and a brother.
Joseph W. Epstein, M. D., Cleveland; Western
Reserve University School of Medicine, 1911; aged
80; died October 2; member of the Ohio State Medi-
cal Association, the American Medical Association,
and the American Academy of Pediatrics; diplomate
of the American Board of Pediatrics. A native of
Lithuania, Dr. Epstein entered medical school in
Cleveland in 1907, pioneered in pediatrics, and be-
came chief of pediatrics when Mount Sinai Hospital
opened. A member of the board at Park Synagogue,
he is survived by his widow and three sons, among
them, Dr. Harold Epstein, of Cleveland, and Dr.
Lloyd Epstein, of Tucson, Arizona.
Robert Russell Hollister, M. D., Yellow Springs;
Harvard Medical School, 1902; aged 93; died Sep-
tember 7. A practitioner in Omaha, Nebraska, for
some 40 years, Dr. Hollister moved to Yellow
1310
The Ohio State Medical Journal
Springs in 1947. Dr. Nathaniel R. Hollister, of
Dayton, is one of three sons who survive. His
widow’ and a daughter are also among survivors.
Edward Thomas Hurley, M. D., Fort Lauderdale,
Florida; Stritch School of Medicine of Loyola Uni-
versity, 1916; aged 85; died October 13; former
member of the Ohio State Medical Association. Dr.
Hurley practiced for many years in Conneaut, and
in Cleveland’s West Side before he retired in 1959
and moved to Florida. He w as a veteran of World
War I. Surviving are his widow’, a son, and a
daughter.
Virgil E. Hutchens, M. D., Wilmington; Eclectic
Medical College, Cincinnati, 191 1; aged 84; died
September 30; member of the Ohio State Medical
Association and the American Medical Association.
A practitioner of long standing in Clinton County,
Dr. Hutchens was active in numerous civic activities.
He w’as a member of the Rotary Club, the Masonic
Lodge, Methodist Church, and the Odd Fellow’s
Lodge. Among survivors are his widow’ and a son.
William Wolfgang Klement, M. D., Cincinnati,
Eclectic Medical College, Cincinnati, 1917; aged 76;
died October 8; member of the Ohio State Medical
Association, the American Medical Association,
and American Academy of General Practice; Fellow
of the American College of Physicians. A prac-
titioner in Cincinnati for many years, Dr. Klement
was a member of the Association of Military Sur-
geons. Among other affiliations, he was a member
of several Masonic bodies.
George Louis Lambright, Ormond Beach, Florida;
Ohio State University College of Medicine, 1913;
aged 77; died October 22; former member of the
Ohio State Medical Association and the American
Medical Association; Fellow’ of the American Col-
lege of Physicians. A former practitioner in Cleve-
land, Dr. Lambright specialized in internal medicine
and allerg}’. He retired in 1954 and was making his
home in Florida. His w idow’ and a daughter survive.
Amore Longano, M. D., Cleveland; Faculty of
Medicine of the University of Rome, Italy, 1946;
aged 50; died August 17; former member of the
Ohio State Medical Association and the American
Medical Association. Dr. Longano was engaged in
the general practice of medicine in Cleveland. He
was married and the father of tw’o children.
George Jacob Mateja, M. D., Cleveland; Ohio
State University College of Medicine, 1918; aged
75; died October 2; former member of the Ohio
State Medical Association. A practitioner of long
standing in Cleveland, Dr. Mateja w’as a veteran of
World War I and a member of the American Legion.
Other affiliations included membership in the Masonic
Lodge. His widow’ and a son survive.
Thomas Carolus G. Matolcsy, M. D., Cleveland;
Medical Faculty of the University of Budapest, 1924;
aged 65; died October 20. Dr. Matolcsy was edu-
cated in Europe and practiced there before he came
to this country in 1957. His practice in Cleveland
was in the field of surgery. Survivors include his
widow’, a son, and four daughters.
Ethel Doris Pillion, M. D., Lorain; State Univer-
sity of New York at Buffalo School of Medicine,
1924; aged 63; died October 1; member of the
Ohio State Medical Association, the American Medi-
cal Association, and the American Academy of Gen-
eral Practice. Dr. Pillion devoted virtually all of
her professional career to practice in the Lorain
area.
Harry Walter Reed, M. D., Lathrup Village,
Mich.; Western Reserve University School of Medi-
cine, 191 1; aged 7 6; died June 28. Dr. Reed left
Ohio many years ago to practice in Detroit.
Harry Frank Schneider, M. D., Mount Washing-
ton; University of Cincinnati College of Medicine,
1954; aged 40; died October 1; member of the
Ohio State Medical Association, the American
Medical Association, and the American Academy of
General Practice. A lifelong resident of Mount
Washington, Dr. Schneider set up his practice in
that part of the Greater Cincinnati area when he
completed his medical training. He is survived by
his widow, his parents, and a brother.
Frederick Henry Stires, M. D., Canton; Ohio
State University College of Medicine, 1921; aged 71;
died October 10; member of the Ohio State Medical
Association and the American Medical Association.
Dr. Stires began his practice in Malvern, in Carroll
County. He later took residency’ training in Akron
and opened his practice for surgery in Canton. Re-
tirement w’as in 1954. Tw’o physician members of
the family are a son, Dr. William J. Stires, of Can-
ton, and a brother, Dr. Joseph Stires, of Malvern.
Other survivors are his widow*, a daughter, a second
son, a sister and another brother.
Paul Windom Sutton, M. D., Cincinnati; Johns
Hopkins University School of Medicine, 1921; aged
72; died October 7; member of the Ohio State Medi-
cal Association and the American Medical Associa-
tion; diplomate of the American Board of Surgery.
A practitioner in the field of surgery for many years
in Cincinnati, Dr. Sutton w*as associate clinical pro-
fessor of surgery in the University of Cincinnati Col-
for December, 1966
1311
lege of Medicine. Among survivors are his widow,
two sons, three sisters, and three brothers.
New Members . . .
Helen Burton Todd, M. D., Meriden, Conn.; Bos-
ton University School of Medicine, 1914; aged 79;
died August 29; former member of the Ohio State
Medical Association. Dr. Todd moved to Connecti-
cut in 1949 after a long career at Bowling Green,
where she was associated with the medical center of
the Bowling Green State University.
Walter Charles Vester, M. D., Cincinnati; Uni-
versity of Cincinnati College of Medicine, 1922;
aged 71; died October 14; member of the Ohio
State Medical Association, the American Medical
Association, and the American College of Cardiology.
A native of Cincinnati, Dr. Vester devoted a lifetime
to practice there, specializing in cardiology. Surviv-
ing are a daughter and three sons, one of whom is
Dr. John W. Vester, of Pittsburgh, Pa.
Homer H. Williams, M. D., Dayton; Ohio State
University College of Medicine, 1917; aged 75; died
October 19; member of the Ohio State Medical
Association and the American Medical Association.
A career health officer, Dr. Williams began his
service with the Dayton Health Department in 1923
as bacteriologist, and was appointed health commis-
sioner in 1937. He was at his office in the Dayton
Municipal Building when fatally stricken. His widow
survives.
Health Insurance Protection
Widespread in America
Twenty-six states have at least 75 per cent of their
civilian populations protected by some form of pri-
vate health insurance, the Health Insurance Institute
reported.
At the beginning of 1966, another 23 states had
between 50 and 75 per cent population coverage.
Alaska, said the Institute, was the only state below
the 50 per cent mark (44 per cent) .
The nation as a whole had 81 per cent of the
civilian population protected under some form of
private health insurance provided by insurance com-
panies, Blue Cross, Blue Shield, and other health care
expense plans.
The Institute said its report was based on the
Health Insurance Council’s 20th Annual Survey on
the Extent of voluntary health insurance in the
United States in 1965. Survey data was compiled
according to place of employment.
Insurance companies, government agencies and pub-
lished Blue Cross, Blue Shield reports, were sources
for the Council’s statistics.
In a breakdown of percentage coverage by regions,
the East North Central States, including Ohio, showed
an 89 per cent population protection, second only to
the Middle Atlantic States with 91 per cent.
Following are names of new members of the Ohio
State Medical Association certified to the Headquar-
ters Office during October. List shows name of physi-
cian, county, and city in which he is practicing, or
temporary addresses for those taking graduate work-
Ashtabula
Arthur P. Holstein, Ashtabula
Butler
Frederick S. Cieslak, Hamilton
Albert S. Palatchi, Hamilton
Agustin R. Rodriguez,
Middletown
Ramon D. Turman, Hamilton
Clark
Dale E. French, Springfield
Garner M. Robertson,
Springfield
Thomas J. Williams,
Springfield
Clinton
Paul William Terrell,
New Vienna
Columbiana
Benjamin S. Francisco, Salem
Cuyahoga
David A. Conant, Cleveland
William B. Lasersohn,
Cleveland
Morris J. Mandel, Cleveland
Frederick P. Meyerhoefer,
Cleveland
Klaus H. Neumann, Cleveland
Baba G. Pawar, Cleveland
Charles B. Payne, Cleveland
Abbas Rejali. Cleveland
Martin W. Sklaire, Cleveland
Timothy L. Stephens, Jr.,
Cleveland
Ivan Tewarson, Cleveland
Charles R. Young, Cleveland
Franklin
Robert B. Hewitt, Columbus
Martin A. Torch, Abilene,
Texas
Greene
Edward P. Call,
Yellow Springs
Jose R. Ensenat, Fairborn
Hamilton
Alvin A. Huesman, Cincinnati
James Bennett Kahl,
Cincinnati
Ralph D. Parks, Cincinnati
M. Richard Schorr, Cincinnati
Frederick W. Wiese,
Cincinnati
Ben T. Yamaguchi, Jr.,
Cincinnati
Jefferson
Fernando T. Rivera, Jr.,
Steubenville
Francis A. Sunseri,
Steubenville
Knox
Emerson L. Laird,
Mt. Vernon
Robert L. Westerheide,
Mt. Vernon
Lorain
Mohammed A. Amiri, Lorain
George P. Gotsis, Lorain
Lawrence G. Thorley,
Amherst
Charles E. Zepp, Elyria
Ross
Jechiel M. Friedmann,
Chillicothe
Summit
Constantine Mourat, Akron
National Rural Health Conference
Scheduled in Charlotte, N. C.
The 20th National Conference on Rural Health,
sponsored by the American Medical Association
Council on Rural Health, will be held on Friday
and Saturday, March 10 and 11, at the Queen Char-
lotte Hotel, Charlotte, North Carolina.
With the theme "Rural-Urban Health Relation-
ships,” the purpose will be to explore new needs
and report on developments in the following fields:
Community planning and responsibility for health
facilities and services; future patterns of personal
health care; rural accident prevention and first aid
instructions; health manpower planning and utilizing.
Dr. Julius Nemeth, director of the Community
Services Unit of Woodside Receiving Hospital,
Youngstown, was elected president of the Association
of Physicians of the Ohio Department of Mental
Hygiene and Correction at the recent convention in
Columbus.
1312
The Ohio State Medical Journal
Frankly, most antihyper-
tensives are pretty good if
you give an adequate dose.
I’m looking for one with a
simple regimen so that mix-
ups in doses and therefore
I the chance of side effects
are minimized.
Regrotorf
chlorthalidone 50 mg. reserpine 0.25 mg.
1 tablet daily
brings pressure down
Advantage: Both components of Regroton
are long-acting.
Average dosage: One tablet daily with
breakfast.
Contraindications: History of mental
depression, hypersensitivity, and most
cases of severe renal or hepatic diseases.
Warning: Discontinue 2 weeks before
general anesthesia, 1 week before electro-
shock therapy, and if depression or
peptic ulcer occurs. With administration
of enteric-coated potassium supplements,
the possibility of small bowel lesions
should be kept in mind.
Precautions: Reduce dosage of con-
comitant antihypertensive agents by one-
half. Discontinue if the BUN rises or
liver dysfunction is aggravated. Electro-
lyte imbalance and potassium depletion
may occur; take particular care in
cirrhosis or severe ischemic heart disease,
and in patients receiving corticosteroids,
ACTH, or digitalis. Sait restriction is not
recommended. Use with caution in
patients with ulcerative colitis, gall-
stones, or bronchial asthma.
Side effects: Nausea, vomiting, diarrhea,
muscle cramps, headaches and dizziness.
Potential side effects include angina pecto-
ris, anxiety, depression, drowsiness,
hyperglycemia, hyperuricemia, lassitude,
leukopenia, nasal stuffiness, nightmare,
purpura, urticaria, and weakness.
For full details, see the complete prescrib-
ing information.
Availability: Bottles of 100 and 1000 tablets.
Geigy
%
• • •
Activities of County Societies
First District
(COUNCILOR: PAUL N. IVINS, M. D„ HAMILTON)
HAMILTON
For the November 15 meeting of the Academy of
Medicine of Cincinnati, the program consisted of a
panel discussion on the topic, "Governmental Medi-
cine Here and Abroad.”
Panelists were Dr. Edward W. Parry, consultant
surgeon to Liverpool Regional Hospital Board, and
lecturer in clinical surgery, Medical School, Univer-
sity of Liverpool, England; and Dr. Philip R. Lee,
assistant secretary, Department of Health, Education,
and Scientific Affairs, Washington, D. C.
Moderator of the panel was Dr. Frank P. Cleve-
land, associate professor of forensic pathology, Uni-
versity of Cincinnati College of Medicine.
In addition to activities of the Academy of Medi-
cine, a number of specialty groups are centered in
and around Hamilton County and hold regular meet-
ings and scientific programs. The following group
meetings during October and early November were
announced :
October 5 — Cincinnati Surgical Society.
October 15 — Cincinnati Medical Association.
October 16 — Southwestern Ohio Society of Fam-
ily Physicians.
October 19 — Cincinnati Society of Neurology
and Psychiatry.
October 20-22 — - Ohio Valley Proctologic Society.
October 20 - — Cincinnati Obstetrical and Gyne-
cological Society.
October 24 — Cincinnati Otolaryngological Society.
November 2 - — Cincinnati Dermatological Society.
The Academy of Medicine of Cincinnati had as
guest speaker at its October 18 meeting U. S. House
Leader Gerald R. Ford, of Michigan, who discussed
the outlook in Congress particularly as it pertains to
Medicare and similar legislation.
Second District
(COUNCILOR: THEODORE L. LIGHT, M. D„ DAYTON)
CLARK
Dr. Clark D. West, Children’s Hospital Research
Foundation, Cincinnati, was guest speaker for the
October 17 meeting of the Clark County Medical So-
ciety in Springfield. His topic was "Urinary Tract
Infections in Childhood.”
DARKE
The Darke County Medical Society and the Wayne
Hospital staff recently announced plans for affiliation
with the Community Blood Center in Dayton. The
plan calls for a countywide blood donor program
sponsored by the Medical Society, the supply to be
channeled through the Dayton area center.
Third District
(COUNCILOR: FREDERICK T. MERCHANT, M. D., MARION)
ALLEN
Dr. John P. Minton, Columbus, was principal
speaker for the October 18 dinner meeting of the
Academy of Medicine of Lima and Allen County.
This topic, "My Experience with the Laser Beam,”
described the research being carried on at Ohio
State University College of Medicine in the field of
laser application in the treatment of cancer.
CRAWFORD
The Crawford County Medical Society met in mid-
September at the Galion Country Club, Galion, for
a dinner and program.
Fourth District
(COUNCILOR: ROBERT N. SMITH, M. D., TOLEDO)
LUCAS
The Bulletin of the Academy of Medicine of Toledo
and Lucas County listed among other meetings in the
Toledo area the following:
November 10-11 — Postgraduate Lecture Series
presented by the Medical Advancement Trust of
Maumee Valley Hospital. Guest speaker was Dr.
Sydney Gellis, chief of pediatrics, Tufts-New Eng-
land Medical Center, Boston, who spoke on various
phases of pediatrics.
November 18 — Seminar on Marriage Counseling,
sponsored by the Toledo Obstetrical and Gynecologi-
cal Society, held at the Academy Building. Guest
speaker was Richard H. Klemer, Ph. D., associate
professor of family relations, University of Wash-
ington, Seattle.
Fifth District
(COUNCILOR: P. JOHN ROBECHEK, M. D., CLEVELAND)
CUYAHOGA
A medicine and religion meeting of the Academy
of Medicine of Cleveland was held on the evening of
October 19. The theme, "Pacing the Nameless
1314
The Ohio State Medical Journal
A Professional Approach
to Your Financial Problems
Doctors are busy.
So are good life insurance agents.
Representatives of Ohio National stay
busy because they perform a continuing
valuable service to busy men like you.
Ohio National agents offer a range of
quality plans and a keen knowledge of
their business, which enables them to
virtually custom design a sound financial
environment for other professional men.
For Example :
■ personal life and health
■ estate liquidity
■ partnership funding
■ qualified retirement plans
■ group insurance
■ major medical
■ annuities
Let an Ohio National quality agent review, recommend and service your
life and health insurance — business and personal.
There are Ohio National offices in these and other Ohio Cities:
Dayton
The Larry Boord Agency
2718 Salem Avenue
Phone : 278-4272
Cincinnati
The C. James Meakin Agency
233 William H. Taft
Phone: 861-2330
Toledo
The James Fingerhuth Agency
United Savings Bldg., Suite 309
Phone: 246-7494
Wadsworth
The E. William Neiser Agency
186 Highland Avenue
Phone: 334-1414
Sandusky
The Harold Hill Agency
603 Columbus Avenue
Phone: 626-3982
Marietta
The Ransom O. Slack Agency
317 Fourth Street
Phone : 373-5876
Cuyahoga Falls
The George Stevens Agency
123 Portage Trail
Phone: 923-9946
Canton
The N. J. Tschantz Agency, Inc.
Wells Professional Building
Phone: 456-0076
Columbus
The Emmett W. Millholland
and Don Brown Agency
16 E. Broad Street
Phone: 228-1527
The
0/
OHIO NATIONAL Life Insurance Company
a Q/uality name in mutual life and health insurance • Cincinnati
for December, 1966
1315
Fear,” dealt with the proposition of the individual’s
struggle for personal meaning in a world of anony-
mity.
Among speakers on the panel discussion were Rob-
ert O. Blood, Jr., Ph. D., Robert H. Bonthius, Ph. D.,
and Arthur D. Weatherhead, M. D. Executive Secre-
tary Robert A. Lang was moderator.
Sixth District
(COUNCILOR: EDWIN R. WESTBROOK, M. D„ WARREN)
MAHONING
Dr. Edward R. Annis addressed the Mahoning
County Medical Society by special telephone hook-up
from South Bend, Indiana, at the regular society
meeting, October 18. Guests at the meeting were
Dr. Lawrence C. Meredith, OSMA President, and
Dr. Edwin R. Westbrook, Sixth District Councilor.
Dr. Annis spoke on the general subject of "Or-
ganized Medicine at the Crossroads,” and took extra
time to answer questions from members attending
the meeting.
He accused HEW of violating the medicare law
by writing regulations contrary to the intent of the
law. He warned against signing special forms of
certification of hospitalization as an initial step
which might lead to further restrictions on doctors,
such as loss of the right to prescribe name drugs to
medicare patients, and mandatory acceptance of
assignments.
He urged all physicians to obey the medicare law,
but to resist governmental interference that threatens
patient care.
Dr. Jack Schreiber, program chairman, moderated
the telephone conversation, which was heard by the
audience over the loud-speakers. Dr. Harold J.
Reese, president-elect, presided.
Seventh District
(COUNCILOR: SANFORD PRESS, M. D., STEUBENVILLE)
BELMONT
The Belmont County Medical Society with the
Auxiliary met at the Belmont Hills Country Club on
October 20 for an afternoon business session and
dinner.
Highlight of the meeting was presentation of the
Ohio State Medical Association 50- Year Award to
Dr. Frederick P. Sutherland, physician of long stand-
ing in the Martins Ferry area. Dr. Sanford Press,
Steubenville, Councilor of the Seventh District, made
the presentation.
Eleventh District
(COUNCILOR: WILLIAM R. SCHULTZ, WOOSTER)
LORAIN
Recognition of two area physicians, signifying their
graduation from Medical School 50 years ago, was a
feature of the regular meeting of Lorain County Medi-
cal Society during the November 8 meeting at Oberlin
Inn.
The Pins and Certificates of Distinction conferred
by Ohio State Medical Association, were presented
by William R. Schultz, M. D., of Wooster, Councilor
of the Eleventh District, to Frank A. Lawrence, M. D.,
of Elyria, and John H. Nichols, M. D., of Oberlin.
Preceding the presentations, James T. Stephens, M. D.,
of Oberlin, outlined the achievements of Dr. Nichols,
and Joseph M. Strong, M. D., of Elyria, recalled
the contributions of Dr. Lawrence in service to his
community over the years. Dr. John B. McCoy ac-
cepted on behalf of Dr. Lawrence who spends the
winter months in Florida.
A Cleveland physician, Randall H. Travis, M. D.,
presented the evening’s program on the topic "Physi-
ological Aspects of Diuretic Therapy,” illustrating
his lecture with slide presentations. This interesting
program was sponsored by the Medical Services De-
partment of G. D. Searle & Company, of Chicago,
arranged with their local representative, William L.
Perkins, of Bay Village, under the Searle Company’s
Postgraduate Education Program.
Dr. Travis is assistant professor in the Department
of Physiology, Western Reserve University School
of Medicine, Cleveland, and a member of the Ameri-
can Association for the Advancement of Science.
During the business meeting, Dr. John W. Wherry,
chairman of the Nominating Committee, presented
the slate of officers for 1967.
A project of the Education Committee, during Com-
munity Health Week in October, was the presenta-
tion to High Schools in Lorain County of copies of
the American Medical Association’s publication Hori-
zons Unlimited. These were forwarded for use by
the Career Counselors and in the Library of each High
School as guidance material for students seriously
interested in medicine and health- related fields as a
career.
RICHLAND
Members of the Richland County Medical Society
participated in a public demonstration and workshop
for personnel in use of a packaged disaster hospital
unit. The program was in cooperation with the
Mansfield General Hospital.
Visiting speaker was Dr. Max Klinghoffer, chair-
man of the medical disaster care committee in Illinois.
Dr. Harry Wain, Mansfield-Richland County health
commissioner, took a leading role, as did persons
from the Ohio Department of Health.
Dr. Frank P. Cleveland, Hamilton County coroner,
was speaker for a dinner meeting of the Southwestern
Ohio Association of Industrial Nurses, where he
spoke on the topic "Forensic Medicine.”
1316
The Ohio State Medical Journal
Dignitaries at Cleveland Award Dinner
— • Photo Courtesy The Cleveland Tress
Shown at the Stouffer Prize dinner meeting in Cleveland, from left, are Dr. Ernst Klenk, one of the prize winners ;
Dr. Irvine H. Page, chairman of the selection committee; Former President Dwight D. Eisenhower; Dr. Harry Goldblatt,
Cleveland prize winner; and Vernon Stouffer, founder of the award.
Impressive Ceremonies Mark First
Of Stouffer Annual Awards
Nearly 700 persons attended the dinner meeting
for presentation of the first annual Stouffer Prize for
outstanding contributions in the fight against hyper-
tension.
Among persons who spoke for the occasion were
Former President Dwight D. Eisenhower; Sir George
Pickering, Regius professor of medicine, Oxford
University, England; Dr. Edward H. Ahrens, Jr.,
Rockefeller University, New York; Dr. Irvine H.
Page, Cleveland, chairman of the committee to select
award winners; and Cleveland Mayor Ralph Locher.
Vernon Stouffer, head of a chain of restaurants
and motor hotels, is founder of the prize award
which carries a $50,000 prize as well as citation. This
occasion marked the initial presentation of the an-
nual award.
The award was shared by Cleveland’s Dr. Harry
Goldblatt, emeritus professor of experimental path-
ology at Western Reserve University School of
Medicine and director of the Louis D. Beaumont
Memorial Research Laboratories, Mount Sinai Hos-
pital; and Dr. Ernst Klenk, of Cologne, Germany,
who has been called the father of modern lipid
chemistry.
Fort Steuben Academy
The Fort Steuben Academy of Medicine had as
speaker for its November 8 meeting Dr. John
Moossy, Pittsburgh, Pa., whose subject was "Cere-
brovascular Disease: Necropsy Studies and Clinical
Implications.” The dinner meeting was held in the
Fort Steuben Hotel in Steubenville.
For its October 11 meeting, the Academy had as
speaker Dr. Peritz Scheinberg, of Miami, Florida,
professor and chairman of the Department of Neurol-
ogy, Jackson Memorial Hospital, who discussed cere-
bral vascular disease.
Dr. James Q. Dorgan, Columbus, was among a
group of physicians who left this country late in
September for a two-months tour of volunteer service
in South Vietnam. The physicians are serving in
civilian provincial hospitals under the AMA Volun-
teer Physicians for Vietnam Program.
for December, 1966
1317
“ - *
Does she really care?
Is she alert, encouraged,
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about getting completely
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Or has she given in to
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When functional fatigue
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Alertonic can help...
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Nothing fosters confidence and a sense of well-
being better than your own personal warmth, under-
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to help insure prompt response.
Adequate dosage is important: Prescribe Alertonic—
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meals.. . tastes best chilled.
And for your patient’s sake, prescribe Alertonic
in the convenient, economical one-pint bottle.
Alertonic
Available Only On Prescription
Each 45 cc. (3 tablespoonfuls) contains: alcohol, 15%; pipradrol hydro-
chloride, 2 mg.; thiamine hydrochloride (vitamin Bi) (10 MDR*), 10
mg.; riboflavin (vitamin Bo) (4 MDR); 5 mg.; pyridoxine hydrochloride
(vitamin B6), 1 mg.; niacinamide (5 MDR), 50 mg.; choline, t 100 mg.;
inositolj 100 mg.; calcium glycerophosphate, 100 mg. (supplies 2%
MDR for calcium and for phosphorus) and 1 mg. each of the following:
cobalt (as chloride), manganese (as sulfate), magnesium (as acetate),
zinc (as acetate); and molybdenum (as ammonium molybdate).
♦Multiple of adult Minimum Daily Requirement supplied.
fThe need for these substances in human nutrition has not been established.
Indications: 1. Functional fatigue such as that often associated with: a
depressing life experience or stressful time of life; advancing years;
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vitamin-mineral deficiency as they occur in: patients having faulty eat-
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Dosage: Adults, 1 tablespoonful; children (over 15 years old), 1 to 2
teaspoonfuls; children (4 to 15 years old), 1 teaspoonful. To be taken
three times daily 30 minutes before meals.
Contraindications: As with other drugs with CNS stimulating action,
Alertonic is contraindicated in hyperactive, agitated or severely anxious
patients and in chorea or obsessive compulsive states.
Side effects: Reports of overstimulation have been rare. Patients who
are known to be unduly sensitive to the effects of stimulant drugs should
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N THE WM. S. MERRELL COMPANY
Merrell ) Division of Richardson-Merrell Inc.
/ Cincinnati, Ohio 45215
• • •
Woman’s Auxiliary Highlights
By MRS. S. L. MELTZER, Publicity Committee
Chairman, 2442 Dorman Dr., Portsmouth 45662
CHRISTMAS is synonomous with giving. It
brings into focus all that is good in man —
his thought for others — his willingness to
share — his desire to help. Perhaps to no one time
of the year does the project of International Health
belong more than to this holiday season. It ties
in with the Christmas observance in a very special,
very touching way.
To quote Mrs. Max T. Schnitker, state chairman,
"in this rapidly shrinking, ever interdependent world,
the word 'neighbor’ must have a broader interpretation
. . . the poor, medically, be it in Viet Nam or South
America or anywhere else, are also our concern . . .
pain and suffering have no regard for race, creed,
color, or geographic location.” Isn’t that an integral
part of "Peace on Earth, Good Will Toward Man” ?
— something to be practiced not only at Christmas,
but the whole year long?
I like to think of Enid Schnitker as the Auxiliary’s
day-in-and-day-out Santa. Assuredly she’s the most
attractive Santa around and she has many, many
helpers throughout the state. Enid has sparked
Project Hope and World Medical Relief into an
outstanding activity of Ohio’s doctors’ wives, with
the blessing and help of Mrs. James N. Wychgel,
state president.
What better gift could each county auxiliary give
this Christmas of 1966 than an organizational mem-
bership in Project Hope? It doesn’t have to involve
a large sum of money (welcome, of course, as that
would be). Ruth Wychgel urges that every local
group be such an organizational member this year.
Your reporter thinks that this is the ideal time to go
about being just that! Did you know that it costs
five million dollars a year to "run” Hope? The
doctors are flown to the ship on a rotating basis and
serve without pay. The nurses, technicians, physical
therapists, etc., are paid, but far less than they would
make in the same job in the United States, and they
sign on for a year. For all the other days looming
ahead this Auxiliary year, play up Hope in your
communities; show Hope films to other groups; spon-
sor talks on this unique ship; publicize Hope as you
have never before done.
Remember World Medical Relief as another
project belonging in a sense to the Christmas season,
but belonging equally to every day of the year.
While the Christmas spirit is in the air, consider this
relief project a worth while candidate for special
gifts. In a little over a year, that organization has
shipped $3.6 million in drugs, supplies, and equip-
ment to medical civilian action teams working among
the ill and destitute civilians of Viet Nam. Only
as our medical community keeps World Medical
Relief supplied, will it be possible to continue send-
ing desperately needed items to the doctors working
so unselfishly, not only in Viet Nam but all over the
world.
This past auxiliary year, Ohio groups (35 of
them) gave 458 cartons, 21 barrels, and 1,564
pounds of drugs. There is no uniformity in the
way local auxiliaries send in their reports, hence the
"carton,” "barrel,” and "pound” designations. There
was a large variety of equipment that ran the gamut
from sterilizers to operating tables. Mrs. Schnitker
suggests that in packaging drugs and supplies, local
groups use substantial cardboard cartons (such as
those originally containing canned soups), or fiber-
board dmms in which restaurants receive their sup-
plies. The offices of World Medical Relief are at
11745 Twelfth Street, Detroit, Michigan, 48206.
I asked what supplies were the most needed and
the answer was almost anything in usable condition.
There are these exceptions: No basal metabolism
machines, no old diathermy, no double beds or
mattresses, no heat lamps unless recent models, no
ancient electric-treatment apparatus, no clothing ex-
cept baby shirts and diapers, no electrocardiographs,
no fluoroscopes, no medical books or journals, no old
therapy machines, no x-ray machines over 5 years old
and not under 200 AMP. There is a mimeographed
list available, detailing items needed as well as those
not considered useable, which Mrs. Schnitker will
be glad to send to any local International Health
chairman requesting it (although it is my understand-
ing that each such chairman should have received that
list recently). Get with it, "girls” ! (Well, aren’t we! !)
Edna Mae Castle
The Navy League of Cincinnati, an all-male or-
ganization, presented citations recently at a luncheon
meeting to two women for exceptional patriotic
achievements. One of the two is a doctor’s widow
and Hamilton County auxiliary member, Mrs. Gerald
H. Castle, who has served as volunteer educational
chairman for Navy groups in the Cincinnati area for
more than 20 years. No less a personage than Lieu-
tenant General James Masters, commandant of the
Marine Corps School at Quantico, Virginia, presented
the awards. Your reporter does not usually play
up in this column "extra-curricular” activities of
1320
The Ohio State Medical Journal
Medicine Gains aluable Ground
In 1966 General Election
Friends of medicine won telling victories in the
1966 General Election under the banners of both
political parties, and many candidates whose actions
have produced a threat to the quality of medical care
of the American people have been defeated.
One of the outstanding tributes to the activities of
of the Ohio profession and families appeared in the
October 25 issue of The Wall Street Journal. Philip
M. Boffey, writer of the article, toured Ohio and
wrote an eye-witness account of activities underway
at that time.
He told of the independent efforts of Dr. Robert
S. Young, of Johnstown, who organized doctors in
the campaign which re-elected John M. Ashbrook
to Congress from the re-districted 17th District. He
also discussed the efforts of the doctors in the cam-
paign which resulted in election of Charles W.
Whalen, Jr., to Congress in the Dayton area, and
Robert A. Taft, Jr., in Cincinnati.
Mr. Boffey related efforts of Ohio medical groups,
primarily the Woman’s Auxiliaries in conducting
registration and get-out-the-vote drives. He noted
that such efforts in the Cincinnati area brought about
a registration of about 96 per cent of members of the
Academy and their wives, and some 95 per cent in
the Dayton area.
Political experts predict that 47 seats picked up
by the Republican Party in the U. S. House of
Representatives will prompt the 90th Congress to
put the brakes on the wild spending spree of the
89th Congress. This prediction is especially true
since many analysts name excessive federal spending
as a telling issue of the campaign. Sweeping vic-
tories and trends of the election will give conserva-
tives of both political parties opportunity to make
their voting records count.
Of the Republican gains in the U. S. House, 21
were from the Midwest, with five each from Ohio
and Michigan, and four from Iowa. Ohio now has
19 Republican and five Democratic Congressmen.
This will be the largest GOP state delegation in the
90th Congress.
In campaigns for the Ohio General Assembly, vic-
tories were even more telling. An early start in
the campaigns by physicians and their wives paid
off with friends of medicine from both parties win-
ning sweeping victories. The political line-up in
the 107th Ohio General Assembly, convening Jan-
uary 2, will be, in the House 62 Republicans and
37 Democrats; in the Senate 23 Republicans and 10
Democrats. Again the alignment is weighed heavily
in favor of friends of conservative medical and health
legislation from both parties.
The Ohio State Medical Association Pre-Election
District Conferences during September were well at-
tended by physicians and wives. These conferences
did much to unite efforts at the grass-roots level.
The Ohio Medical Political Action Committee had
its first big year. Watch for the next issue of The
Journal and summary of the score chalked up by
OMPAC. OMPAC is already building for the 1968
campaign.
Dr. William G. Pace, III, will direct a three-year
study in effectiveness of cryogenic surgery on malig-
nant tumors at Ohio State University College of
Medicine, under a SI 00,000 grant from the John
A. Hartford Foundation. A phase of the study will
be to determine what kinds of tumors respond and
degree of the ultra freezing technique most effective.
The American Association of Medical Assistants
at its convention in St. Louis named Mrs. Margaret
Swank, of Newark, Ohio, as president-elect. She
will be installed as president at next year’s convention.
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of Psychiatric Disorders
Booklet available on request.
JOHN H. NICHOLS, M. D., Medical Director G. PAULINE WELLS, R. N., Admin. Director HERBERT A. SIHLER, Jr., Pres.
MEMBER: American Hospital Association — National Association of Private Psychiatric Hospitals — Ohio Hospital Association
for December , 1966
1327
State Association Officers and Committeemen
Headquarters Office: 17 S. High St. — Suite 500, Columbus 43215. Telephone: (61 U) 228-6971
OFFICERS and COUNCILORS
Lawrence C. Meredith, M. D., President
205 Elyria Block, Elyria 44035
Robert E. Howard, M. D., President-Elect
2600 Central Trust Tower, Cincinnati 45202
Paul N. Ivins, M. D., First District
306 High Street, Hamilton 45011
Theodore L. Light, M. D., Second District
2670 Salem, Avenue, Dayton 45406
Frederick T. Merchant, M. D., Third District
1051 Harding Memorial Parkway,
Marion 43305
Robert N. Smith, M. D., Fourth District
3939 Monroe Street, Toledo 43606
P. John Robechek, M. D., Fifth District
10525 Carnegie Avenue, Cleveland 44106
Henry A. Crawford, M. D., Past President
1058 Hanna Bldg., Cleveland 44115
Philip B. Hardymon, M. D., Treasurer
350 East Broad St., Columbus 43215
Edwin R. Westbrook, M. D., Sixth District
438 North Park Avenue, Warren 44481
Sanford Press, M. D., Seventh District
525 N. Fourth Street, Steubenville 43952
Robert C. Beardsley, M. D., Eighth District
2236 Maple Avenue, Zanesville 43705
Oscar W. Clarke, M. D., Ninth District
4th & Sycamore St., Gallipolis 45631
Richard L. Fulton, M. D., Tenth District
1211 Dublin Road, Columbus 43212
William R. Schultz, M. D., Eleventh District
1749 Cleveland Road, Wooster 44691
THE EXECUTIVE STAFF
Hart F. Page, Executive Secretary
Herbert E. Gillen, Administrative Assistant
W. Michael Traphagan, Administrative Assistant
Charles W. Edgar, Director of Public Relations
and Assistant Executive Secretary
Jerry J. Campbell, Administrative Assistant
R. Gordon Moore, Executive Editor
THE EDITOR: Perry R. Ayres, M. D.
COMMITTEES
Committee on Education — Thomas E. Rardin, Columbus, Chair-
man (1971) ; Clyde W. Muter, Warren (1970) ; Thomas S.
Brownell, Akron (1969) ; John G. Sholl, Cleveland (1968) ;
Elmer R. Maurer, Cincinnati (1967).
Judicial and Professional Relations Committee — Frank F. A.
Rawling, Toledo, Chairman (1968) ; Henry A. Crawford, Cleve-
land (1971) ; Homer A. Anderson, Columbus (1970) ; Chester H.
Allen, Portsmouth (1969) ; David Fishman, Cleveland (1967).
Committee on Public Relations and Economics — Frederick P.
Osgood, Toledo, Chairman (1969) ; Horace B. Davidson, Colum-
bus (1971) ; Luther W. High, Millersburg (1970) ; John H.
Budd, Cleveland (1968) ; John J. Cranley, Jr., Cincinnati
(1967).
Committee on Scientific Work — Samuel Saslaw, Columbus,
Chairman (1968) ; Jerry Hammon, West Milton (1971) ; Robert
E. Zipf, Dayton (1971) ; Jack Schreiber, Canfield (1970) ;
Walter J. Zeiter, Cleveland (1970) ; John D. Battle, Jr., Cleve-
land (1969) ; Harold J. Schneider, Cincinnati (1969) ; Isador
Miller, Urbana (1968) ; William Hamelberg, Columbus (1967) ;
F. A. Simeone, Cleveland (1967).
Committee on AMA-ERF — Robert S. Martin, Zanesville,
Chairman.
Committee on Auditing and Appropriations — William R.
Schultz, Wooster, Chairman ; Edwin R. Westbrook, Warren :
Richard L. Fulton, Columbus.
Committee on Cancer — Arthur G. James, Columbus, Chair-
man ; Thomas D. Allison, Lima ; Andrew M. Barone, Lima ;
William F. Boukalik, Cleveland; William J. Flynn, Youngs-
town ; Douglas P. Graf, Cincinnati ; Stanley O. Hoerr, Cleve-
land; William A. Newton, Jr., Columbus; W. D. Nusbaum,
Lancaster ; Arthur E. Rappoport, Youngstown ; Carl A. Wilz-
bach, Cincinnati.
Committee on Disaster Medical Care — Thomas D. Allison,
Lima, Chairman ; Thomas P. Bowlus, Toledo ; Nino M. Camardese,
Norwalk ; Drew L. Davies, Columhus ; John H. Davis, Cleveland ;
Gregory G. Floridis, Dayton ; Robert D. Gillette, Huron ; Robert
S. Heidt, Cincinnati ; Robert E. Holmberg, Cleveland ; N. J. M.
Klotz, Wadsworth ; Thomas W. Morgan, Gallipolis ; Sterling
W. Obenour, Jr., Zanesville; Vol K. Philips, Columbus; Liaison
with the American Medical Association : Wendell A. Butcher,
Columbus.
Committee on Environmental Health — Rex H. Wilson, Akron,
Chairman ; William W. Davis, Columbus ; Lairy L. Hipp, Gran-
ville; Robert C. Markey, Bowling Green; B. C. Myers, Lorain;
Tuathal P. O’Maille, Marietta ; Thomas N. Quilter, Marion ; I. C.
Riggin, Lorain; Robert E. Schulz, Wooster; Victor A. Simiele,
Lancaster; John P. Storaasli, Cleveland; Robert Vogel, Dayton;
Robert C. Waltz, Cleveland ; Tennyson Williams, Delaware ;
John L. Zimmerman, Fremont.
Committee on Eye Care — Arthur D. Collins, Cleveland, Chair-
man ; Martin J. Cook, Springfield ; Thomas L. Edwards, Lima ;
Robert H. Magnuson, Columbus ; Russell J. Nicholl, Cleveland ;
Claude S. Perry, Columbus ; Norman W. Pinschmidt, Gallipolis ;
Barnet R. Sakler, Cincinnati; Robert L. Willard, Toledo.
Committee on Government Medical Care Programs — H. Wil-
iam, Porterfield, Columbus, Chairman ; Chester H. Allen, Ports-
mouth ; James O. Barr, Chagrin Falls; Robert Bartlett, Akron;
Dwight L. Becker, Lima ; Robert A. Borden, Fremont ; Edwin
W. Burnes, Van Wert; George A. deStefano, Cincinnati; Rob-
ert B. Elliott, Ada; George T. Harding, Sr., Worthington; Roger
E. Heering, Columbus ; M. Robert Huston, Millersburg ; Paul A.
Jones, Zanesville; Maurice M. Kane, Greenville; Francis M.
Lenhart, Defiance; William J. Lewis, Jr., Dayton; Carl G.
Madsen, Jr., Painesville ; Marvin R. McClellan, Cincinnati;
Harold E. McDonald, Elyria ; Robert C. Markey, Columbus ;
Thomas W. Morgan, Gallipolis ; Marvin J. Rassell, Hamilton ;
Elliott W. Schilke, Springfield ; Bernard A. Schwartz, Cincin-
nati ; Clarence V. Smith, Canton ; Joseph B. Stocklen, Cleveland ;
James F. Sutherland, Martins Ferry; Raymond J. Thabet, Mans-
field; M. M. Thompson, Toledo; Robert E. Tschantz, Canton;
Don P. Van Dyke, Kent; William T. Washam, Columbus; Wil-
liam M. Wells, Newark ; James F. Zeller, New Philadelphia.
Committee on Hospital Relations — Robert M. Craig, Dayton,
Chairman ; L. Fred Bissell, Aurora ; L. A. Black, Kenton ;
Wendell T. Bucher, Akron ; Oscar W. Clarke, Gallipolis ; Henry
A. Crawford, Cleveland; John V. Emery, Willard; Harvey C.
Gunderson, Toledo; Henry L. Hartman, Toledo; E. R. Haynes,
Zanesville ; Middleton H. Lambright, Cleveland ; Lloyd E. Lar-
rick, Cincinnati; James C. McLarnan, Mt. Vernon; Ben V.
Myers, Elyria ; E. W. Schilke, Springfield ; Robert A. Tennant,
Middletown ; V. William Wagner, Port Clinton ; William A.
White, Canton.
Committee on Insurance — David A. Chambers, Cleveland,
Chairman ; William F. Bradley, Columbus ; Walter A. Daniel,
Tiffin ; Chester R. Jablonoski, Cleveland ; William A. Knapp,
Zanesville ; Marvin R. McClellan, Cincinnati ; William Neal,
Archbold ; Oliver E. Todd, Toledo ; Robert E. Tschantz, Canton ;
Allan L. Wasserman, Dayton; John W. Wherry, Elyria; Wil-
liam A. White, Canton.
Committee on Laboratory Medicine — Horace B. Davidson,
Columbus, Chairman ; William H. Benham, Columbus ; John B.
Hazard, Cleveland ; Melvin Oosting, Dayton ; Arthur E. Rappo-
port, Youngstown; William Sinclair, Cleveland; Gilbert B.
Stansell, Toledo; Philip B. Wasserman, Cincinnati.
1328
The Ohio State Medical Journal
State Association Officers and Committeemen (Continued)
Committee on Legislation — James T. Stephens, Oberlin, Chair-
man ; Chester H. Allen, Portsmouth ; Donald R. Brumley, Find-
lay; Jonathan G. Busby, Columbus; George D. J. Griffin, Cin-
cinnati; Jack L. Kraker, Lancaster; William J. Lewis, Dayton;
Maurice F. Lieber, Canton ; James C. McLarnan, Mt. Vernon ;
Wesley J. Pignolet, Willoughby ; Marvin J. Rassell, Hamilton ;
Theodore E. Richards, Urbana; Robert E. Rinderknecht, Dover;
John H. Sanders, Cleveland; William W. Trostel, Piqua.
Committee on Maternal Health — Anthony Ruppersberg, Colum-
bus, Chairman ; Otis G. Austin, Medina ; Raymond E. Barker,
Columbus ; William D. Beasley, Springfield ; Keith R. Brande-
berry, Gallipolis ; Thomas E. Byrne, Mentor ; Mel A. Davis,
Columbus; Marion F. Detrick, Jr., Findlay; John P. Garvin,
Columbus; Richard P. Glove, Cleveland; Robert A. Heilman,
Columbus; John F. Hillabrand, Toledo; Robert E. Johnstone,
Cincinnati ; Albert A. Kunnen, Dayton ; James F. Morton,
Zanesville ; Ralph K. Ramsayer, Canton ; Robert E. Swank,
Chillicothe ; Densmore Thomas, Warren; Robert S. VanDervort,
Elyria.
Committee on Medicine and Religion — Charles A. Sebastian,
Cincinnati, Chairman ; John D. Albertson, Lima ; Eugene F.
Damstra, Dayton ; Francis M. Lenhart, Defiance ; Ralph W.
Lewis, Portsmouth ; George W. Petznick, Cleveland ; J. Kenneth
Potter, Cleveland ; John R. Seesholtz, Canton ; William B.
Smith, Zanesville; James T. Stephens, Oberlin; Donald J.
Vincent, Columbus ; Don G. Warren, West Lafayette.
Committee on Mental Health — Wendell A. Butcher, Columbus,
Chairman ; Homer A. Anderson, Columbus ; Robert D. Eppley,
Elyria ; Max D. Graves, Springfield ; Richard G. Griffin, Worth-
ington ; Warren G. Harding, Columbus; Edward O. Harper,
Cleveland; Henry L. Hartman, Toledo; William H. Holloway,
Akron ; C. Eric Johnston, Columbus ; Robert E. Reiheld, Orr-
ville ; Philip C. Rond, Columbus ; W. Donald Ross, Cincinnati ;
Viola V. Startzman, Wooster; Victor M. Victoroff, Cleveland.
Military Advisory Committee — Drew L. Davies, Columbus,
Chairman ; Ralph G. Carothers, Cincinnati ; Homer D. Cassel,
Dayton ; Henry A. Crawford, Cleveland ; Walter L. Cruise,
Zanesville ; Charles R. Keller, Mansfield ; Ralph W. Lewis,
Portsmouth ; Edward L. Montgomery, Circleville ; Frank T.
Moore, Akron ; Frederick P. Osgood, Toledo ; Earl Rosenblum,
Steubenville; Richard G. Weber, Marion.
Committee on Rural Health — Robert E. Reiheld, Orrville,
Chairman ; Chester J. Brian, Eaton ; Robert R. C. Buchan,
Troy ; J. Martin Byers, Greenfield ; Walter A. Campbell, Co-
shocton ; E. Joel Davis, East Canton ; Victor R. Frederick,
Urbana ; Benjamin W. Gilliotte, Zanesville ; Jerry L. Hammon,
West Milton; Jasper M. Hedges, Circleville; Luther W. High,
Millersburg ; E. D. Mattmiller, Athens ; John R. Polsley, North
Lewisburg ; Leonard S. Pritchard, Columbiana ; Harold C.
Smith, Van Wert; Kenneth W. Taylor, Pickerington.
OSMA Advisory Committee to the Ohio State Society of
Medical Assistants — Richard L. Fulton, Columbus, Chairman ;
George Newton Spears, Ironton.
Committee on School Health — Charles H. McMullen, Loudon-
ville. Chairman; Walter Felson, Greenfield; Howard H. Hop-
wood, Cleveland; Dale A. Hudson, Piqua; Howard J. lckes.
Canton ; Charles L. Kagay, Dayton ; Thomas E. Wilson, Warren ;
Robert C. Markey, Bowling Green ; Robert J. Murphy, Colum-
bus ; Carey B. Paul, Jr., Columbus ; Carl L. Petersilge, Newark ;
William H. Rower, Ashland; Thomas E. Shaffer, Columbus;
Aubrey L. Sparks, Warren ; Homer B. Thomas, Gallipolis.
OSMA Members of the Joint Committee on School Bus Driver
Examinations — Carey B. Paul, Jr., Columbus; Thomas N.
Quilter, Marion ; Drew L. Davies, Columbus.
OSMA Members of the Joint Advisory Committee on Athletic
Injuries — Walter A. Hoyt, Jr., Akron; John R. Jones, Toledo;
Don A. Kelly, Cleveland; Sol Maggied, West Jefferson; Marvin
R. McClellan, Cincinnati ; Robert P. McFarland, Oberlin ;
Charles H. McMullen, Loudonville ; Robert J. Murphy, Colum-
bus ; Carey B. Paul, Jr., Columbus ; Thomas E. Shaffer,
Columbus.
Committee on Workmen’s Compensation — H. P. Worstell,
Columbus, Chairman ; A. L. Berndt, Portsmouth ; Thomas H.
Brown, Jr., Toledo; Charles A. Browning, Jr., Bellefontaine ;
Oscar W. Clarke, Gallipolis ; Frederick A. Flory, Columbus ;
Lawrence T. Hadbavny, Cleveland ; Clyde O. Hurst, Ports-
mouth ; Edmund F. Ley, Tiffin ; Joseph Lindner, Sr., Cincinnati ;
John D. Osmond, Jr., Cleveland; James G. Roberts, Akron;
George L. Sackett, Sr., Painesville ; William V. Trowbridge,
Cleveland; Rex H. Wilson, Akron; James N. Wychgel, Cleve-
land ; Joseph H. Shepard, Columbus ; Frederick A. Wolf,
Cincinnati.
Woman’s Auxiliary Advisory Committee — Robert C. Beard-
sley, Zanesville, Chairman ; Theodore L. Light, Dayton ; Fred-
erick T. Merchant, Marion.
Ohio Medical Indemnity Liaison Committee — Robert E.
Tschantz, Canton, Chairman ; Henry A. Crawford, Cleveland ;
Lawrence C. Meredith, Elyria ; Mr. Hart F. Page, Executive
Secretary, OSMA, Columbus.
DELEGATES AND ALTERNATES
Delegates and Alternates to the American Medical Association
— George W. Petznick, Cleveland ; H. T. Pease, Wadsworth, alter-
nate ; Carl A. Lincke, Carrollton ; Robert S. Martin, Zanesville,
alternate ; Theodore L. Light, Dayton ; Kenneth D. Arn, Dayton,
alternate; Edmond K. Yantes, Wilmington; Harry K. Hines,
Cincinnati, alternate; John H. Budd, Cleveland; P. John Robe-
chek, Cleveland, alternate ; Richard L. Meiling, Columbus ;
Frank F. A. Rawling, Toledo, alternate ; Frederick P. Osgood,
Toledo ; Robert N. Smith, Toledo, alternate ; Charles A. Sebas-
tian, Cincinnati ; J. Robert Hudson, Cincinnati, alternate ; Ed-
win H. Artman, Chillicothe ; Philip B. Hardymon, Columbus,
alternate ; Robert E. Tschantz, Canton ; Henry A. Crawford,
Cleveland, alternate.
County Societies’ Officers and Meeting Dates
First District
Councilor: Paul N. Ivins, Hamilton 45011
306 High Street
ADAMS — Gary J. Greenlee, President, Manchester 45144 ; Stan-
ley H. Title, Secretary, Manchester 45144.
BROWN — Charles H. Maly, President, Sardinia 45171 ; Charles
W. Hannah, Secretary, Sardinia 45171. 1st Monday monthly.
BUTLER — Robert Johnson, President, 500 S. Breiel Boulevard.
Middletown 45042 ; Mr. Charles G. Greig, Executive Secretary.
110 North Third Street, Hamilton 45011. 4th Wednesday
monthly.
CLERMONT — Cecil F. Barber, President, State Route 133, Feli-
city 45120 ; Phillips F. Greene, Secretary, Route 1, Box 509,
New Richmond 45157. 3rd Wednesday monthly, except July
and August.
CLINTON— Richard R. Buchanan, President, 115 West Main,
Wilmington 45177 ; Mary Ranz Boyd, Secretary, Box 629,
Wilmington 45177. 4th Tuesday monthly.
HAMILTON — Elmer R. Maurer, President, 320 Broadway, Cin-
cinnati 45202 ; Mr. Edward F. Willenborg, Executive Secretary,
320 Broadway, Cincinnati 45202. Monthly meeting dates, 1st
Tuesday ; Academy, 3rd Tuesday, except June, July and August.
HIGHLAND — Thomas L. Jones, President, 528 South St., Green-
field 45123 ; Walter Felson, Secretary, 357 South St., Greenfield
45123. 3rd Tuesday bimonthly.
WARREN — O. Williaid Hoffman, President, 20 East Fourth
Street, Franklin 45005 ; Ray E. Simendinger, Secretary, 901
North Broadway Street, Lebanon 45036. 2nd Tuesday monthly.
Second District
Councilor: Theodore L. Light, Dayton 45406
2670 Salem Ave.
CHAMPAIGN — Myron J. Towle, President, 848 Scioto Street,
Urbana 43078 ; Fred R. Denkewalter, Secretary, 848 Scioto
Street, Urbana 43078. 2nd Wednesday monthly.
CLARK — Henry M. Tardif, President, 2608 E. High Street,
Springfield 45505 ; Mrs. Marion L. Wilcoxson, Executive
Secretary, 616 Building, Room 131, 616 N. Limestone St.,
Springfield 44503. 3rd Monday monthly, except June, July
and August.
DARKE — William A. Browne, President, 722 Sweitzer St.,
Greenville 45331 ; Delbert D. Blickenstaff, Secretary, 552 S.
West St., Versailles 45380. 3rd Tuesday monthly.
GREENE — Clement G. Austria, President, 1142 North Monroe
Drive, Xenia 45385 ; Mrs. C. K. Elliott, Executive Secretary,
225 Pleasant Street, Xenia 45385. 2nd Thursday monthiy
except July and August.
MIAMI — David Brown, President, 1060 North Market Street,
Troy 45373 ; Jack P. Steinhilber, Secretary, 145 Sunset Drive,
Piqua 45356. 1st Tuesday monthly.
MONTGOMERY — Charles E. O’Brien, President, 600 Fidelity
Building, Dayton 45402 ; Mr. Robert F. Freeman, Executive
Secretary, 280 Fidelity Medical Building, Dayton 45402. 1st
Friday monthly October through May — 1st Wednesday June.
PREBLE — John D. Darrow, President, 228 N. Barron St., Eaton
45320 ; Willard C. Clark, Jr., Secretary, 228 N. Barron, Eaton
45320. Irregular meetings.
SHELBY— George J. Schroer, President, 322 Second Ave., Sidney
45365 ; Alfonsas Kisielius, Secretary, Ohio Bldg., Sidney 45365.
for December, 1966
1329
County Societies’ Officers and Meeting Dates (Continued)
Third District
Councilor: Frederick T. Merchant, Marion 43305
1051 Harding Memorial Pky.
ALLEN — Carl H. Zinsmeister, President, 729 W. Market Street,
Lima 45801 ; Thomas D. Allison, Secretary, 401 Metropolitan
Bank Building, Lima 45801. 3rd Tuesday monthly.
AUGLAIZE — Robert Sobocinski, President, 75 Blackhoof Street,
Wapakoneta 45895 ; J. F. Bowling, Secretary, 319 West Spring
Street, St. Marys 45885. 1st Thursday monthly except July.
CRAWFORD — Don E. Ingham, President, 201 N. Market Street,
Galion 44833 ; Johnson H. Chow, Secretary, 1040 Devonwood
Drive, Galion 44833. Called meetings.
HANCOCK — Raymond J. Tille, President, 801 S. Main St., Find-
lay 45840 ; Herbert L. Queen, Secretary, 828 Woodworth Dr.,
Findlay 45840.
HARDIN — William D. Dewar, President, 405 North Main Street,
Kenton 43326 ; John J. Roget, Secretary, Belle Center 43310.
2nd Tuesday monthly.
LOGAN — Thomas Seitz, President, 223 E. Columbus Street,
Bellefontaine 43311 ; Glen Miller, Secretary, R. D. 2, West
Liberty 43357. 1st Friday monthly.
MARION — Ransome Williams, President, 1035 Harding Me-
morial Parkway, Marion 43302 ; Alice Fisher, Secretary, 1040
Delaware Avenue, Marion 43302. 1st Tuesday monthly.
MERCER — R. Duane Bradrick, President, Rockford 45882 ; R. L.
Dobbins, Secretary, 5402 State Route 29 East, Celina. 3rd
Thursday, monthly.
SENECA — Olgierd C. Garlo, President, 53 Clay Street, Tiffin
44883 ; Leonard M. Gaydos, Secretary, 233 South Monroe
Street, Tiffin 44883. 3rd Tuesday monthly.
VAN WERT — Norman L. Marxen, President, Medical Arts Bldg.,
Fox Road, Van Wert 45891 ; W. L. Iler, Secretary, Medical
Arts Bldg., Fox Road, Van Wert 45891. 4th Friday monthly.
WYANDOT — Herschel A. Rhodes, President, 777 N. Sandusky
Ave., Upper Sandusky 43351 ; J. J. Browne, Secretary, 777 N.
Sandusky Ave., Upper Sandusky 43351. 2nd Tuesday monthly.
Fourth District
Councilor: Robert N. Smith, Toledo 43606
3939 Monroe St.
DEFIANCE — L. F. Berry, Jr., President, 1400 East Second
Street, Defiance 43512; Miss Lois Coffin, Executive Secretary,
P. O. Box 386, Defiance 43512.
FULTON — B. H. Reed, Jr., President, Delta 43515 ; R. L. Davis,
Secretary, Wauseon 43567. 2nd Tuesday quarterly March,
June, September, December.
HENRY — J. J. Harrison, President, 113 East Clinton Street,
Napoleon 43545 ; Gamble S. Hall, Secretary, 834 Strong
Street, Napoleon 43545. 1st Tuesday monthly.
LUCAS — E. L. Doermann, President, 2001 Collingwood Blvd.,
Toledo 43620 ; Mr. Robert W. Elwell, Executive Secretary, 3101
Collingwood Blvd., Toledo 43610. 3rd Tuesday monthly except
July and August.
OTTAWA — V. Wm. Wagner, President, 122 East Perry, Port
Clinton 43452 ; William Coon, Secretai-y, 120 East Perry, Port
Clinton 43452. 2nd Thursday monthly.
PAULDING — Roy R. Miller, President, 220 W. Perry, Paulding
45879 ; D. Paul Ward, Secretary, Box 416, Oakwood 45873.
Meetings called.
PUTNAM — Arthur P. Daniel, President, 144 N. Walnut, Ottawa
45875 ; Oliver N. Lugibihl, Secretary, Pandora 45877. 1st
Tuesday monthly.
SANDUSKY- — J. L. Zimmerman, President, Memorial Hospital
of Sandusky County, Fremont 43420 ; Mrs. Patsy J. Askins.
Executive Secretary, Memorial Hospital of Sandusky County,
Fremont 43420. 3rd Wednesday monthly.
WILLIAMS — John E. Moats, President, Central Drive, Bryan
43506 ; Neil T. Levenson, Secretary, 907 Noble Drive, Bryan
43506. 2nd Tuesday monthly.
WOOD — Roger A. Peatee, President, 140 S. Prospect Street,
Bowling Green 43402 ; Douglas Hess, Secretary, 920 North
Main St., Bowling Green, Ohio 43402. 3rd Thursday monthly.
Fifth District
Councilor: P. John Robechek, Cleveland 44106
10525 Carnegie Ave.
ASHTABULA — J. R. Nolan, President, 2736 Lake Avenue, Ash-
tabula 44004 ; Richard Millberg, Secretary, 430 West 25th
Street, Ashtabula 44004. 2nd Tuesday monthly.
CUYAHOGA — David Fishman, President, Room 404, 10515 Car-
negie Avenue, Cleveland 44106 ; Mr. Robert A. Lang, Executive
Secretary, 10525 Carnegie Avenue, Cleveland 44106.
GEAUGA — Bruce F. Andreas, President, 400 Downing Drive,
Chardon 44024 ; Mrs. Martha Withrow, Executive Secretary,
P. O. Box 249, Chardon 44024. 2nd Friday monthly.
LAKE — Robert W. Colopy, President, 89 E. High Street, Paines-
ville 44077 ; Mrs. Owen A. McLaren, Executive Secretary,
7408 Cadle Avenue, Mentor 44060. 4th Wednesday evening
monthly, January, May, March, September and November
unless otherwise ordered by Council.
Sixth District
Councilor: Edwin R. Westbrook, Warren 44481
438 North Park Ave.
COLUMBIANA — Edith S. Gilmore, President, 432 W. 5th St.,
E. Liverpool 43920 ; Mrs. Gilson Koenreich, Executive Secre-
tary, 193 Park Avenue, Salem 44460. 3rd Tuesday monthly.
MAHONING — F. A. Resch, President, Doctors Park, Canfield
44406 ; Mr. Howard C. Rempes, Jr., Executive Secretary, 245
Bel-Park Building, 1005 Belmont Avenue, Youngstown 44504.
3rd Tuesday monthly except July and August.
PORTAGE — David Palmstrom, President, 124 North Prospect
Street, Ravenna 44266 ; William R. Brinker, Secretary, 141
East Main Street, Kent 44240. 3rd Tuesday monthly.
STARK — A. R. Furnas, Jr., President, 420 Lake Avenue, N. E.,
Massillon 44646 ; Mr. John H. Austin, Executive Secretary,
405 4th Street, N. W., Canton 44702. 2nd Thursday monthly.
SUMMIT — James G. Roberts, President, 655 West Market Street,
Akron 44303 ; Mr. Sidney H. Mountcastle, Executive Secretary,
437 Second National Building, 159 South Main Street, Akron
44308. 1st Tuesday monthly.
TRUMBULL — John F. McGreevey, President, 297 Hawthorne
Lane N. E., Warren 44484 ; Mrs. Kay Ticknor, Executive
Secretary, 280 North Park Avenue, Warren 44481. 3rd
Wednesday monthly September through May.
Seventh District
Councilor: Sanford Press, Steubenville 43952
525 North Fourth Street
BELMONT — James Sutherland, President, 9 North 4th Street,
Martins Ferry 43935 ; Bertha M. Joseph, Secretary, 100 South
4th Street, Martins Ferry 43935. 3rd Thursday of February,
March, April, June, September, October, November and
December.
CARROLL — Glen C. Dowell, President, 207 West Main, Car-
rollton 44615 ; Thomas J. Atchison, Secretary, 292 East
Main, Carrollton 44615. 1st Thursday monthly.
COSHOCTON — Don Warren, President, 600 East Main Street,
West Lafayette 43845 ; Harold Lear, Secretary, 133 South
Fourth Street, Coshocton 43812. 2nd Tuesday monthly.
HARRISON — Charles D. Evans, President, 159 South Main
Street, Cadiz 43907 ; G. E. Vorhies, Secretary, Scio 43988,
Quarterly.
JEFFERSON — Jacob R. Cohen, President, 341 Market Street,
Steubenville 43952 ; Irving Dreyer, Secretary, Ohio Valley
Hospital, Steubenville 43952. 4th Tuesday monthly except
December, January, February.
MONROE — Byron Gillespie, Secretary, Woodsfield 43793.
TUSCARAWAS — Robert J. Kuba, President, 319 Grant St., Den-
nison 44621 ; Thomas E. Ogden, Secretary, 138 E. Main St.,
Gnadenhutten. 2nd Thursday monthly.
Eighth District
Councilor: Robert C. Beardsley, Zanesville 43705
2236 Maple Ave.
ATHENS — D. R. Johnson, President, 52 West Washington
Street, Nelsonville 45764 ; L. A. Hamilton, Secretary, 400 East
State Street, Athens 45701. 2nd Tuesday monthly except July
and August.
FAIRFIELD — George W. LeSar, President, 216 Harmon Avenue,
Lancaster 43130 ; Stephen R. Hodsden, Secretary, 1423 West
Market Street, Baltimore 43105. 2nd Tuesday monthly.
GUERNSEY— A. C. Smith, President, 1115 Clark Street, Cam-
bridge 43725 ; Dayle O. Snyder, Secretary, 840 Wheeling
Avenue, Cambridge 43725. 1st Tuesday monthly.
LICKING — Carl L. Petersilge, President, 104 Hudson Avenue,
Newark 43065 ; Robert P. Raker, Secretary, 317 N. Granger
Street, Granville 43023. 4th Tuesday monthly.
MORGAN — A. H. Whitacre, President, Chesterhill 43728 ; Henry
Bachman, Secretary, Box 199, Malta 43758.
MUSKINGUM — Paul A. Jones, President, 838 Market Street,
Zanesville 43701 ; Myron Powelson, Secretary, 2825 Maple
Avenue, Zanesville 43705. 2nd Tuesday monthly.
NOBLE — Frederick M. Cox, President, Caldwell 43724; Edward
G. Ditch, Secretary, 415 Main Street, Caldwell 43724. 1st
Tuesday monthly.
PERRY — Charles B. McDougal, President, 319 High St., New
Lexington 43764; Michael P. Clouse, Secretary, West Main St.,
Somerset 43783.
WASHINGTON — Mary L. Whitacre, President, Rt. 6, Marietta
45750 ; G. E. Huston, Secretary, 328 Fourth St., Marietta
45750. 2nd Wednesday monthly.
1330
The Ohio State Medical Journal
County Societies’ Officers and Meeting Dates (Continued)
Ninth District
Councilor: Oscar W. Clarke, Gallipolis 45631
4th & Sycamore St.
GALLIA — Quentin Korfhage, President, Gallipolis Clinic, Gal-
lipolis 45631 ; John Groth, Secretary, Holzer Clinic, Gallipolis
45631. Monthly meetings at called times.
HOCKING — Jan S. Matthews, President, 9 East Second Street,
Logan 43138 ; H. M. Boocks, Secretary, Route 3, Logan 43138.
2nd Tuesday monthly.
JACKSON — John M. Cook, President, Box 316, Oak Hill 45656 ;
Earl J. Levine, Secretary, 120 N. Ohio Ave., Wellston 45692.
LAWRENCE — Frank W. Crowe, President, 2110 South 9th
Street, Ironton 45638 ; George Newton Spears, Secretary, 2213
South Ninth Street, Ironton 45638. Quarterly at called times.
MEIGS — Charles J. Mullen, President, 210% E- Main St., Pome-
roy 45769 ; Edmund Butrimas, Secretary, 204 E. Main St.,
Pomeroy 45769.
PIKE — Robert T. Leever, President, 100 East Third St., Waverly
45690 ; Albert M. Shrader, Secretary, East Water St., Waverly
45690. 1st Tuesday monthly.
SCIOTO — Chester H. Allen, President, 1405 Offnere Street,
Portsmouth 45662 ; Erich Spiro, Secretary, 1735 Waller Street,
Portsmouth 45662. 2nd Monday in February, April and Octo-
ber ; December meeting and summer meeting decided by the
Council and members notified one month in advance.
VINTON — Richard E. Bullock, President, 203 South Market St.,
McArthur 45651.
Tenth District
Councilor: Richard L. Fulton, Columbus 43212
1211 Dublin Rd.
DELAWARE — Don K. Michel, President, 98 W. William, Dela-
ware 43015 ; Tennyson Williams, Secretary, Box 265, Delaware
43015. 3rd Tuesday monthly.
FAYETTE — R. D. Woodmansee, President, 403 East Market
Street, Washington C. H. 43160 ; M. H. Roszmann, Secretary,
1005 East Temple Street, Washington C. H. 43160. 2nd
Friday monthly
FRANKLIN — Joseph A. Bonta, President, 3100 Olentangy River
Road, Columbus 43202 ; Mr. W. “Bill” Webb, Jr., Executive
Secretary, 17 South High St., Suite 528, Columbus 43215.
3rd Tuesday monthly.
KNOX — Richard L. Smythe, President, 812 Coshocton Road,
Mt. Vernon 43050 ; Robert E. Sooy, Secretary, Box 470, Mt.
Vernon 43050. 1st Wednesday evening monthly.
MADISON — Sol Maggied, President, 15 East Pearl Street, West
Jefferson 43162 ; Michael Meftah, Secretary, 11 East 2nd
Street, London 43140. 1st Wednesday monthly.
MORROW — Francis W. Kubb, President, 140 North Main, Mt.
Gilead 43338 ; William S. Deffinger, Secretary, Box 8, Marengo
43334. 1st Tuesday monthly.
PICKAWAY — V. D. Kerns, President, 143 E. Main Street,
Circleville 43113 ; Carlos Alvarez, Secretary, 147 Pinckney
Street, Circleville 43113. 1st Friday evening monthly, except
months of July and August.
ROSS — Joseph McKell, President, 174 W. Main Street, Chilli-
cothe 45601 ; Lowell O. Smith, Secretary, 217 Delano Avenue,
Chillicothe 45602. 1st Thursday evening monthly.
UNION — Malcolm Maclvor, President, 110 N. Court St., Marys-
ville 43040 : May B. Zaugg, Secretary, 225 Stockdale Drive,
Marysville 43040. 1st Tuesday, February, April, October,
December.
Eleventh District
Councilor: William R. Schultz, Wooster 44691
1749 Cleveland Road
ASHLAND — Henry C. Chalfant, President, 309 Arthur Street,
Ashland 44805 ; H. W. Smith, Secretary, 414 Samaritan Ave-
nue, Ashland 44805. 1st Thursday monthly.
ERIE — Clinton F. Lavender, President, 1218 Cleveland Road,
Sandusky 44870 ; Mrs. David Wolfert, Executive Secretary,
1428 Hollywood Road, Sandusky 44870.
HOLMES — Charles H. Hart, President, 109 South 'Clay Street,
Millersburg 44654 ; William A. Powell, Secretary, 8 West
Adams Street, Millersburg 44654. 3rd Thursday monthly.
HURON — W. R. Graham, President, 15 Main Street, Wakeman
44889 ; E. R. McLoney, Secretary, 257 Benedict Avenue, Nor-
walk 44857. 2nd Wednesday of February, April, June, Au-
gust, October, and December.
LORAIN — Joseph A. Cicerrella, President, 209 6th Street, Lorain
44052 ; Mrs. Gladys Davidson, Executive Secretary, 428 West
Avenue, Elyria 44035. 2nd Tuesday monthly except June,
July and August.
MEDINA — Myrl A. Nafziger, President, Albrecht Building,
Wadsworth 44281 ; Mr. A. Dana Whipple, Executive Secretary,
320 East Liberty Street, Medina, Ohio 44256. 3rd Thursday
monthly.
RICHLAND — C. J. Shamess, President, 74 Wood Street, Mans-
field 44903 ; Mrs. M. K. Leggett, Executive Secretary, Mans-
field General Hospital, Mansfield 44903. 3rd Thursday
monthly except June, July, and August.
WAYNE — Howard MacMillan, President, 1740 Cleveland Road,
Wooster 44691 ; R. J. Watkins, Secretary, 1736 Beall Avenue,
Wooster 44691. 2nd Wednesday monthly, January, February,
April, September, November and December.
The Council for High Blood Pressure Research has
named Dr. Irvine H. Page, Cleveland, editor-in-chief
of a coming comprehensive textbook on renal hyper-
tension. Already well advanced, the project includes
contributions from authorities the world over. Dr.
James McCubbin and other Cleveland physicians are
working on the text.
At a meeting in Cleveland sponsored by the grad-
uate chapter of the Newman Apostolate, three phy-
sicians discussed ethical questions involved in treat-
ing patients by methods not yet wholly approved
by the profession. They were Drs. Joseph M. Foley
and Robert J. White, professors of neurology, and
Allen C. Moore, director of research, Western Re-
serve University.
for December, 1966
1331
THE OHIO STATE MEDICAL JOURNAL
INDEX TO VOLUME
62 —
1966
January
Pages
i
to
88
February
yy
89
to
192
March
yy
193
to
280
April
yy
281
to
404
May
yy
405
to
524
June
yy
525
to
626
July
yy
627
to
752
August
yy
753
to
852
September
yy
853
to
976
October
yy
977
to
1098
November
yy
1099
to
1228
December
yy
1229
to
1342
SCIENTIFIC
PAPER
! S
Abstracts from Regional Meeting of American College of
Physicians, Held in Pittsburgh, November 19-20, 1965 — 129
Adenoma of Brunner’s Glands. A Case Report (Noel Pur-
kin) - - 1040
Adenomatous Polyps of the Colon (Abdul F. Naji, Fayiz
A. Salwan, and Robert R. Bartunek) 447
Adrenal Cysts. A Case Report (Ernest B. Mainzer) 463
Adverse Reactions to Drugs. Report Them to A. M. A. (Ed.) 332
Aftercare, Psychiatric. A Discussion of the Importance of
Predischarge Planning. (Theodor Bonstedt and Hoo-
shang Khalily) 672
Aging and the Skin (Lawrence B. Meyerson) 453
American College of Physicians Regional Meeting Held in
Pittsburgh November 19-20, 1965 129
Aneurysm, Intracranial. A Nine-Year Study (William E.
Hunt, John N. Meagher, and Robert M. Hess) 1168
Aneurysm, Ruptured Dissecting, Medionecrosis of the Aorta
with (Clinicopathological Conference) 1290
Anomaly of the Gallbladder. Case Report of an Unusual
Location (J. L. Bilton and C. L. Huggins) 1034
Anticoagulation Therapy, Report of a Case, Hemocholecyst,
Associated with (Jane Brawner, Hargovind Trivedi,
and Lee R. Sataline) 1028
Aortography, Diagnosis of Obscure Splenic Cyst by ; A Case
Report (Charles D. Hafner and Majid A. Qureshi) 575
Apnea Due To Intramuscular Colistin Therapy. Report of a
Case (Michael A. Anthony and David L. Louis) 336
Artery, Right Renal, Thrombosis of (Clinicopathological
Conference) 143
Artificial Pacemaker, The Runaway, Report of a Case (Her-
man K. Hellerstein, Tom R. Hornsten, and Jay L. An-
keney) 907
Biliary Fistulas, Spontaneous Internal (See Fistulas, Biliary)
Birth Defects Registry, Evaluation of a New Program in
Cincinnati (Chris Holmes, Kenneth I. E. Macleod, and
Winslow Bashe) 563
Bone Cyst, Aneurysmal, of the Calvarium. Report of a Case
with Isotopic Visualization (Oscar A. Turner, Thomas
Laird, and Leon L. Bernstein) 1174
Bowel, Small, Intussusception of, on a Cantor Tube. Report
of a Case (Samuel S. Teitelbaum) 808
Brain Scanning (D. Bruce Sodee) 798
Breast, Carcinoma of the. Chromatin Sexing in (Ronald
E. Cohn, Thomas W. Wykoff, and E. E. Ecker) 48
Brunner’s Glands, Adenoma of — A Case Report (Noel
Purkin) 1040
Budd-Chiari Syndrome (Clinicopathological Conference) 1177
Calvarium, Aneurysmal Bone Cyst of the. Report of a Case
with Isotopic Visualization (Oscar A. Turner, Thomas
Laird, and Leon L. Bernstein) 1174
Carcinoma of the Breast, Chromatin Sexing in (Ronald E.
Cohn, Thomas W. Wykoff, and E. E. Ecker) 48
Carcinoma, Pelvic, Palliation for — A Study of Isolated
Perfusion with Chemotherapeutic Agents (Robert N.
Swaney and William G. Pace) 795
Carcinomatous Neuromyopathies (See Neuromyopathies)
Cardiac Arrest, Resuscitation After ; Case Report of Two
Successful Resuscitations Four Years Apart (A. Ian
G. Davidson and David S. Leighninger) 905
Cardiology, Computers in ; A Look Toward the Future (G.
Douglas Talbott) 897
Catheterization, Suprapubic ; Preliminary Report of a New
Postoperative Technic (Donald W. Shanabrook) 92
Chemotherapeutic Agents, Isolated Perfusion with (See
Carcinoma, Pelvic)
Children, Emotional Problems of, Attending a Heart Clinic
(Bernard Schwartz, Brian J. McConville, and Sandra
Tonkin) 125
Chromosome Analysis, The Importance of, in Down’s Syn-
drome. A Case Report of a 21/21 Translocation (Leslie
M. Eber and Richard M. Goodman) 40
Chromatin Sexing in Carcinoma of the Breast (Ronald E.
Cohn, Thomas W. Wykoff, and E. E. Ecker) 48
Cincinnati, Birth Defects Registry ; Evaluation of a New
Program (Chris Holmes, Kenneth I. E. Macleod, and
Winslow Bashe) 563
Cincinnati, Ohio — 1900 to 1960, Health Officers of, and the
Problems of Their Day (Kenneth I. E. Macleod)
654, 782, 880, 1012, 1138, 1254
Cirrhosis of the Liver (Infectious?) (Clinicopathological
Conference) 339
Cirrhosis, Postnecrotic, Infectious Hepatitis with (Clinico-
pathological Conference) 1177
Clinicopathological Conference :
Cystic Fibrosis Involving Lungs and Pancreas 51
Thrombosis of Right Renal Artery 143
Kyphoscoliotic Heart Disease, Traumatic Origin 242
(1) Chronic Idiopathic Pulmonary Hypertension 339
(2) Chronic Myocardiopathy, Type Undetermined 339
(3) Cirrhosis of the Liver (Infectious?) 339
Acute Polymyositis — 466
Hypothyroid Megacolon with Fecal Impaction 580
Goodpasture’s Syndrome 684
(1) Chronic Lymphatic Leukemia 814
(2) Constrictive Pericarditis 814
Neuroblastoma — . 916
Traumatic Perforation of Duodenum with Angiospastic
Infarction of the Bowel _ 1043
(1) Infectious Hepatitis with Postnecrotic Cirrhosis 1177
(2) Budd-Chiari Syndrome ._. — 1177
Medionecrosis of the Aorta with Ruptured Dissecting
Aneursym _ 1290
Colistin Therapy, Intramuscular, Apnea Due To (Michael
A. Anthony and David L. Louis) 336
Colon, Adenomatous Polyps of the (Abdul F. Naji, Fayiz A.
Salwan, and Robert R. Bartunek) 447
1332
The Ohio State Medical Journal
Computers in Cardiology. A Look Toward the Future (G.
Douglas Talbott) 897
Cornpicker’s Pupil (See Pupil, Cornpicker’s)
Cyst, Aneurysmal Bone, of the Calvarium. Report of a
Case with Isotopic Visualization (Oscar A. Turner,
Thomas Laird, and Leon L. Bernstein) 1174
Cyst, Splenic, Diagnosis of, by Aortography ; A Case Re-
port (Charles D. Hafner and Majid A. Qureshi) 575
Cysts, Adrenal ; A Case Report (Ernest Mainzer) 463
Cystic Fibrosis Involving Lungs and Pancreas (Clinico-
pathological Conference) 51
Decongestant, a New Nasal (See Xylometazoline)
Deficiency, Immunologic, States. A Review (James I.
Tennenbaum) 1157
Dehydrogenase, Serum Lactic, Levels, A Study of — Ex-
perimental Pulmonary Embolism: (William Bogedain,
John Carpathios, Paoli Zerbi, Do Van Suu, and Teh
Cheng Huang) 236
Demethylchlortetracycline Overdosage. A Case Report of
Toxic Effects in a Patient with Impaired Renal Function
(Armand Mandel) 333
Depression, The Many Faces of (Ian Gregory) 1023
Diagnosis of Obscure Splenic Cyst by Aortography. A Case
Report (Charles D. Hafner and Majid A. Qureshi) 575
Disease, Hodgkin’s, Pulmonary, with Cavitary Lesions
(Hema Gopinathan and Lee R. Sataline) 233
Disease, Kyphoscoliotic Heart, Traumatic Origin (Clinico-
pathological Conference) 242
Disease, Polycystic Liver. Report of a Case Employing
Needle Biopsy and Liver Scanning (R. Thomas Holz-
bach and Marvin Rollins) 570
Down’s Syndrome, The Importance of Chromosome Analysis
in. A Case Report of a 21/21 Translocation (Leslie
M. Eber and Richard M. Goodman) 40
Dreamwork 1966. A Symposium
(1) An Overview of Current Research Into Sleep and
Dreams (Roy M. Whitman) 1271
(2) Physical Concomitants of Dreaming and the Effect
of Stimulation on Dreams (Bill J. Baldridge) 1273
(3) Dreams and Conflicts (Paul H. Ornstein) 1275
(4) Drugs, Depression, and Dream Sequences. An Ex-
ploration of Dream Content Changes Induced by Medi-
cation, by Psychopathologic Conditions, and by Varia-
tions in the Ego’s Adaptability (Milton Kramer) 1277
Drugs, Adverse Reactions to. Report Them to the A. M. A.
(Ed ) 332
Duodenum, Traumatic Perforation of, with Angiospastic
Infarction of the Bowel (Clinicopathological Confer-
ence) 1043
Dysgenesis, Gonadal. Report of a Case of Male Genotype
with Female Phenotype. “Pure Testicular Dysgenesis.”
(M. Balucani and Donald E. Schnell) 44
Ear, The Middle. A Simplified Discussion of Some Common
Disorders (William H. Saunders) 668
Embolism, Pulmonary, Experimental — A Study of Serum
Lactic Dehydrogenase Levels (William Bogedain, John
Carpathios, Paoli Zerbi, Do Van Suu, and Teh Chang
Huang) _ 236
Emotional Problems of Children Attending a Heart Clinic
(Bernard Schwartz, Brian McConville, and Sandra
Tonkin) 125
Endoscopy Revisited (F. L. Mendez, C. W. Hoyt, and E.
R. Maurer) 1166
Erythroblastosis, Predicting Severity of (Lucius F. Sinks,
Colin R. Macpherson, J. Philip Ambuel, Warren E.
Wheeler, William E. Copeland, and William C. Rigsby) 137
Family Physician, The, and Psychiatry. A Discussion of a
New Method of Instruction (Warren G. Harding II, and
Wendell A. Butcher) 321
Family Physician, The Role of the: Introduction to Widow-
hood (George D. Clouse) 1281
Fecal Impaction, Hypothyroid Megacolon with (Clinicopath-
ological Conference) 580
Fibrosis, Idiopathic Retroperitoneal. Report of a Case
(Wai-man Leung and Charles L. Cogbill) 681
Fistulas, Biliary, Spontaneous Internal. Report of 12 Cases
with Discussion. (Sharif Baig) 1031
Fossa, Posterior, Subdural Hemotoma in. Report of a Case
Complicated by Meningitis in a Newborn Infant (C.
Norman Shealy) - 1172
Frank Vectorcardiograms (See Vectorcardiograms)
Frontier Doctor, Pastor, and Statesman — Levi Rogers
(P. F. Greene) 118, 212, 288
Gallbladder, Anomaly of the. Case Report of an Unusual
Location (J. L. Bilton and C. L. Huggins) 1034
Genetics, The Application of, in Medicine Today (Richard
M. Goodman) 33
Genotype, Male, with Female Phenotype. Report of a Case
of Gonadal Dysgenesis — “Pure Testicular Dysgenesis”
(M. Balucani and Donald E. Schnell) 44
Goodpasture’s Syndrome (Clinicopathological Conference) 684
Health Officers of Cincinnati, Ohio, and the Problems of
Their Day — 1900 to 1960 (Kenneth I. E. Macleod)
654, 782, 880, 1012, 1138, 1254
Heart Clinic, Emotional Problems of Children Attending
a (Bernard Schwartz, Brian J. McConville, and Sandra
Tonkin) 125
Heart Disease, Kyphoscoliotic, Traumatic Origin (Clinico-
pathological Conference) 242
Hemocholecyst. Report of a Case Associated with Anti-
coagulation Therapy (Jane Brawner, Hargovind Tri-
vedi, and Lee R. Sataline) 1028
Hemophilus Influenza Meningitis. Report of a Case Compli-
cated by Subdural Empyema (C. Norman Shealy) 915
Hemotoma, Subdural, in Posterior Fossa. Report of a Case
Complicated by Meningitis in a Newborn Infant. (C.
Norman Shealy) 1172
Hepatitis, Infectious, with Postnecrotic Cirrhosis (Clinico-
pathological Conference) 1177
Hernia, Lumbar, Bilateral Congenital (Benjamin W. Butler
and Alan D. Shafer) 577
“Hippocrates” — [a short Poem] (Marie Markle) 797
Hodgkin’s Disease, Pulmonary, with Cavitary Lesions (Hema
Gopinathan and Lee R. Sataline) 238
Hyperglobulinemic Purpura. Report of a Case and Review
of the Literature (C. Joseph Cross, W. A. Millhon, J.
S. Millhon, and D. E. Hoffman) 1036
Hypersensitivity Diseases of the Lung. A Review (Jon
Tipton) H62, 1285
Hypertension, Pulmonary, Chronic Idiopathic (Clinicopath-
ological Conference) 339
Hypothyroid Megacolon with Fecal Impaction (Cliniciopath-
ological Conference) 580
Immunologic Deficiency States. A Review (James I. Tennen-
baum) 1157
Infarction of the Bowel (See Duodenum, Traumatic Perfor-
ation)
Infectious Hepatitis with Postnecrotic Cirrhosis (Clinico-
pathological Conference) 1177
Intracranial Aneurysm. A Nine-Year Study (William E.
Hunt, John N. Meagher, and Robert M. Hess) 1168
Intussusception of Small Bowel on a Cantor Tube. Report
of a Case (Samuel S. Teitelbaum) 808
Kyphoscoliotic Heart Disease, Traumatic Origin (Clinico-
pathological Conference) 242
Letter to the Editor : On Mustard and Heart Disease (David
G. Cornwell) . 199
Leukemia, Acute, Pregnancy in ; Report of a Case (T. D.
Stevenson, William C. Rigsby, and D. P. Smith) 811
Leukemia, Lypmphatic, Chronic (Clinicopathological Con-
ference) 814
Liver Biopsy. A Report of Experience in 151 Cases (C.
Joseph Cross, William A. Millhon, Judson S. Millhon,
and Donald E. Hoffman) 572
Liver, Cirrhosis of the (Infectious?) (Clinicopathological
Conference) 339
Liver, Polycystic, Disease. Report of a Case Employing
Needle Biopsy and Liver Scanning (R. Thomas Holzbach
and Marvin Rollins) 570
Lung, Hypersensitivity Diseases of the; A Review (Jon
Tipton) 1162, 1285
Lungs and Pancreas, Cystic Fibrosis Involving (Clinicopath-
ological Conference) 51
Male Genotype with Female Phenotype (See Genotype, Male)
Maternal Health in Ohio:
Adequate Prenatal Care. “Be Good to Mother Before Baby
Is Born” 247
Maternal Mortality Report for Ohio — 1963 585
Material Deaths Involving Suicide 1294
Medical Travelogue (Willem J. Kolff) 323
Medionecrosis of the Aorta with Ruptured Dissecting Aneu-
rysm (Clinicopathological Conference) 1290
Megacolon, Hypothyroid, with Fecal Impaction (Clinicopath-
ological Conference) 580
Meningitis, Hemophilus Influenza. Report of a Case Com-
plicated by Subdural Empyema (C. Norman Shealy) — 915
Mustard and Heart Disease, Letter to the Editor on (David
G. Cornwell) 199
for December, 1966
1333
Mydriasis from Jimson Weed Dust (Stramonium), Corn-
picker’s Pupil: A Clinical Note Regarding (James A.
Goldey, Dover A. Dick, and William L. Porter) 921
Myocardiopathy, Chronic, Type Undetermined (Clinico-
pathological Conference) 339
Neuroblastoma (Clinicopathological Conference) 916
Neuromyopathies, Carcinomatous. A Review of Neurological
Syndromes Associated with Malignant Neoplasms and
Unrelated to Metastases (Timothy Fleming) 225
Nose Drops, What About, in Kids ? Controlled Study of
Xylometazoline — a New Nasal Decongestant (H. P.
Sengelmann) 141
Obesity, Phenmetrazine Effect Without Dietary Restriction
(John R. Huston) 805
Ohio, Cincinnati, 1900 to 1960 (See Cincinnati)
Ohio — 1963, Maternal Mortality Report for 585
Ohio, Yellow Fever in (Part II) (N. Paul Hudson) 8
Pacemaker, Artificial, The Runaway, Report of a Case (Her-
man K. Hellerstein, Tom R. Hornsten, and Jay L.
Ankeney) 907
Pancreas, Cystic Fibrosis Involving Lungs and (Clinico-
pathological Conference) 51
Pericarditis, Constrictive (Clinicopathological Conference) 814
Phenmetrazine Effect (See Obesity)
Physician, The Family (See Family Physician)
Placental Localization (Donald W. Shanabrook) 677
Polymyositis, Acute (Clinicopathological Conference) 466
Polyps, Adenomatous, of the Colon (Abdul F. Naji, Fayiz
A. Salwan, and Robert R. Bartunek) 477
Pregnancy in Acute Leukemia. Report of a Case (T. D.
Stevenson, William C. Rigsby, and D. P. Smith) 811
Prenatal Care, Adequate — “Be Good to Mother Before
Baby is Born” (Anthony Ruppersberg, Jr.) 247
Psychiatric Aftercare. A Discussion of the Importance of
Predischarge Planning (Theodor Bonstedt and Hoo-
shang Khalily) 672
Psychiatry, The Family Physician and, — A Discussion of
a New Method of Instruction (Warren G. Harding II,
and Wendell A. Butcher) 321
Psychotherapy, Supportive (Harrison Evans) 232
Pulmonary Embolism, Experimental (See Embolism, Pul-
monary)
Pulmonary Hypertension (See Hypertension, Pulmonary)
Pupil, Cornpicker’s. A Clinical Note Regarding Mydriasis
from Jimson Weed Dust (Stramonium) (James A.
Goldey, Dover A. Dick, and William L. Porter) 921
Purpura, Hyperglobulinemic. Report of a Case and Re-
view of Literature. (C. Joseph Cross, W. A. Millhon,
J. S. Millhon, and D. E. Hoffman) 1036
Resuscitation after Cardiac Arrest. Case Report of Two
Resuscitations Four Years Apart (A. Ian G. Davidson
and David S. Leighninger) 905
Rogers, Levi, Frontier Doctor, Pastor, and Statesman (P.
F. Greene) 118, 212, 288
Scanning, Brain (D. Bruce Sodee) 798
Septic Shock (See Shock, Septic)
Shock, Septic, Treatment of — -A Progress Report (Frank
W. Ames and Martin J. Fischer) 329
Skin, Aging and the (Lawrence B. Meyerson) 453
Sound Perception. Its Theoretical History and Present Status
(James T. McMahon) ___ 665
Splenic Cyst (See Cyst, Splenic)
Subdural Hemotoma in Posterior Fossa. Report of a Case
Complicated by Meningitis in a Newborn Infant (C.
Norman Shealy) 1172
Suicide, Maternal Deaths Involving 1294
Suprapubic Catheterization. Preliminary Report of a New
Postoperative Technic (Donald W. Shanabrook) 912
Symposium — “Dreamwork 1966” (See Dreamwork)
Syndrome, Budd-Chiari (Clinicopathological Conference) ..1177
Syndrome, Down’s (See Down’s Syndrome)
Syndrome, Goodpasture’s (Clinicopathological Conference) .. 684
Therapy, Anticoagulation, Report of a Case Associated with
(See Hemocholecyst)
Thrombosis of Right Renal Artery (Clinicopathological
Conference 143
Travelogue, Medical (Willem J. Kolff) 323
Vectorcardiograms, Frank, of Normal Adults (Robert T.
Murnane, Louis H. Skimming, and James R. Snyder) 457
Widowhood, Introduction to, The Role of the Family Physi-
cian (George D. Clouse) 1281
Xylometazoline, Controlled Study of, — a New Nasal De-
congestant (H. P. Sengelmann) 141
AUTHORS OF SCIENTIFIC PAPERS AND CASE RECORDS
Ambuel, J. Philip (Columbus) 137
Ames, Frank W. (Akron) 329
Ankeney, Jay L. (Cleveland) 907
Anthony, Michael A. (Columbus) 336
Baig, Sharif (Dayton) 1031
Baldridge, Bill J. (Cincinnati) 1271
Balucani, M. (Pescara, Italy) 44
Bartunek, Robert R. (Cleveland) 447
Bashe, Winslow (Cincinnati) 563
Bernstein, Leon L. (Youngstown) 1174
Bilton, J. L. (Cleveland) 1034
Bogedain, William (Canton) 236
Bonstedt, Theodor (Cincinnati) 672
Brawner, Jane (Cleveland) 1028
Butcher, Wendell A. (Columbus) 321, 1284
Butler, Benjamin W. (Dayton) 577
Carpathios, John (Canton) 236
Clouse, George D. (Columbus) 1281
Cogbill, Charles L. (Dayton) _ 681
Cohn, Ronald E. (Pittsburgh, Pa.) 48
Copeland, William E. (Columbus) 137
Cornwell, David G. (Columbus) 199
Cross, C. Joseph (Columbus) 572, 1036
Davidson, A. Ian G. (Foresterhill, Aberdeen, Scotland) 905
Davis, Galen H. (Dublin, Ohio) i 457
Dick, Dover A. (Oxford, Ohio) 921
Eber, Leslie M. (Columbus) 40
Ecker, E. E. (Cleveland) 48
Evans, Harrison (Los Angeles, Calif.) 232
Fischer, Martin J. (Akron) 329
Fleming, Timothy (Cincinnati) 225
Goldey, James A. (Oxford, Ohio) 921
Goodman, Richard M. (Columbus) 33, 40
Gopinathan, Hema (Cleveland) 238
Greene, P. F. (New Richmond) 118, 212, 288
Gregory, Ian (Columbus) 1023
Hafner, Charles D. (Cincinnati) 575
Harding, Warren G. II (Columbus) 321
Hellerstein, Herman K. (Cleveland) 907
Hess, Robert M. (Columbus) 1168
Hoyt, C. W. (Cincinnati) 1166
Hunt, William E. (Columbus) 1168
Hoffman, Donald E. (Columbus) 572, 1036
Holmes, Chris (Cincinnati) 563
1334
The Ohio State Medical Journal
Holzbach, R. Thomas (Cleveland)
Hornsten, Tom R. (Cleveland)
Huang-, Teh Cheng (North Canton)
Hudson, N. Paul (Columbus)
Huggins, C. L. (Cleveland)
Huston, John R. (Columbus)
570
907
236
Khalily, Hooshang (Cincinnati)
Kolff, Willem J. (Cleveland)
Kramer, Milton (Cincinnati)
Laird, Thomas (Youngstown)
Leighninger, David S. (Cleveland)
Leung, Wai-man (Dayton)
Louis, David L. (Columbus)
1034
. 805
. 672
Macpherson, C. R. (Columbus)
Macleod, Kenneth I. E. (Cincinnati)
880, 1012, 1138,
Maurer, E. R. (Cincinnati)
Meagher, John N. (Columbus)
323, 906
1277
1174
905
681
336
137
563, 654, 782,
Mendez, F. L., Jr. (Cincinnati)
Mainzer, Ernest B. (Mansfield)
Mandel, Armand (Parma)
Markle, Marie (Dayton)
1254
1166
1168
.1166
. 463
. 333
. 797
McConville, Brian J. (Ontario, Canada) 125
McMahon, James T. (Los Angeles, Calif.) 665
Meyerson, Capt. Lawrence B., M. C. (APO San Francisco) _ 453
Millhon, Judson S. (Columbus) ..
Millhon, William A. (Columbus)
Murnane, Robert T. (Columbus)
Naji, Abdul F. (Cleveland)
Ornstein, Paul H. (Cincinnati) ...
Pace, William G. (Columbus)
- 572, 1036
- 572, 1036
457
447
Porter, William L. (Oxford, Ohio)
Qureshi, Majid A. (Cincinnati)
1275
795
921
1 575
Purkin, Noel (Calgary, Alberta, Canada)
Rigsby, William C. (Columbus)
Rollins, Marvin (Cleveland)
Ruppersberg, Anthony, Jr. (Columbus)
Salwan, Fayiz A. (Cleveland)
Sataline, Lee (Toledo)
Saunders, William H. (Columbus)
Schnell, Donald E. (Toledo)
Schwartz, Bernard A. (Cincinnati)
Sengelmann, H. P. (Columbus)
Shafer, Alan D. (Dayton)
Shanabrook, Donald W. (Tiffin)
Shealy, C. Norman (La Crosse, Wisconsin)
Sinks, Lucius (Cambridge, England)
Skimming, Louis H. (Middletown)
Smith, D. P. (Sycamore)
Snyder, James R. (Suitland, Maryland)
Sodee, D. Bruce (Cleveland)
Stevenson, T. D. (Columbus)
Swaney, Robert N. (Columbus)
Talbott, G. Douglas (Kettering)
Teitelbaum, Samuel S. (Cleveland)
Tennenbaum, James I. (Columbus)
Tipton, Jon P. (Durham, North Carolina)
Tonkin, Sandra (Cincinnati)
Trivedi, Hargovind (Cleveland)
Turner, Oscar A. (Youngstown)
Van Suu, Do (Canton)
Wheeler, Warren E. (Lexington, Ky.)
Whitman, Roy M. (Cincinnati)
Wykoff, Thomas W. (Maxwell AFB, Alabama) .
Zerbi, Paoli (Columbus)
808, 1040
137, 811
570
247
447
238, 1028
668
44
125
141
577
677, 912
915, 1172
137
457
811
457
798
811
795
897
808
1157
1162, 1285
125
1028
1174
236
137
1271
48
236
for December, 1966
1335
GENERAL
INDEX
Advertising, Index to — 86, 190, 278, 402, 522, 624, 750, 850,
973, 1096, 1226, 1340
Advertising, Classified — • 87, 191, 279, 403, 523, 625, 751, 851,
974, 1097, 1227, 1341
Alcoholism — -
Ten Commandments for the Prevention of Alcoholic
Addiction 296
American Medical Association —
AMA Environmental Health Program Scheduled, 268 ;
Ohioans Have Special Interest in AMA Annual Con-
vention, 506 ; Dr. Hudson To Be Installed as President
of AMA, 606 ; Ohio Physicians Appointed to AMA
Committees, 612 ; OSMA Announces Candidacy of Dr.
John H. Budd for AMA House Vice-Speaker, 607 ; Di-
rector Is Named for AMA Department of Health Care
Services, 638 ; AMA Films Being Shown at Record Rate,
736 ; October 16-22 Designated as Community Health
Week, 764 ; AMA 20th Clinical Convention Scheduled in
Las Vegas, 935 ; AMA Takes Firm Stand at Convention ;
Ohioans Play Leading Roles, 936 ; In Inaugural Ad-
dress, Dr. Hudson Warns Against Expansion of Fed-
eral Role, 939 ; Physician’s Role in Medicare, 940 ; AMA
Issues Comprehensive Report on Distribution of Physi-
cians, 984 ; AMA Las Vegas Meeting, 1069 ; Socio-Eco-
nomics of Health Care Topic of Congress, 1095 ; Socio-
Economics of Health Care, Topic for AMA Program,
1126; AMA Las Vegas Meeting Announced 1194
American Medical Association Education and Research
Foundation —
AMA-ERF Checks Presented to Deans of Medical
Schools, 711 ; AMA-ERF Campaign Launches in Ohio,
1195 ; Medicine’s Own Pioneering Effort 1300
American Medical Political Action Committee (AMPAC)
(See under Ohio Medical Political Action Committee)
Annual Meeting — (See also House of Delegates, The
Council, Exhibits)
Application for Space in Annual Meeting Scientific
Exhibit, 65 ; Hotel Reservation Blank for OSMA Annual
Meeting, 67 ; 1966 Annual Meeting Highlights a New
Look, 160 ; Medical Booth Seminars, 161 ; Schedule of
Events in Brief, 162 ; Hotel Reservation Page, 165,
262; Care of the Patient: 1966 — Theme of Annual
Meeting, 257 ; Announcing the Official Program, 347 ;
Honors to Dr. Platter at Annual Meeting, 506 ; Hotel
Reservation Page, 508 ; Reports of the 1966 OSMA
Annual Meeting : Presenting Officers, 692 ; Proceedings
of the House, 695 ; Past Presidents Present, 703 ; Dr.
Platter Honored, 703; Three Officers Pictured, 707;
Vietnam Service Awards presented, 707 ; AMA-ERF
Checks Presented, 711 ; House Roll Call, 716 ; President’s
Address, 718 ; Outstanding Exhibits, 722 ; Inaugural
Address, 723 ; Annual Meeting Attendance, 725 ; An-
nual Meeting in Review; Woman’s Auxiliary Report — 729
Apparatus — (See under Pharmaceuticals, Apparatus and
and Related Products)
Associations, Societies and Organizations — (See also
Specialty Societies) (Local and Ohio)
Special Events of Special Groups at OSMA Annual
Meeting, 378 ; Cleveland Health Museum Offers “Oper-
ation Bus Stop” 379
Associations, Societies and Organizations — (See also
Specialty Societies) (Regional, National, and International)
Ohioans to Play Leading Role in American College of
Physicians Meeting, 216 ; American College of Surgeons
Joint Cleveland Meeting, 260 ; MEDICO Helps People
to Help Themselves, 383 ; Fertility Control Film Avail-
able from Planned Parenthood Library 956
Athletic Injury — (See under School Health)
Audit, Annual of OSMA and The Journal Books — 608
Birth Defects Registry —
Birth Defects Registry in Cincinnati 563
Blood Banks —
Ohio Association of Blood Banks Announces Officers 849
Blue Shield, Blue Cross — Blue Shield Plan Membership
Reaches All-Time High, 64 ; Blue Shield Symbol Pro-
tected by Court, 791 ; Blue Shield Plan Membership and
Benefits Continue Climb 944
Board Certification —
Comments on Specialty Board Members 39
Book Reviews — (See Physician’s Bookshelf)
Cancer —
Western Reserve Project Applies Smear Test to Dental
Patients, 158 ; Extensive Cancer Survey Underway at
Ohio State University 1148
Change of Address Coupon — 189
Child Care — (See also under School Health)
Maternal and Child Care Conference Scheduled in San
Francisco, 502 ; “Sudden Infant Death Syndrome”
Studied 840
Civic and Governmental Affairs —
Are You Registered to Vote? 948
Civil Defense — (See Disaster Medical Care)
Coming Meetings — 1090, 1227
Conference of County Medical Society Officers —
Report of the Medical Society Officers’ Conference 496
Contract Practice —
“Contract Practice” — A Large Project (in Summit
County) 499
Cornpicker’s Pupil —
Cornpicker’s Pupil — an Editorial 877
Council, The —
Proceedings of The Council, Meeting of November 21,
1965, 62 ; New Provisions of OSMA Bylaws Pertaining
to Nomination of President-Elect, 63, 258 ; Proceedings
of December 11-12, 1965 Meeting, 150 ; Approved Budget
for 1966, 151 ; Proceedings of February 20 Meeting, 381 ;
Proceedings of March 20 Meeting, 474 ; Policy Regard-
ing Governmental Medical Care Programs, 492 ; Candi-
dates for the Office of President-Elect of OSMA, 495 ;
Proceedings of April 23-24 Meeting, 592 ; Presenting
Officers and Councilors, 692 ; Proceedings of July 23-24
Meeting, 922 ; Proceedings of September 9-11 Meeting,
1182 ; Dr. Oscar W. Clarke, Named Ninth District
Councilor, 1185 ; Heart-Cancer-Stroke Plan in Ohio
Reported to The Council, 1191 ; Proceedings of Special
Sessions 1238
County Medical Societies —
Youngstown Program Puts Meaning into Community
Health Week, 75 ; Stark County Medical Society Honors
50-Year Physicians, 112 ; Carroll County Medical So-
ciety Announces Medical Seminar, 184, 272 ; “Contract
Practice” — A Large Project (in Summit County), 499;
Dr. Melnick Presents Mahoning County Medical Society
Trophy, 519 ; Ohio County Society Executives Move to
Strengthen Ties, 531 ; Cleveland Academy Sponsors
Hawaiian Tour, 734 ; Executives of Ohio Medical So-
cieties Attend Second Chicago Conference 1074
Activities of County Medical Societies — 72, 175, 264, 394,
518, 618, 737, 839, 965, 1082, 1206, 1312
Roster of County Medical Society Officers and Meeting
Dates— 84, 187, 276, 400, 514, 747, 847, 980, 1093, 1223, _.__1329
Deaths — (See Obituaries)
Diabetes —
Two Ohioans on American Diabetes Association Pro-
gram 30
Disaster Medical Care —
Conference on Disaster Medical Care Proceedings Pub-
lished, 851 ; Disaster Institute Program Announced,
955 ; 1049
Distribution of Physicians —
Distribution of Physicians, Hospitals, and Hospital
Beds in the U. S., an AMA Booklet 1104
District Societies and District Meetings —
Sixth Councilor District Postgraduate Day Program
Announced, 958, 1050
Drugs — (See Pharmaceuticals)
Editorials —
Cornpicker’s Pupil 877
Elections — (See Civic and Governmental Affairs)
Emergency Rooms — (See also Hospitals)
Medical Staffing of Emergency Rooms ; Legal and Ethical
Considerations, 600 ; Official OSMA Policy Statement
on Staffing Emergency Rooms 604
Environmental Health —
Environmental Health Project Authorized for Uni-
versity of Cincinnati 642
Ethics, Matters of Policy, etc. —
Hippocrates 797
Executives —
Ohio Medical Society Executives Move to Strengthen
Ties 531
Exhibits — (See also Annual Meeting)
Application for Space in OSMA Annual Meeting Ex-
hibit, 159 ; Roster of Scientific Exhibits for Annual
Meeting, 373 ; Roster of Technical Exhibits for An-
nual Meeting, 375 ; Application Form for Space in
Exhibits, 1083 ; Outstanding Scientific Exhibits Awarded
at Annual Meeting, 722, 942, 1070, 1198
Federal Bureau of Investigation —
Hospital Orderly Wanted by FBI Believed to Be in
Ohio 263
Federal Government — (See also under headings, such as
Social Security, Taxation, etc.)
Government Policies Are Inconsistent, Contradictory — 994
Financial Report, OSMA and The Journal 608
Fifty-Year Physicians — (See also under County Medical
Societies, Activities of)
Ohio Honors 54 Senior Physicians with Certificates of
Distinction, 112 ; Dean of Toledo Physicians Retires 828
1336
The Ohio State Medical Journal
General Practice of Medicine —
Corporate Medical Laboratories ; a Policy Statement of
AAGP, 412 ; OAGP Annual Scientific Assembly Pro-
gram, 736 ; Ohio Academy of General Practice Officers,
956; A View of the Future (Excerpt), 1027; The Future
of General Practice — a Lecture on OSU Campus by Dr.
Robert E. Carter . 1058
Handicapped — (See Rehabilitation)
Health Care Insurance — (See under Insurance, Social
Security, etc.)
Health Commissioners — (See also Public Health and
Ohio Department of Health)
Ohio Health Commissioners’ Institute 371
Heart —
Heart Association Speaker Will Be Cardiologist, 391 ;
Ohio State Heart Association Elects Officers, 694 ; Heart
Group Offers Handbook on Low-Sodium Diet, 733 ; Cin-
cinnati Heart Studies Extended, 984 ; American Heart
Association Honors Cleveland Research Physician, 1148 ;
Dieting Results Shown in Anti-Coronary Club 1259
Heart-Cancer-Stroke —
Plan under Heart Disease, Cancer and Stroke Amend-
ments of 1965 Proposed for Parts of Ohio 1191
History —
Yellow Fever in Ohio, Part II, 8; William Osier Medal
Student Essay Contest, 9 ; Levi Rogers - — Frontier Doc-
tor, Pastor and Statesman, Part I, 118 ; Part II, 212 ;
Part III, 290 ; Health Officers of Cincinnati, and the
Problems of Their Day — 1900 to 1960, Part I, 654 ;
Part II, 782 ; Part III, 880 ; Part IV, 1012 ; Part V, 1138 ;
Part VI, 1254 ; Ohioans on Program of International
Congress of Medical History, 965 ; Proctology in Ancient
Egypt 1042
Hospitals —
Seminar on Premature Care at Good Samaritan Hospi-
tal, 216 ; Hyperbaric Symposium Sponsored by Maumee
Valley Hospital, 274 ; Good Samaritan of Cincinnati
Seminar on Premature Care, 374 ; A Statement on :
Composition and Duties of Hospital Utilization Review
Committees, 498 ; “Contract Practice” — A Large Proj-
ect (Summit County), 499; Medical Staffing of Emer-
gency Rooms ; Legal and Ethical Considerations, 600 ;
Official OSMA Policy Statement on Staffing Emergency
Rooms, 604 ; Children’s Hospital, Columbus, Served 84
Counties, 612 ; Conference on Control and Prevention
of Infection in Health Care Facilities, 624 ; Lectures
on Human Reproduction in Cleveland, 958 ; St. Rita’s
Hospital, Lima, Inhalation Therapy Seminar, 1051 ; 12
Hospitals Designated in Ohio as Needed for TB Pa-
tients, 1072 ; Distribution of Physicians, Hospitals, etc.,
an AMA Booklet, 1104 ; Institute on Areawide Planning
Scheduled 1308
House of Delegates, OSMA —
New Provisions of the OSMA Bylaws pertaining to
Nomination of President-Elect, 63, 164, 258 ; Deadline
for Submission of Resolu'dtios, 64, 158, 261 ; Roster of
Delegates and Alternates, 354 ; Advance Resolutions,
Nominations to Be Published, 379 ; Resolutions Which
Will Be Considered at 1966 Annual Meeting, 481 ; Candi-
dates for the Office of President-Elect of OSMA, 495 ;
Agenda for House of Delegates Meeting, 506 ; Pro-
ceedings of the House of Delegates, 1966 Annual Meet-
ing, 695 ; House Roll Call, 716 ; President’s Address,
718; Inaugural Address, 723; Woman’s Auxiliary Re-
port Before the House 729
Hudson, Charles L. —
Dr. Hudson To Be Installed as President at AMA Con-
vention, 606 ; Dr. Hudson Speaks at Annual Meeting,
715 ; In Inaugural Address, Dr. Hudson Warns Against
Expansion of Federal Role 939
Immunization —
OSMA Campaign for Immunization Against Measles,
18 ; USPHS Purchases Measles Vaccine for Local Pre-
school Programs 314
Industrial Commission of Ohio— (See Workmen’s
Compensation, Bureau of)
Industrial Health — (See Occupational Health)
In Our Opinion —
MEDICO Helps People to Help Themselves ; Merits
Support, 383 ; Continuing Education, a Mark of the
Profession, 383 ; Emotional Problems Related to Health
of School Children, 383 ; Brand vs. Generic Names ;
a Physician’s Comments, 994 ; Government Policies Are
Inconsistent, Contradictory, 994 ; The Bureaucrat and
the Doctor, 1116 ; Some Interesting Background, on Chiro-
practic Facilities 1116 ; The Impact of a Patriarch on
American Medicine, 1264 ; Health and Safety Tips In-
clude Home Fire Drill 1254
Insurance —
Regular Medical Expense Insurance on Increase, 24 ;
Ohio Among Top States in Number of Health Insurance
Groups, 24; Life Insurance Research Fund Helps Proj-
ects in Ohio, 96 ; Malpractice Insurance Rate Increase,
611 ; Life Insurance Fund Sponsors Grants, 791 ; Health
Insurance Protection Widespread 1312
Investments —
Caribbean Territories Sales Group Gets Cease and De-
sist Order 391
Joint Commission on Accreditation of Hospitals — (See
under Hospitals)
The Journal —
The Ohio State Medical Journal Is Circulated Abroad,
104 ; OSMA and The Journal Have New Address, 491 ;
Statement of Ownership, Management, and Circulation
of The Journal 1073
Labor — (See Occupational Health)
Laboratories —
Corporate Medical Laboratories ; a Policy Statement
of AAGP, 412 ; Technicians Receive Certificates in
Laboratory Animal Care 827
Laws, Legislation, and Court Decisions —
New Drug Abuse Law 168
Legal Medicine —
Medical Staffing of Emergency Rooms ; Legal and Ethi-
cal Considerations, 600 ; Law-Medicine Conference Sched-
uled at OSU 840
Letters to the Editor —
Regarding Article by Dr. Jackson Blair Relating to
Ingestion of Mustard, 199 ; Added Note by the Author
of “Medical Travelogue” 906
Licensure — (See State Medical Board of Ohio)
Limited Practitioners —
Some Interesting Background on Chiropractic Facilities, 1116
Major Medical Insurance Program — (See Insurance)
Maternal Health — (See under Scientific and Clinical Papers)
M. D.’s in the News— 66, 210, 307, 442, -
Measles —
Mortus a Morbilli — OSMA Campaign for Immuniza-
tion Against Measles, 18 ; “Death to Measles” Article
Poses Lesson in Latin, 221 ; USPHS Purchases Measles
Vaccine for Local Preschool Programs 314
Medical Education —
OSU College of Medicine Course in Pediatrics, 19 ;
OSU College of Medicine Announces Courses, 64 ; “Spon-
sored Funds” Putting Strain on Medical School Fi-
nances, 102 ; Diseases of the Colon, One of Courses at
OSU, 184 ; Medical Ethics Essay Open to Medical Stu-
dents, 184 ; Western Reserve Dental School Tests
Self-Teaching Method, 260 ; OSU Medical College Gets
Grant for Basic Science Building, 261 ; Pediatric
Lectureship at University of Cincinnati, 261;
Cincinnati learn Pioneers in Clinical Use of Argon
Laser, 286 ; University of Virginia Alumni Cleveland
Reception, 379 ; Continuing Education, a Mark of the
Profession, 383 ; Fellowship in Immunology-Allergy
Offered at Cincinnati University, 391 ; Ohio State Uni-
versity Offers Courses, 512 ; A Future in Family Medi-
cine Is Topic for OSU Lecture, 512 ; Health Service Stu-
dent Loans and Scholarships Announced, 534 ; Toledo
State College of Medicine’s First President Appointed,
545 ; School of Allied Medical Services To Be Established
at Ohio State, 550 ; Western Reserve Medical School Gets
Substantial Sears Gift, 556 ; Dean of Medical School
Named at Western Reserve, 558 ; Thoughts on Teaching
Medicine (Excerpt), 579 ; University of Cincinnati Gets
Environmental Health Project, 642 ; OSU Alumni Hon-
ored, 660 ; Department Chairman Named at Western
Reserve, 730 ; OSU Section for Directors of Medical
Education, 731 ; Director Named at OSU for New School
of Allied Medical Services, 738 ; Diabetic Detection
Film, 750 ; Foundation Grant Furthers Study of Pre-
maturity at OSU, 751 ; Ohio Physician as Film Partici-
pant Discusses the “Flabby” Male, 778 ; OSU Offers
Courses, 778 ; Prototype Refresher Course for Women
Physicians Studied, 837 ; OSU Medical Education Net-
work Wins Top Honors, 845 ; Eye Research at Three
Colleges Promoted, 850 ; Ohioans on Texas Gynecology
Program, 860 ; Ohio Physicians Help Establish Virus
Classification System, 874 ; Establish Training Pro-
gram for Obstetric Anesthesiology, 895 ; OSU Third
Symposium on Diabetes Mellitus, 1051 ; Cleveland Clinic
Foundation Announces Courses, 1052 ; OSU Team Seeks
Standards in Care of Newborn Babies, 1075 ; National
Library of Medicine Expands, 1109 ; Cleveland Clinic
Announces Courses, 1195 ; Controversies in General Sur-
gery Is Cleveland Clinic Topic 1259
Medical Writing —
American Medical Journalism — Its Impact on Foreign
Countries, 104; Ohio State Medical Journal Is Circulated
Abroad, 104 ; Attention Program Chairmen, 121 ; In-
structions to Contributors of Scientific Papers, 246, 589
Medicare — (See under Social Security)
Medicine and Religion —
Specialization in Medicine (Too Frequently Focus of
Attention Narrows), 906 ; The Art of Medicine (Ab-
stract) — 1039
Members, Roster of New— 76, 184, 274, 298, 428, 538, 633,
837, 874, 1126, - — 1312
Mental Health —
Physicians of the Department of Mental Hygiene and
and Correction To Meet, 961 ; — 1052
Miscellaneous —
“When a Fellow Needs a Friend !” Accident Victim Com-
forted by Physician — 744
Narcotics —
Written Prescription Required for Class A Narcotic
Drugs, 251 ; Keep Narcotic Drugs Safeguarded 1299
for December, 1966
1337
Nursing —
Professional Placement Maintained by Ohio State Nurses
Association, 19 ; Ohio Licensed Practical Nurses An-
nounce New Organization, 169 ; Ohio State Pioneers in
Nursing Education Program, 298 ; OSU School of
Nursing Given Federal Grant for Building, 390 ; Grant
Promotes Nursing Program at Western Reserve, 550 ;
New Ways to Teach Nursing Promoted
Contract for Artificial-Heart Research, 851 ; Malignant
Tumors Studied in Trout, 890 ; Investigators Compile
Collection of Papers on Berylliosis, 890 ; Grants Promote
Research at OSU, 972 ; Cincinnati Heart Studies Ex-
tended, 984 ; Study of Adolescents Scheduled, 1001 ; Cleve-
land Pathologist Shares First of Stouffer Awards, 1072 ;
Two Columbus Physicians Launch Preschooler Nutrition
961 Study, 1121 ; Dignitaries at Cleveland Award Dinner ... 1317
Obituaries— 68, 172, 262, 386, 504, 614, 732, 836, 962, 1076,
1202, 1309
Medical Executive of Long Standing, Stanley R. Mauck,
Dies 203
Resolutions — (See House of Delegates)
Rosters — (See under Ohio State Medical Association,
County Medical Societies, Woman’s Auxiliary, etc.)
Occupational Health and Medicine —
Work Days Restricted by Illness in Billions, 298 ; Ohioan
Will Receive National Award at Occupational Health
Meeting 944
Ohio Academy of General Practice — (See under General
Practice)
Ohio Department of Health —
Health Referral Service in Ohio for Selective Rejectees,
550 ; Health Department Cosponsors Conference on Con-
trol of Infections, 610 ; New Public Health Regulations
on PKU Testing in Ohio, 822 ; 12 Hospitals Designated
in Ohio as Needed for TB Patients, 1072 ; Public Health
in Ohio — Report of the Health Director 1238
Ohio Medical Political Action Committee (OMPAC) —
OMPAC Memberships Rolling In, 170 ; OMPAC Mem-
bership Now 2,228 ; OMPAC Luncheon Scheduled, 357 ;
bership Now 2,228, page 259 ; OMPAC Luncheon Sched-
uled, 357 ; OMPAC Membership Hits 2,610 384
Ohio State Medical Association —
Ohio State Medical Association and The Journal Have
New Columbus Address, 491 ; OSMA Executive Secretary
Named to Two National Committees, 791 ; New Mem-
ber Joins Staff of OSMA, 941 ; Notice to All Members
Regarding Payment of Dues _ 1305
Roster of OSMA Officers and Committeemen, 83, 186,
275, 399, 513, 746, 846, 969, 1092, 1222, 1328
Old Age and Survivors Insurance — (See Social Security)
Pharmaceuticals, Apparatus, and Related Products —
Death by Default (Abstract), 50; C. Joseph Stetler
Named President of Pharmaceutical Manufacturers As-
sociation, 70 ; Current Comments, 76, 96, 296, 424, 648,
870 ; Drug Company Takes Steps to Keep Damaged Pro-
ducts Off Market, 117 ; New Drug Abuse Law, 168 ;
Some Disposable Syringes Can Yield Contaminants, 241;
Written Prescription Required for Class A Narcotic
Drugs, 251 ; Adverse Reactions to Drugs ; Report Them
to New AMA Registry, 332 ; Drug Information Associa-
tion, Allied Groups to Meet, 377 ; Three Ohioans Award-
ed Fellowships for Overseas Tour, 522 ; Prescription
Medicines (Excerpt), 579 ; More Than One Billion Pre-
scriptions Will Be Filled, 584 ; Operating under the
Profit System, Pharmaceutical Industry Has Made Con-
tributions, 667 ; Drug Firm Foundation Promotes Career
Selection Program, 724 ; Drug Manufacturing Company
Announces New Identification Code, 956 ; Brand vs.
Generic Names ; a Physican’s Comments, 944 ; New
Executive Secretary Named for State Board of Phar-
macy 1073
Phenylketonuria (PKU) —
New Public Health Regulations on PKU Testing in
Ohio 822
Physical Medicine — (See Rehabilitation)
Physician’s Bookshelf —
Army Medical Department Issues Edition in History
Series, 660 ; 1966 Edition of New Drug Text, 660 ; Hand-
book of Clinical Laboratory Data, etc. 1113
Placement Service — (See Classified Advertising Pages)
Platter, Herbert H., M. D. — (See under State Medical
Board of Ohio)
Poison Control —
Poison Information Centers in Ohio , 189
Postgraduate Activities — (See also under District
Programs, Medical Education)
American College of Surgeons Sectional Program in
Cleveland, 61 ; Physicians Invited to Ob-Gyn Lectures in
Akron, 61 ; Cleveland Clinic Offers Surgery Courses, 63 ;
Weil Memorial Lectureship Scheduled in Akron,' 260 ;
Lectures on Human Reproduction Scheduled in Cleve-
land, 845 ; Institute for the Study of Human Reproduc-
tion Offers Course 1225
Preceptorship — (See under Rural Health)
Prescriptions — (See under Pharmaceuticals)
Public Health — (See Ohio Department of Health)
Quackery —
National Congress on Quackery Scheduled in Chicago 946
Query —
Is Shingles Contagious ? 860
Rehabilitation —
Library Photoduplication Service Offered Research
Groups, 512 ; Employment of Handicapped Award Goes
to Dayton Physician 1132
Rural Health —
Preview of Practice — Lectures to Medical Students
Sponsored by OSMA Committe on Rural Health, 255 ;
OSMA Rural Medical Scholarships Awarded, 829 ; Na-
tional Rural Health Conference Scheduled 1312
Safety —
One in Ten Ohio Automobiles Found Unsafe for Driving,
158 ; Related Factors in Increasing Motorscooter Acci-
dents, 874 ; American Motorists Among Safest Drivers
the World Over, 1121 ; Ohio State to Conduct Studies
on Accident Prevention, 1132 ; Motorcycle Driver Risk .1249
Scholarship — fSee Rural Health Medical Scholarship
under Rural Health)
School Health —
Emotional Problems Related to Health of School Chil-
dren, 383 ; Conference on Sports Scheduled in Las Veg-
as, 538 ; Joint Committee Moves to Combat Athletic
Injuries 1307
Scientific Exhibits — (See under Exhibits)
Socialization of Medicine —
Article in Ohio Newspaper Emphasizes Troubles in
British Health Service 1150
Social Security —
Utilization Review under Medicare, 249; Medicare Inter-
mediaries in Ohio Named, 254 ; “To All My Patients,”
307 ; Policy Statement of the OSMA Council Regarding
Government Medical Care Programs, 492 ; Physician’s
Role in Medicare — AMA Statement, 940; Ohio Voices
Objections to HEW, 952 ; The Bureaucrat and the Doc-
tor 1H6
Specialty Groups — (See under Cancer, Heart, etc.)
Specialty Sections —
The OSMA Section for Directors of Medical Education,
731 ; Cincinnati Physician Is Recipient of National
Pediatrics Award, 865 ; Roster of Officers of OSMA Spe-
cialty Sections 646
Specialty Societies —
Separate Events of Special Groups Scheduled at OSMA
Annual Meeting, 378 ; Plans for Ohio State Surgical As-
sociation Annual Meeting Discussed, 391 ; Ohio State
Surgical Association Presents “Medicare: Another View-
point,” 503 ; Ohioans Inducfci i 'nto Fellowship by Ameri-
can College of Physicians, 633 ; Clevelander Heads Board
of Regents of American College of Chest Physicians,
870 ; American College of Surgeons To Convene, 890 ;
American College of Physicians Regional Meeting, 895
Roster of Officers of Ohio Specialty Societies, 946 ;
American Rheumatism Association to Hold Program
in Cincinnati, 958 ; American College of Physicians
PG Courses, 961 ; American Academy of Pediatrics
Features Ohioans on Program, 1068 ; American College
of Physicians Gastroenterology Program, 1090 ; Ohioan
Installed President of American Society of Anesthesi-
ologists, 1104 ; American College of Surgeons, Sec-
tional Meeting, 1104 ; American Academy of Orthopaedic
Surgeons Program in Cleveland _ 1192
Sports — (See under School Health)
State Medical Board of Ohio —
Venerable Medical Board Secretary Retires After 48-
Year Record, 169 ; Canton Physician Named to State
Medical Board, 171 ; Resolution in Behalf of Dr. Wil-
liam Hoyt, 171 ; Board Issues Annual Report, 203 ;
Medical Board Resolution Pays Tribute to Dr. Platter,
258 ; Honors to Dr. Platter at OSMA Annual Meeting,
506 ; Dr. Lloyd R. Evans, Assistant Dean of OSU Col-
lege of Medicine, Named to State Medical Board, 521 ;
Resolution Expresses Appreciation for Service (of Dr.
John N. McCann) on Medical Board, 604 ; Dr. Platter
Honored by House of Delegates, 703 ; Dr. William T.
Washam Named Executive Secretary of State Medical
Board, 749, 827 ; Licenses Issued as Result of June
Examinations, 1109 ; Dr. Henry A. Crawford Named
to State Medical Board, 1193 ; Death of Dr. Platter 1309
Taxation —
New IRS Tax Guide Issued for Income Tax Withhold-
ings, 540 ;
Technical Exhibits — (See Exhibits)
Tobacco —
Smoker Death Rate Tie Shown Among GI Policyholders 214
Research —
Life Insurance Research Fund Helps Research Projects
in Ohio, 96 ; Cincinnati Team Pioneers in Clinical Use
of Argon Laser, 286 ; Stouffer Foundation Posts Award
in Vascular Research Field, 540 ; Ohio Corporation Gets
Veterans Administration —
VA Policy Announced Regarding Treatment of Cer-
tain GIs, 171 ; VA Hospitals Providing More Beds
for Nursing Care, 874 ; VA Medical Research Conference
Scheduled in Cincinnati 1205
1338
The Ohio State Medical Journal
Vietnam, Project —
Ten Doctors Leave for Vietnam, 30 ; AMA Takes Re-
sponsibility for Project Vietnam, 638 ; Physicians Hon-
ored for Service in Vietnam 707
Utilization Review —
Utilization Review under Medicare, 249 ; A Statement
on: Composition and Duties of Hospital Utilization Re-
view Committees 493
Vital Statistics —
Age and Stillbirths (Abstract), 47 ; Ohio’s Vital Sta-
tistics, 1964 Annual Report of the Ohio Department of
Health, 94 ; Americans Are Highly Mobile People,
865 ; Vital Statistics in Ohio — a Report of the Ohio De-
partment of Health 999
Vocational Rehabilitation — (See Rehabilitation)
What To Write For— 117, 558, 888
Woman’s Auxiliary —
Woman’s Auxiliary Highlights, 78, 180, 270, 379, 510,
621, 830, 966, 1088, 1210, 1317
Woman’s Auxiliary Roster of State Officers, 80 ; 180,
510, 749, 849, 972, 1095
26th Annual Convention Program, 372 ; Report of the
Woman’s Auxiliary Annual Meeting, 739 ; Mrs. Karl
Ritter Named President-Elect 830
Workmen’s Compensation, Bureau of, and Industrial
Commission of Ohio—
Bureau of WC Desperately Needs Doctors, 66 ; Ohio
Workmen’s Compensation Actuarial Report on Funds,
117 ; Opinion of Chief, Legal Section, Bureau of Work-
men’s Compensation Inter-Office Communication 494
Youth Commission —
Opinion on Medical Treatment for Ohio Youth Com-
ission Wards 545
OSMA Members Not Required to
no longer will be required to sign a pledge that they
have complied with nondiscrimination provisions of
the Civil Rights Act in order to bill for services to
welfare patients. After some 16 months of efforts
by OSMA, the Department of Health, Education,
and Welfare has recognized the Principles of Medical
Ethics as evidence of nondiscrimination.
OSMA’s position has been that members of the
Association pledge adherence to the Principles of
Medical Ethics, and the Principles preclude discrimi-
nation.
The Department of Health, Education, and Wel-
fare has accepted OSMA’s position upon assurance
that if and when charges of discrimination are pre-
ferred, disciplinary procedures will be set in motion
and followed through as for other violations of the
Principles.
Physicians who are not members of the Association
must sign a pledge or enter a nondiscrimination
statement on their fee bills.
Dr. Ralph J. Frackelton, Lakewood, addressed the
Lakewood Historical Society on the topic "Great
Moments in Medicine.”
Protect Your Family — Now — With the OSMA - PLAN
of comprehensive group major medical insurance sponsored by the
Ohio State Medical Association for its members and their families
NEW —
Also available to Ohio Physicians:
up to $100,000
DISABILITY
PRACTICE
ACCIDENTAL
OVERHEAD
DEATH AND
and INCOME and
EXPENSE
DISABILITY
PROTECTION
INSURANCE
INSURANCE
(All three at low group rates)
Call or write: DANIELS-HEAD & ASSOCIATES, Inc.
Daniels-Head Building, Portsmouth, Ohio 45662 Tel. 353-3124
Sign Nondiscrimination Pledge
For Welfare Billing
Members of the Ohio State Medical Association
Usual Tax Roundup for Physicians
Will Be Published in January
Due to unforeseen circumstances beyond con-
trol of The Journal staff, the Annual Tax
Roundup for Physicians does not appear in this
issue. It will be rescheduled for the January
number.
Parts of the article pertaining to federal in-
come taxes and social security taxes were sent
to the Cincinnati office of the Internal Revenue
Service for final review before publication. Be-
cause of pending minor changes in regulations,
that office was not able to return the text to
Columbus before publication deadline.
Paul A. Schuster, District Director of Inter-
nal Revenue at Cincinnati, and executive per-
sonnel in his office have been most cooperative
with The fourtial staff in reviewing tax articles
this year and in previous years. The staff also
has had valuable assistance and advice from that
office. Only pending changes brought about a
delay this year.
Watch for the January issue and valuable in-
formation on several categories of tax laws un-
der which most physicians must file returns and
pay taxes.
for December, 1966
1339
JOURNAL ADVERTISERS
Advertisers in The Journal are friends of the profession.
By accepting their advertising we show confidence in
them and in their services and products. They under-
write a large portion of the printing cost of The Journal,
and help make it a quality publication. In return we
place their messages on the desks of Ohio’s physicians.
Please familiarize yourself with their services and pro-
ducts, and let them know that you see their advertising
in The Journal.
In This Issue :
Ames Company, Inc 1232
American Medical Association Education
& Research Foundation 1300
Appalachian Hall 1258
Ayerst Laboratories 1262 - 1263
The Brown Pharmaceutical Co 1244, 1258
Burroughs Wellcome & Co. (USA) Inc 1248
Carnation Company 1250-1251
The Coca-Cola Company 1249
Dorsey Laboratories, a division of
The Wander Company 1304
Daniels-Head & Associates, Inc 1339
Dairy Councils of Cleveland, Columbus &
Stark County District 1255
Geigy Pharmaceuticals, Division of
Geigy Chemical Corporation 1313
Hynson, Westcott & Dunning, Inc 1229
Lederle Laboratories, A Division of American
Cynamid Company 1241, 1266-1267-
1268-1269, 1321 and Inside Back Cover
Lilly, Eli, and Company 1270
Loma Linda Foods,
Medical Products Division 1239
The Medical Protective Company 1259
Merrell, The Wm. S., Company, Division of
Richardson-Merrell Inc 1318-1319
Neisler Laboratories, Inc., Subsidiary of
Union Carbide Corporation 1252-1253
The Ohio National Life Insurance Company 1315
Parke, Davis & Company Inside Front Cover
Pitman-Moore, Division of
Dow Chemical Company 1245
Robins, A. H., Company, Inc 1325 - 1326
Roche Laboratories, Division of
Hoffmann-La Roche Inc Back Cover
Searle, G. D., & Company 1265, 1302 - 1303
Smith Kline & French Laboratories 1243
Squibb, E. R., & Sons 1257, 1301, 1342
Syntex Laboratories Inc 1233 -
1234 - 1235 - 1236 - 1237
Turner & Shepard, Inc 1322
Tutag, S. J., & Co 1324
Warner-Chilcott Laboratories, Division of
Warner-Lambert Pharmaceutical
Company 1260 - 1261
The Wendt-Bristol Company 1331
West-ward, Inc 1323
Windsor Hospital 1327
Winthrop Laboratories 1230
Wyeth Laboratories 1246 - 1247
Table of Contents
(Continued From Page 1231)
Page
1249 Motorcycle Driver Risk
1259 Dieting Results Shown in Anti-Coronary
Club
1259 Controversies in General Surgery Is Topic
At Cleveland Clinic Foundation Program
1264 In Our Opinion:
The Impact of a Patriarch on American
Medicine
Health and Safety Tips Include Home Fire
Drill
1299 Keep Narcotic Drugs Safeguarded
1300 American Medical Association Education
and Research Foundation
1306 Application for Space in the Scientific
Exhibit, 1967 OSMA Annual Meeting
1309 Obituaries:
Dr. H. M. Platter Among Recently
Deceased Physicians
1312 Health Insurance Protection Widespread
in America
1312 New Members of the Association
1312 National Rural Health Conference Scheduled
1314 Activities of County Medical Societies
1317 Photo Shows Dignitaries at Cleveland
Award Dinner
1320 Woman’s Auxiliary Highlights
1327 Medicine Gains Valuable Ground in 1966
General Election
1328 Roster of State Association Officers and
Committeemen
1329 Roster of County Medical Society Officers and
Meeting Dates
1332 Cross Index to 1966 Issues of The Journal
1339 OSMA Members Not Required to Sign
Nondiscrimination Pledge
1339 Usual Tax Roundup for Physicians Will Be
Published in January
1340 The Journal’s Advertisers in This Issue
1341 Classified Advertisements
1340
The Ohio State Medical Journal
X67-992
Ohio state medical journal*
v*62,
1966.
DATE
ISSUED TO
- - —
r n ^ i .
X67-992
Ohio state medical journal*
v.62, 1966*
RETURN THIS BOOK ON OR BEFORE LAST DATE STAMPED
SEP 2 ) '67
OCT 9 '67
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